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1.
Chin J Nat Med ; 21(1): 47-57, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36641232

RESUMO

Sepsis-induced uncontrolled systemic inflammatory response syndrome (SIRS) is a critical cause of multiple organ failure. Acute kidney injury (AKI) is one of the most serious complications associated with an extremely high mortality rate in SIRS, and it lacked simple, safe, and effective treatment strategies. Leontopodium leontopodioides (Willd.) Beauv (LLB) is commonly used in traditional Chinese medicine for the treatment of acute and chronic nephritis. However, it remains unclear whether lipopolysaccharide (LPS) affects LPS-induced AKI. To identify the molecular mechanisms of LLB in LPS-induced HK-2 cells and mice, LLB was prepared by extraction with 70% methanol, while a lipopolysaccharide (LPS)-induced HK-2 cell model and an AKI model were established in this study. Renal histopathology staining was performed to observe the morphology changes. The cell supernatant and kidney tissues were collected for determining the levels of inflammatory factors and protein expression by ELISA, immunofluorescence, and Western blot. The results indicated that LLB significantly reduced the expression of IL-6 and TNF-α in LPS-induced HK-2 cells, as well as the secretion of IL-6, TNF-α, and IL-1ß in the supernatant. The same results were observed in LPS-induced AKI serum. Further studies revealed that LLB remarkably improved oxidative stress and apoptosis based on the content of MDA, SOD, and CAT in serum and TUNEL staining results. Notably, LLB significantly reduced the mortality due to LPS infection. Renal histopathology staining results supported these results. Furthermore, immunofluorescence and Western blot results confirmed that LLB significantly reduced the expression of the protein related to the NF-κB signaling pathway and NLRP3, ASC, and Caspase-1 which were significantly increased through LPS stimulation. These findings clearly demonstrated the potential use of LLB in the treatment of AKI and the crucial role of the NF-κB/NLRP3 pathway in the process through which LLB attenuates AKI induced by LPS.


Assuntos
Injúria Renal Aguda , NF-kappa B , Animais , Camundongos , NF-kappa B/genética , NF-kappa B/metabolismo , Lipopolissacarídeos/efeitos adversos , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/metabolismo , Rim , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/patologia
2.
Artigo em Inglês | WPRIM | ID: wpr-971663

RESUMO

Sepsis-induced uncontrolled systemic inflammatory response syndrome (SIRS) is a critical cause of multiple organ failure. Acute kidney injury (AKI) is one of the most serious complications associated with an extremely high mortality rate in SIRS, and it lacked simple, safe, and effective treatment strategies. Leontopodium leontopodioides (Willd.) Beauv (LLB) is commonly used in traditional Chinese medicine for the treatment of acute and chronic nephritis. However, it remains unclear whether lipopolysaccharide (LPS) affects LPS-induced AKI. To identify the molecular mechanisms of LLB in LPS-induced HK-2 cells and mice, LLB was prepared by extraction with 70% methanol, while a lipopolysaccharide (LPS)-induced HK-2 cell model and an AKI model were established in this study. Renal histopathology staining was performed to observe the morphology changes. The cell supernatant and kidney tissues were collected for determining the levels of inflammatory factors and protein expression by ELISA, immunofluorescence, and Western blot. The results indicated that LLB significantly reduced the expression of IL-6 and TNF-α in LPS-induced HK-2 cells, as well as the secretion of IL-6, TNF-α, and IL-1β in the supernatant. The same results were observed in LPS-induced AKI serum. Further studies revealed that LLB remarkably improved oxidative stress and apoptosis based on the content of MDA, SOD, and CAT in serum and TUNEL staining results. Notably, LLB significantly reduced the mortality due to LPS infection. Renal histopathology staining results supported these results. Furthermore, immunofluorescence and Western blot results confirmed that LLB significantly reduced the expression of the protein related to the NF-κB signaling pathway and NLRP3, ASC, and Caspase-1 which were significantly increased through LPS stimulation. These findings clearly demonstrated the potential use of LLB in the treatment of AKI and the crucial role of the NF-κB/NLRP3 pathway in the process through which LLB attenuates AKI induced by LPS.


Assuntos
Animais , Camundongos , NF-kappa B/metabolismo , Lipopolissacarídeos/efeitos adversos , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Interleucina-6/metabolismo , Injúria Renal Aguda/metabolismo , Rim , Síndrome de Resposta Inflamatória Sistêmica/patologia
5.
Biomed Pharmacother ; 117: 109163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238257

RESUMO

Xuebijing (XBJ) injection, a Chinese traditional medicine injection, is widely used in the treatment of sepsis in China, and shows a promising clinical therapeutic effect. However, its impacts on the metabolic changes of sepsis have not yet been reported. We established a septic rat model using cecal ligation and puncture (CLP) and treated with XBJ or placebo (saline). The survival rates were monitored for 7d, the effects of XBJ on liver and kidney tissue morphology, serum biochemistry [alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatinine (Cr)] and cytokines [tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6)] production were assessed. Plasma samples were profiled by gas chromatography/mass spectrometer (GC/MS) and analyzed to evaluate the metabolites changes. We found that XBJ can increase the survival rate of septic rats by reducing multi-organ dysfunctions shown as decrease in serum biochemistry indicators, cytokines, and morphologic changes. A Partial Least-Squares Discriminant Analysis (PLS-DA) score plot indicated that rats undergo significant metabolic changes between the three groups. 21 distinct metabolites with VIP>1.5 and p<0.05 were were identified between these group. These metabolites primarily reflected disorders in energy metabolism, glucose metabolism and amino acid metabolism. This study established the foundation for further research of the mechanisms and therapeutic targets of sepsis.


Assuntos
Ceco/patologia , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/uso terapêutico , Cromatografia Gasosa-Espectrometria de Massas , Metabolômica , Punções , Sepse/tratamento farmacológico , Sepse/metabolismo , Animais , Medicamentos de Ervas Chinesas/farmacologia , Ligadura , Masculino , Redes e Vias Metabólicas/efeitos dos fármacos , Metaboloma , Análise Multivariada , Ratos Sprague-Dawley , Sepse/sangue , Síndrome de Resposta Inflamatória Sistêmica/patologia
6.
Horm Behav ; 110: 90-97, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30826308

RESUMO

Seasonal changes in day length enhance and suppress immune function in a trait-specific manner. In Siberian hamsters (Phodopus sungorus) winter-like short days (SDs) increase blood leukocyte concentrations and adaptive T cell dependent immune responses, but attenuate innate inflammatory responses to simulated infections. Thyroid hormone (TH) signaling also changes seasonally and has been implicated in modulation of the reproductive axis by day length. Immunologically, TH administration in long days (LD) enhances adaptive immune responses in male Siberian hamsters, mimicking effects of SDs. This experiment tested the hypothesis that T3 is also sufficient to mimic the effects of SD on innate immune responses. Adult male hamsters housed in LDs were pretreated with triiodothyronine (T3; 1 µg, s.c.) or saline (VEH) daily for 6 weeks; additional positive controls were housed in SD and received VEH, after which cytokine, behavioral, and physiological responses to simulated bacterial infection (lipopolysaccharide; LPS) were evaluated. SD pretreatment inhibited proinflammatory cytokine mRNA expression (i.e. interleukin 1ß, nuclear factor kappa-light-chain-enhancer of activated B cells). In addition, the magnitude and persistence of anorexic and cachectic responses to LPS were also lower in SD hamsters, and LPS-induced inhibition of nest building behavior was absent in SD. T3 treatments failed to affect behavioral (food intake, nest building) or somatic (body mass) responses to LPS in LD hamsters, but one CNS cytokine response to LPS (e.g., hypothalamic TNFα) was augmented by T3. Together these data implicate thyroid hormone signaling in select aspects of innate immune responses to seasonal changes in day length.


Assuntos
Comportamento Animal/efeitos dos fármacos , Citocinas/metabolismo , Phodopus , Síndrome de Resposta Inflamatória Sistêmica/patologia , Tri-Iodotironina/farmacologia , Animais , Anorexia/induzido quimicamente , Anorexia/metabolismo , Anorexia/patologia , Peso Corporal/fisiologia , Cricetinae , Modelos Animais de Doenças , Hipotálamo/efeitos dos fármacos , Hipotálamo/metabolismo , Comportamento de Doença/efeitos dos fármacos , Imunidade Inata/efeitos dos fármacos , Infecções/induzido quimicamente , Infecções/metabolismo , Infecções/patologia , Lipopolissacarídeos , Masculino , Phodopus/metabolismo , Fotoperíodo , Reprodução/efeitos dos fármacos , Estações do Ano , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
7.
Int J Antimicrob Agents ; 53(6): 830-837, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30716446

RESUMO

This post-hoc analysis compared the pharmacokinetics and clinical outcomes of ceftaroline fosamil 600 mg every 12 (q12h) versus every 8 hours (q8h) in patients with acute bacterial skin and skin-structure infection (ABSSSI) and signs of sepsis. Clinical outcomes at test-of-cure in patients with ABSSSI and systemic inflammatory signs/systemic inflammatory response syndrome (SIRS) as well as ceftaroline minimum inhibitory concentrations (MICs) against baseline pathogens were compared between the COVERS trial (ceftaroline fosamil 600 mg q8h, 2-h infusion) and the CANVAS 1 and 2 trials (ceftaroline fosamil 600 mg q12h, 1-h infusion). Ceftaroline exposure among patients in COVERS with or without markers of sepsis was compared using population pharmacokinetic modelling. In COVERS, 62% (312/506) and 41% (208/506) of ceftaroline fosamil-treated patients had ≥1 systemic inflammatory sign or SIRS, respectively, compared with 55% (378/693) and 22% (155/693), respectively, in the CANVAS trials. Clinical cure rates for the modified intent-to-treat population in COVERS and CANVAS were similar for ceftaroline fosamil-treated patients with ≥1 sign of sepsis [82% (255/312) and 85% (335/394)] and for those with SIRS [84% (168/199) and 85% (131/155)]. Ceftaroline MIC distributions were similar across trials. Sepsis did not affect predicted individual steady-state ceftaroline exposure. Clinical cure rates in patients with ≥1 systemic inflammatory sign or SIRS were comparable for both ceftaroline fosamil dosage regimens. Pathogen susceptibilities to ceftaroline were similar across trials. Ceftaroline exposure was not affected by disease severity. Ceftaroline fosamil 600 mg q12h is a robust dosage regimen for most ABSSSI patients with sepsis [ClinicalTrials.gov ID: NCT01499277, NCT00424190, NCT00423657].


Assuntos
Antibacterianos/administração & dosagem , Cefalosporinas/administração & dosagem , Dermatopatias Bacterianas/complicações , Dermatopatias Bacterianas/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacocinética , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Cefalosporinas/farmacocinética , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Dermatopatias Bacterianas/patologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Resultado do Tratamento , Ceftarolina
8.
Clin Sci (Lond) ; 131(8): 733-746, 2017 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-28246131

RESUMO

In the present study, we examined the effects of cortisol on steatotic and non-steatotic liver grafts from brain-dead donors and characterized the underlying mechanisms involved. Non-steatotic liver grafts showed reduced cortisol and increased cortisone levels in association with up-regulation of enzymes that inactivate cortisol. Conversely, steatotic liver grafts exhibited increased cortisol and reduced cortisone levels. The enzymes involved in cortisol generation were overexpressed, and those involved in cortisol inactivation or clearance were down-regulated in steatotic liver grafts. Exogenous administration of cortisol negatively affected hepatic damage and survival rate in non-steatotic liver transplantation (LT); however, cortisol treatment up-regulated the phosphoinositide 3-kinase (PI3K)-protein kinase C (PKC) pathway, resulting in protection against the deleterious effects of brain-dead donors on damage and inflammatory response in steatotic LT as well as in increased survival of recipients. The present study highlights the differences in the role of cortisol and hepatic mechanisms that regulate cortisol levels based on the type of liver. Our findings suggest that cortisol treatment is a feasible and highly protective strategy to reduce the adverse effects of brain-dead donor livers in order to ultimately improve liver graft quality in the presence of steatosis, whereas cortisol treatment would not be recommended for non-steatotic liver grafts.


Assuntos
Fígado Gorduroso/metabolismo , Hidrocortisona/uso terapêutico , Transplante de Fígado/métodos , Hormônio Adrenocorticotrópico/sangue , Animais , Glicemia/metabolismo , Morte Encefálica , Cortisona/metabolismo , Avaliação Pré-Clínica de Medicamentos/métodos , Fígado Gorduroso/patologia , Hidrocortisona/metabolismo , Hidrocortisona/farmacologia , Fígado/metabolismo , Fígado/patologia , Hepatopatias/etiologia , Hepatopatias/patologia , Hepatopatias/prevenção & controle , Transplante de Fígado/efeitos adversos , Fosfatidilinositol 3-Quinase/biossíntese , Proteína Quinase C/biossíntese , Ratos Zucker , Transdução de Sinais/efeitos dos fármacos , Taxa de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Regulação para Cima/efeitos dos fármacos
9.
Cell Death Differ ; 23(9): 1565-76, 2016 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-27177019

RESUMO

Necroptosis is a caspase-independent form of cell death that is triggered by activation of the receptor interacting serine/threonine kinase 3 (RIPK3) and phosphorylation of its pseudokinase substrate mixed lineage kinase-like (MLKL), which then translocates to membranes and promotes cell lysis. Activation of RIPK3 is regulated by the kinase RIPK1. Here we analyze the contribution of RIPK1, RIPK3, or MLKL to several mouse disease models. Loss of RIPK3 had no effect on lipopolysaccharide-induced sepsis, dextran sodium sulfate-induced colitis, cerulein-induced pancreatitis, hypoxia-induced cerebral edema, or the major cerebral artery occlusion stroke model. However, kidney ischemia-reperfusion injury, myocardial infarction, and systemic inflammation associated with A20 deficiency or high-dose tumor necrosis factor (TNF) were ameliorated by RIPK3 deficiency. Catalytically inactive RIPK1 was also beneficial in the kidney ischemia-reperfusion injury model, the high-dose TNF model, and in A20(-/-) mice. Interestingly, MLKL deficiency offered less protection in the kidney ischemia-reperfusion injury model and no benefit in A20(-/-) mice, consistent with necroptosis-independent functions for RIPK1 and RIPK3. Combined loss of RIPK3 (or MLKL) and caspase-8 largely prevented the cytokine storm, hypothermia, and morbidity induced by TNF, suggesting that the triggering event in this model is a combination of apoptosis and necroptosis. Tissue-specific RIPK3 deletion identified intestinal epithelial cells as the major target organ. Together these data emphasize that MLKL deficiency rather than RIPK1 inactivation or RIPK3 deficiency must be examined to implicate a role for necroptosis in disease.


Assuntos
Inflamação/patologia , Proteínas Quinases/genética , Proteína Serina-Treonina Quinases de Interação com Receptores/genética , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Animais , Apoptose/efeitos dos fármacos , Ceruletídeo/toxicidade , Colite/induzido quimicamente , Colite/metabolismo , Colite/patologia , Sulfato de Dextrana/toxicidade , Modelos Animais de Doenças , Feminino , Inflamação/metabolismo , Lipopolissacarídeos/toxicidade , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pancreatite/induzido quimicamente , Pancreatite/metabolismo , Pancreatite/patologia , Proteínas Quinases/deficiência , Proteínas Quinases/metabolismo , Proteína Serina-Treonina Quinases de Interação com Receptores/antagonistas & inibidores , Proteína Serina-Treonina Quinases de Interação com Receptores/deficiência , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/mortalidade , Traumatismo por Reperfusão/patologia , Sepse/etiologia , Sepse/metabolismo , Sepse/patologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/patologia , Proteína 3 Induzida por Fator de Necrose Tumoral alfa/deficiência , Proteína 3 Induzida por Fator de Necrose Tumoral alfa/genética
10.
Stem Cells Transl Med ; 5(6): 782-92, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27075767

RESUMO

UNLABELLED: We hypothesized that combined treatment with autologous adipose-derived mesenchymal stem cell (ADMSC) and ciprofloxacin is superior to ciprofloxacin only in reducing sepsis-induced urogenital organ damage and mortality in rat sepsis syndrome (SS) caused by intrapelvic injection of cecal bacteria (1.0 × 10(4) cells per milliliter; total, 5.0 ml). Male Sprague-Dawley rats (n = 60) equally divided into group 1 (sham-control), group 2 (SS), group 3 (SS-ADMSC [5.0 × 10(5) intravenously at 0.5, 6, and 18 hours after sepsis induction]), group 4 (SS-ciprofloxacin [3.0 mg/kg, b.i.d.] for 5 days), and group 5 (SS-ADMSC-ciprofloxacin) were sacrificed by day 5. Mortality rate and creatinine level were highest in group 2 and lowest in group 1 and significantly higher in groups 3 and 4 than those in group 5, but there was no difference between groups 3 and 4 (all p < .005). The kidney injury score, inflammatory biomarker expressions at protein (tumor necrosis factor-1α, nuclear factor-κB, matrix metallopeptidase-9, regulated on activation, normal T-cell expressed and secreted, interleukin-1ß) and cellular (CD14+, migratory inhibitor factor positive, CD68+) levels in kidneys and urinary bladder were lowest in group 1 and highest in group 2, higher in group 4 than in groups 3 and 5, and higher in group 3 than in group 5 (all p < .001). Protein expressions of apoptosis (Bax, cleaved caspase 3 and poly[ADP-ribose] polymerase 1, p21 protein [Cdc42/Rac]-activated kinase 2) and oxidative stress (oxidized protein, NADPH oxidase (NOX)-1, NOX-2) in these organs showed an identical pattern compared with that of inflammation in all groups (all p < .001). In conclusion, ADMSC-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rat. SIGNIFICANCE: Autologous adipose-derived mesenchymal stem cell-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rats.


Assuntos
Inflamação/terapia , Doenças Urogenitais Masculinas/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Tecido Adiposo/citologia , Animais , Apoptose/efeitos dos fármacos , Bactérias/patogenicidade , Biomarcadores/metabolismo , Ciprofloxacina/administração & dosagem , Modelos Animais de Doenças , Humanos , Inflamação/genética , Inflamação/microbiologia , Inflamação/patologia , Rim/efeitos dos fármacos , Rim/lesões , Masculino , Doenças Urogenitais Masculinas/genética , Doenças Urogenitais Masculinas/microbiologia , Doenças Urogenitais Masculinas/patologia , Ratos , Ratos Sprague-Dawley , Síndrome de Resposta Inflamatória Sistêmica/genética , Síndrome de Resposta Inflamatória Sistêmica/microbiologia , Síndrome de Resposta Inflamatória Sistêmica/patologia
11.
Shock ; 43(2): 166-71, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25243427

RESUMO

UNLABELLED: Traumatic injury is a significant cause of morbidity and mortality worldwide. Microcirculatory activation and injury from hemorrhage contribute to organ injury. Many adaptive responses occur within the microcirculatory beds to limit injury including upregulation of heme oxygenase (HO) enzymes, the rate-limiting enzymes in the breakdown of heme to carbon monoxide (CO), iron, and biliverdin. Here we tested the hypothesis that CO abrogates trauma-induced injury and inflammation protecting the microcirculatory beds. METHODS: C57Bl/6 mice underwent sham operation or hemorrhagic shock to a mean arterial pressure of 25 mmHg for 120 minutes. Mice were resuscitated with lactated Ringer's at 2× the volume of maximal shed blood. Mice were randomized to receive CO-releasing molecule or inactive CO-releasing molecule at resuscitation. A cohort of mice was pretreated with tin protoporphyrin-IX to inhibit endogenous CO generation by HOs. Primary mouse liver sinusoidal endothelial cells were cultured for in vitro experiments. RESULTS: Carbon monoxide-releasing molecule protected against hemorrhagic shock/resuscitation organ injury and systemic inflammation and reduced hepatic sinusoidal endothelial injury. Inhibition of HO activity with tin protoporphyrin-IX exacerbated liver hepatic sinusoidal injury. Hemorrhagic shock/resuscitation in vivo or cytokine stimulation in vitro resulted in increased endothelial expression of adhesion molecules that was associated with decreased leukocyte adhesion in vivo and in vitro. CONCLUSIONS: Hemorrhagic shock/resuscitation is associated with endothelial injury. Heme oxygenase enzymes and CO are involved in part in diminishing this injury and may prove useful as a therapeutic adjunct that can be harnessed to protect against endothelial activation and damage.


Assuntos
Monóxido de Carbono/uso terapêutico , Microvasos/lesões , Ressuscitação/efeitos adversos , Choque Hemorrágico/prevenção & controle , Animais , Monóxido de Carbono/farmacologia , Adesão Celular/efeitos dos fármacos , Moléculas de Adesão Celular/metabolismo , Células Cultivadas , Citocinas/sangue , Avaliação Pré-Clínica de Medicamentos/métodos , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Molécula 1 de Adesão Intercelular/metabolismo , Leucócitos/fisiologia , Fígado/irrigação sanguínea , Fígado/ultraestrutura , Camundongos Endogâmicos C57BL , Microcirculação , Microscopia Eletrônica de Varredura , Choque Hemorrágico/etiologia , Choque Hemorrágico/patologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle
12.
Mol Med Rep ; 9(1): 355-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24189982

RESUMO

Emodin is the main active constituent of rhubarb and is often used in Chinese herbal medicine for the treatment of systemic inflammatory response syndrome (SIRS). The present study aimed to determine the in vitro effects of emodin on the expression of membrane-bound cluster of differentiation 14 (mCD14) protein in peritoneal macrophages (pMΦs). The severe acute pancreatitis (SAP)̸SIRS model was established in Sprague­Dawley (SD) rats via retrograde injection of 1.5% sodium deoxycholate into the common biliopancreatic duct. The 40 SD rats were randomly divided into the sham­operated (n=10) group (SO) and the model group (n=30). After 24 h, pMΦs were harvested and the model group was randomly divided into three subgroups (n=10 per group), the 5 µg/ml emodin group (EMO), the 0.1 µmol/ml dexamethasone group (DEX) and the SIRS/SAP group (SI). Treatment agents were administered following macrophage adhesion for 24 h. Compared with that of the SO group, the SI group showed significantly increased pathological changes (P<0.01). Compared with that of the SO group, mCD14 expression in pMΦs was significantly decreased in the SI group (P<0.01). Additionally, compared with that of the SI group, mCD14 expression in pMΦs was significantly increased in the EMO group (P<0.01) and in the DEX group (P<0.01). Compared with that of the DEX group, mCD14 expression in pMΦs was significantly increased in the EMO group (25.60±2.79 vs. 20.87±1.99; P<0.01). The pathological changes observed in the pancreas of rats in the model groups were more severe than that of the SO group. Moreover, mCD14 expression levels in pMΦs were significantly decreased in the SI group. The pathological changes of each intervention group improved to various degrees, particularly in the EMO group.


Assuntos
Emodina/farmacologia , Receptores de Lipopolissacarídeos/metabolismo , Macrófagos Peritoneais/efeitos dos fármacos , Doença Aguda , Animais , Dexametasona/farmacologia , Modelos Animais de Doenças , Macrófagos Peritoneais/imunologia , Macrófagos Peritoneais/metabolismo , Masculino , Pancreatite/metabolismo , Pancreatite/patologia , Inibidores de Proteínas Quinases/farmacologia , Ratos , Ratos Sprague-Dawley , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/patologia
13.
Chin J Integr Med ; 19(1): 42-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22160946

RESUMO

OBJECTIVE: To observe the regulatory effect of Chinese drugs for activating blood circulation (ABC) and for activating blood circulation and detoxifying (ABCD) on indices of thrombosis, inflammatory reaction, and tissue damage in a rabbit model of toxin-heat and blood stasis syndrome. METHODS: Fifty-four rabbits were randomized into the normal control group, model group, simvastatin group (simvastatin, 0.93 mg/kg per day), ABC group [Xiongshao Capsule, 0.07 g/kg per day], and ABCD group [Xiongshao Capsule, 0.07 g/kg per day, and Huanglian Capsule, 0.14 g/kg per day]. All except the normal control group received a single injection of bovine serum albumin and were fed with high-fat diets for 6 weeks. At the end of week 4 of giving high-fat diets, a dose of endoxitin was given by ear vein injection, and a randomized 2-week treatment was initiated. At the end of treatment, blood lipids, circulating endothelial cells, and the pathological changes of the aortic arch were assessed. The serum levels of matrix metalloproteinases (MMP-9), tissue inhibitors to metalloproteinase (TIMP-1), granule membrane protein-140 (GMP-140), plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α(TNF-α) were determined. RESULTS: Compared with the model group, ABCD group showed decreased serum triglyceride (TG) level, improvement in the pathological change in the aortic arch, and reduction in the number of circulating endothelial cells (4.00 ± 1.41 per 0.9 µL for ABCD group vs 7.83 ± 1.72 per 0.9 µL for the model group). In addition, the levels of serum GMP-140, PAI-1, and IL-6 in ABCD group were also significantly reduced [0.79 ± 0.20 ng/mL, 5.23 ± 1.39 ng/mL, 40.64 ± 10.11 pg/mL for ABCD group vs 1.08 ± 0.31 ng/mL, 7.28 ± 2.01 ng/mL, 54.44 ± 13.56 pg/mL for the model group, respectively, P < 0.05]. A trend showing improvement in the indices of thrombosis, inflammatory reaction, and tissue damage was observed in the ABC group when compared to the model group, but the changes were not statistically significant (P > 0.05). CONCLUSIONS: Chinese drugs for activating blood circulation and detoxifying have beneficial effects on regulating indices of thrombosis (GMP-140 and PAI-1) and inflammatory reaction (IL-6) in rabbit model with toxic-heat and blood stasis. The effect of the activating blood circulation and detoxifying drugs in regulating the levels of serum GMP-140, PAI-1, and IL-6 was superior to that of the activating blood circulation drugs.


Assuntos
Circulação Sanguínea/efeitos dos fármacos , Medicamentos de Ervas Chinesas/administração & dosagem , Sinvastatina/administração & dosagem , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Trombose/tratamento farmacológico , Análise de Variância , Animais , Aterosclerose/tratamento farmacológico , Aterosclerose/patologia , Modelos Animais de Doenças , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/patologia , Imuno-Histoquímica , Inflamação/tratamento farmacológico , Inflamação/patologia , Masculino , Coelhos , Distribuição Aleatória , Sensibilidade e Especificidade , Síndrome de Resposta Inflamatória Sistêmica/patologia , Trombose/patologia
14.
Am J Clin Nutr ; 97(2): 246-54, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23269816

RESUMO

BACKGROUND: Fish oil (FO) has antiinflammatory effects, which might reduce systemic inflammation induced by a cardiopulmonary bypass (CPB). OBJECTIVE: We tested whether perioperative infusions of FO modify the cell membrane composition, inflammatory responses, and clinical course of patients undergoing elective coronary artery bypass surgery. DESIGN: A prospective randomized controlled trial was conducted in cardiac surgery patients who received 3 infusions of 0.2 g/kg FO emulsion or saline (control) 12 and 2 h before and immediately after surgery. Blood samples (7 time points) and an atrial biopsy (during surgery) were obtained to assess the membrane incorporation of PUFAs. Hemodynamic data, catecholamine requirements, and core temperatures were recorded at 10-min intervals; blood triglycerides, nonesterified fatty acids, glucose, lactate, inflammatory cytokines, and carboxyhemoglobin concentrations were measured at selected time points. RESULTS: Twenty-eight patients, with a mean ± SD age of 65.5 ± 9.9 y, were enrolled with no baseline differences between groups. Significant increases in platelet EPA (+0.86%; P = 0.0001) and DHA (+0.87%; P = 0.019) were observed after FO consumption compared with at baseline. Atrial tissue EPA concentrations were higher after FO than after control treatments (+0.5%; P < 0.0001). FO did not significantly alter core temperature but decreased the postoperative rise in IL-6 (P = 0.018). Plasma triglycerides increased transiently after each FO infusion. Plasma concentrations of glucose, lactate, and blood carboxyhemoglobin were lower in the FO than in the control group on the day after surgery. Arrhythmia incidence was low with no significant difference between groups. No adverse effect of FO was detected. CONCLUSIONS: Perioperative FO infusions significantly increased PUFA concentrations in platelet and atrial tissue membranes within 12 h of the first FO administration and decreased biological and clinical signs of inflammation. These results suggest that perioperative FO may be beneficial in elective cardiac surgery with CPB.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Ponte Cardiopulmonar/efeitos adversos , Emulsões Gordurosas Intravenosas/administração & dosagem , Ácidos Graxos Ômega-3/administração & dosagem , Assistência Perioperatória , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/metabolismo , Anti-Inflamatórios não Esteroides/uso terapêutico , Plaquetas/imunologia , Plaquetas/metabolismo , Membrana Celular/metabolismo , Estudos de Coortes , Método Duplo-Cego , Emulsões Gordurosas Intravenosas/efeitos adversos , Emulsões Gordurosas Intravenosas/metabolismo , Emulsões Gordurosas Intravenosas/uso terapêutico , Ácidos Graxos Ômega-3/efeitos adversos , Ácidos Graxos Ômega-3/metabolismo , Ácidos Graxos Ômega-3/uso terapêutico , Óleos de Peixe/administração & dosagem , Seguimentos , Átrios do Coração/imunologia , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Cardiopatias/complicações , Cardiopatias/imunologia , Cardiopatias/cirurgia , Hospitais Universitários , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/patologia
15.
Chin J Integr Med ; 14(1): 51-5, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18568329

RESUMO

OBJECTIVE: To investigate the role of Shenfu Injection (SFI) in rats with systemic inflammatory response syndrome (SIRS). METHODS: The SIRS rat model was induced by the intravenous injection of lipopolysaccharide (LPS). Forty-five male Wistar rats were randomly divided into 3 groups, the sham operative control group (control group, n=5), the SIRS model group (model group, n=20) and the SFI treatment group (SFI group, n=20). LPS was injected through the external jugular vein (12 mg/kg, 6 mg/mL) to all rats except for those in the control group, and SFI (10 mL/kg) was given to those in the SF group only once through intraperitoneal injection, while the normal saline (10 mL/kg) was given to those in the model group. For those in the control group, normal saline was given through the external jugular vein (2 mL/kg) and intraperitoneal injection (10 mL/kg). Then, rats in the model group and SFI group were divided into 4 subgroups according to the time points, i.e., 1 h, 2 h, 4 h and 6 h subgroups, 5 rats in each group. The activity of nuclear factor of kappa B (NF-kappa B) of in blood mononuclear cells and the plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin 6-(IL-6) were determined using enzyme-linked immunoabsordent assay (ELISA) at 1 h, 2 h, 4 h and 6 h after modeling. Histopathologic changes of the lung and liver were observed under a light microscope. RESULTS: Compared with the control group, the activity of NF-kappa B in mononuclear cells and the plasma level of TNF-alpha were obviously increased at each time points (all P<0.01), reaching the peaks at 2 h after modeling. The plasma level of IL-6 increased gradually as time went by in the model group (P<0.01). Pathological examination showed pulmonary alveoli hemorrhage, edema and inflammatory cell infiltration in the lung tissue, and angiotelectasis, congestion, and local necrosis in the liver tissue in the model group. Compared with the model group, the activity of NF-kappa B and the levels of TNF-alpha and IL-6 in plasma decreased significantly in the SFI group (P<0.01), and the pathological injury in the lungs and liver was significantly alleviated. CONCLUSION: SFI plays a protective role by inhibiting the activity of NF-kappaB, and reducing the expressions of TNF-alpha and IL-6 in SIRS rats.


Assuntos
Aconitum , Panax , Extratos Vegetais/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Animais , Injeções , Interleucina-6/sangue , Fígado/patologia , Pulmão/patologia , Masculino , NF-kappa B/metabolismo , Ratos , Ratos Wistar , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/patologia , Fator de Necrose Tumoral alfa/sangue
16.
Bioorg Med Chem ; 16(3): 1287-98, 2008 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-18024136

RESUMO

We examined the biologic activity of the rationally designed JAK3 inhibitor, JANEX-1, in several cellular and animal models of inflammation. Notably, JANEX-1 exhibited potent anti-inflammatory activity in each of these preclinical models, including mouse models of peritonitis, colitis, cellulitis, and systemic inflammatory response syndrome. Therefore, JANEX-1 may prove useful as a broad-spectrum anti-inflammatory agent. The present study may provide the basis for new and effective treatment as well as prevention programs for inflammatory disorders.


Assuntos
Anti-Inflamatórios/farmacologia , Quinazolinas/farmacologia , Doença Aguda , Animais , Linhagem Celular , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Feminino , Membro Posterior/efeitos dos fármacos , Humanos , Janus Quinase 3/metabolismo , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Macrófagos/enzimologia , Camundongos , Óxido Nítrico/biossíntese , Transdução de Sinais/efeitos dos fármacos , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/patologia , Receptor 4 Toll-Like/metabolismo , Fator de Necrose Tumoral alfa/biossíntese
17.
Zhong Yao Cai ; 30(8): 984-9, 2007 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-18074852

RESUMO

OBJECTIVE: To explore the pharmacodyniamic action and the mechanism of action of the Maxingganshi decoction in acute lung injury rats in order to supply the pharmacology evidence to cure the SIRS-ALI of Maxingganshi decoction. METHODS: The study designed by orthogonal design. The SIRS-ALI model were Conseructed by the LPS intravenous injection and the effects of Maxingganshi decoction and it's different compatibilities to the SIRS-ALI model were observed. The experiments results were analvsised in order to reveal the compatibility rules of the Maxingganshi decocotion. RESULTS: Maxingganshi decocotion and its different compatibilities had good effects of prevention and cure the SIRS-ALI. The mechanism maybe concerned with the Maxingganshi decocotion can decrease the TNF-alpha and increase the IL-10. The experiments results also indicated that the action of the full formula was the best. The principal drug was the most important in the formula. CONCLUSION: Maxingganshitang has a good effect in anti the ALI; the results indicat that the principal drug is the predominant therapeutic action in the formula ministerial drug. Adjuvant drug and messenger drug can strengthen pharmacodynamic action.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Pneumopatias/tratamento farmacológico , Plantas Medicinais/química , Edema Pulmonar/tratamento farmacológico , Doença Aguda , Animais , Permeabilidade Capilar/efeitos dos fármacos , Modelos Animais de Doenças , Combinação de Medicamentos , Medicamentos de Ervas Chinesas/química , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Interleucina-10/sangue , Pneumopatias/sangue , Pneumopatias/patologia , Masculino , Edema Pulmonar/sangue , Edema Pulmonar/patologia , Ratos , Ratos Sprague-Dawley , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/patologia , Fator de Necrose Tumoral alfa/sangue
18.
J Trauma ; 56(3): 501-10; discussion 510-1, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15128119

RESUMO

BACKGROUND: The gut origin of the inflammatory response in trauma patients has been difficult to define. "In vivo" generation of neutrophil-activating factors by gut proteases may be a cause of multiorgan failure after hemorrhagic shock, and can be prevented with the serine protease inhibitor nafamostat mesilate (Futhan). The objective of this study was to determine the effect of nafamostat mesilate given by enteroclysis on enteric serine protease activity, neutrophil activation, and transfusion requirements during hemorrhagic shock. METHODS: Sixteen pigs weighing 21 to 26 kg were divided into control and treatment groups. A laparotomy was performed under anesthesia, and catheters were placed in the duodenum, midjejunum, and terminal ileum. Pigs were bled 30 mL/kg over 30 minutes and maintained at a mean arterial pressure of 30 mm Hg for 60 minutes. Shed blood was then used to maintain a mean arterial pressure of 45 mm Hg for another 3 hours. Treated animals received 100 mL/kg of 0.37 mmol/L nafamostat mesilate in GoLYTELY through the duodenal catheter at 1 L/h. Control animals received GoLYTELY only. Samples of enteral content and blood were taken at baseline, after shock, and at 30-minute intervals during resuscitation. Animals were killed after 3 hours of resuscitation. Enteral trypsin-like activity at the three gut sites was measured by spectrophotometry. Activation of naive human neutrophils by pig plasma was measured by the percentage of cells having pseudopods larger than 1 microm on microscopy. Lung, liver, and small bowel were analyzed by histology and myeloperoxidase assay. RESULTS: Both control and nafamostat mesilate-treated groups had significant reductions in protein and protease levels in the duodenum during enteroclysis; however, only nafamostat mesilate-treated animals had persistent suppression of protease activity throughout the experiment. Nafamostat mesilate-treated animals had a lower transfusion requirement of shed blood, 18.1 +/- 4.5 mL/kg versus 30 +/- 0.43 mL/kg (p = 0.002). Nafamostat mesilate-treated animals had significantly less neutrophil activation than controls at 150 minutes after resuscitation (33.7 +/- 6.48% vs. 42.4 +/- 4.57%,p = 0.01) and 180 minutes after resuscitation (31.1 +/- 3.31% vs. 46.9 +/- 4.53%, p = 0.0002). Lung myeloperoxidase activity was lower in nafamostat mesilate-treated animals (0.31 +/- 0.14) than in control animals (0.16 +/- 0.04, p = 0.04). Histology of liver and small intestine showed less injury in nafamostat mesilate-treated animals. CONCLUSION: Nafamostat mesilate given by means of enteroclysis with GoLYTELY significantly reduces enteral protease levels, leukocyte activation, and transfusion requirements during resuscitation from hemorrhagic shock. This strategy may have clinical promise.


Assuntos
Transfusão de Sangue , Guanidinas/farmacologia , Intestino Delgado/enzimologia , Ativação de Neutrófilo/efeitos dos fármacos , Inibidores de Proteases/farmacologia , Choque Hemorrágico/imunologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Animais , Benzamidinas , Eletrólitos , Enema , Mucosa Intestinal/enzimologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/patologia , Intestino Delgado/imunologia , Intestino Delgado/patologia , Fígado/enzimologia , Fígado/imunologia , Fígado/patologia , Pulmão/enzimologia , Pulmão/imunologia , Pulmão/patologia , Masculino , Ativação de Neutrófilo/imunologia , Peroxidase/metabolismo , Polietilenoglicóis , Choque Hemorrágico/enzimologia , Suínos , Síndrome de Resposta Inflamatória Sistêmica/enzimologia , Síndrome de Resposta Inflamatória Sistêmica/patologia
19.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 21(1): 47-50, 2001 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-12577379

RESUMO

OBJECTIVE: To study the protective effect of Shenmai injection (SMI) on systemic inflammatory reaction syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) in animal model of SIRS, MODS induced by lipopolysaccharide (LPS). METHODS: Male BALB/c mice, 5-7 weeks old were randomly divided into 3 groups, the normal control group, the LPS model group and the LPS + SMI group. The rectal temperature, peripheral white blood cell count (WBC), blood biochemical examination, histopathologic changes of lung and liver as well as the blood levels of endotoxin and tumor necrosis factor alpha (TNF alpha) were determined before and after treatment. RESULTS: LPS could induce endotoxemia and high serum level of TNF alpha, decrease the rectal temperature and WBC, reduce blood glucose and increase serum triglyceride and cholesterol levels. Pathological examination showed that LPS could cause pulmonary alveolar congestion, edema, exudation, capillary dilation and inflammatory cell infiltration in liver and lung tissue. SMI could significantly raise the low body temperature caused by LPS and reduction of WBC, improve the hypoglycemia and high plasma TNF alpha level, alleviate the pathologic changes in organs and reduce the plasma level of LPS (endotoxin). CONCLUSION: SMI has marked effect in protecting LPS caused SIRS, MODS, the mechanism might be related with the lowering of LPS (endotoxin) level and reducing of TNF alpha secretion.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Insuficiência de Múltiplos Órgãos/patologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Fator de Necrose Tumoral alfa/metabolismo , Animais , Combinação de Medicamentos , Endotoxinas/sangue , Lipopolissacarídeos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Panax , Distribuição Aleatória , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente
20.
Crit Care Med ; 28(4): 1101-6, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10809290

RESUMO

OBJECTIVE: To document the effects of propofol on the hemodynamic and inflammatory responses to endotoxemia in an animal model. DESIGN: Randomized, prospective laboratory study. SETTING: University experimental laboratory. SUBJECTS: Thirty-two male rats. INTERVENTIONS: The animals were randomly assigned to one of four groups: a) endotoxemia group (n = 8), which received intravenous Escherichia coli endotoxin (15 mg/kg over 2 mins); b) control group (n = 8), which was treated identically to the endotoxemia group except for the substitution of 0.9% saline for endotoxin; c) propofol group (n = 8), which was treated identically to the control group but also received propofol (10 mg/kg bolus, followed by infusion at 10 mg/kg/hr) immediately after the injection of 0.9% saline; and d) propofol-endotoxemia group (n = 8), which was treated identically to the endotoxemia group with the additional administration of propofol (10 mg/kg bolus, followed by infusion at 10 mg/kg/hr) immediately after endotoxin injection. MEASUREMENTS AND MAIN RESULTS: Hemodynamics, arterial blood gases, and acid-base status were recorded and the blood propofol concentrations and plasma cytokine concentrations were measured during the 5-hr observation. Microscopic findings of lung tissue for each group were obtained at necropsy. The systolic arterial pressure and heart rate of the propofol-endotoxemia group were similar to those of the endotoxemia group. The increases in the plasma cytokine (tumor necrosis factor, interleukin-6, and interleukin-10) concentrations, in the base deficit, and in the infiltration of neutrophils in the air space or vessel walls of the lungs were attenuated in the propofol-endotoxemia group compared with the endotoxemia group. CONCLUSIONS: Propofol attenuated cytokine responses, base deficit, and activation of neutrophils to endotoxemia. These findings suggest that propofol may inhibit inflammatory response and prevent the development of metabolic acidosis during endotoxemia.


Assuntos
Endotoxemia/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Propofol/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Animais , Avaliação Pré-Clínica de Medicamentos , Endotoxemia/sangue , Endotoxemia/patologia , Endotoxemia/fisiopatologia , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hipnóticos e Sedativos/sangue , Hipnóticos e Sedativos/farmacologia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Propofol/sangue , Propofol/farmacologia , Estudos Prospectivos , Distribuição Aleatória , Ratos , Ratos Wistar , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/patologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
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