Early blood purification therapy of severe acute pancreatitis complicated by acute lung injury.

OBJECTIVE: Severe acute pancreatitis (SAP) can often be complicated by acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), leading to increased mortality. Early blood purification clears inflammatory cytokines and promotes immune function recovery. Here we evaluated the usefulness of this therapy in SAP complicated by ALI. PATIENTS AND METHODS: 32 patients received routine treatment (control group), whereas other 32 patients received routine treatment and early blood purification therapy (study group). We evaluated respiratory indexes (PaO2, PaO2/FiO2, alveolar-arterial oxygen difference, intrapulmonary arteriovenous shunt percentage, and respiratory rate), blood biochemical (creatinine, blood urea nitrogen, alanine aminotransferase, and lactate levels) and inflammatory (CRP, IL-10, TNF-α, and IL-10/TNF-α ratio) markers, and prognostic outcomes (multiple organ dysfunction syndrome [MODS] and APACHE II scores) before and 72 hours after the treatment. We also documented mechanical ventilation use, occurrence of MODS and ARDS, and mortality rates. RESULTS: There were no deaths. Mechanical ventilation was used in a similar percentage of patients in either group. Treatment in study group led to a faster and better recovery of respiratory indexes, and less pronounced changes in the levels of blood urea nitrogen and alanine aminotransferase. Inflammatory markers also normalized better in the study group. Furthermore, MODS and APACHE II scores decreased to a greater extent in the study group, paralleled by a lower occurrence of MPDS and ARDS. CONCLUSIONS: Early blood purification therapy improves respiratory function and inflammatory markers in patients with SAP complicated by ALI, and decreases the occurrence of MODS and ARDS.

Association between the C804A polymorphism in the TGF-ß gene and the risk of myocardial infarction: a meta-analysis.

Tumor necrosis factor-ß (TNF-ß) is an important mediator of inflammation and may play a role in the pathogenesis of myocardial infarction (MI). While several published studies have investigated the association between the C804A polymorphism in the TNF-ß gene and MI risk, their results are controversial and ambiguous. In this study, we evaluated the contribution of the TNF-ß C804A polymorphism to MI risk. A literature search was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases to identify eligible studies published before November 1, 2013. We performed a meta-analysis of 9 case-control studies, which included a total of 19,404 MI patients and 13,684 healthy controls. Overall analysis suggested that the TNF-ß C804A polymorphism was associated with a significantly increased risk of MI. Stratified analysis based on ethnicity revealed a significant association in Asian populations, but not in Caucasian populations. In conclusion, this meta-analysis revealed that the TNF-ß C804A polymorphism may be associated with an increased risk of MI only in Asian populations. However, additional studies should be conducted to further confirm the association between TNF-ß C804A and MI risk.