Prognostic value of serum cystatin C in patients with sepsis.

Background: Early identification and diagnosis of sepsis are very important because timely and appropriate treatment can improve the survival outcomes. Aim: The aim of this study was to explore the clinical significance of serum cystatin C level in sepsis. Materials and Methods: The levels of serum cystatin C, C-reactive protein (CRP), and procalcitonin (PCT) were measured via enzyme-linked immunosorbent assay (ELISA). The patients with sepsis were followed up for 30 days to record their survival conditions. Results: The expression level of cystatin C was remarkably elevated in patients with sepsis compared with that in healthy controls. The serum cystatin C level was significantly correlated with the SOFA score and CRP, PCT, and creatinine levels in patients with sepsis. The patients in death group had a markedly higher level of serum cystatin C than those in survival group. The area under curve (AUC) of cystatin C for assessing the 30-day mortality rate of sepsis patients was 0.765. Conclusion: The serum cystatin C level is elevated in patients with sepsis and it may serve as a biomarker for early diagnosis of sepsis and possess promising effects in assessing the severity of sepsis and the prognosis of patients.

Handgrip strength and the prognosis of patients with heart failure: A meta-analysis.

BACKGROUND: Reduced muscular strength is common in patients with heart failure (HF). The aim of the systematic review and meta-analysis was to evaluate the association between handgrip strength (HGS) and prognosis of patients with HF. HYPOTHESIS: Reduced HGS may be a risk factor of poor prognosis of patients with HF. METHODS: Relevant observational studies with longitudinal follow-up were obtained by a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases. A random-effects model was used to pool the results. RESULTS: Fifteen studies involving 7350 patients with HF were included in the meta-analysis. Pooled results showed that HF patients with lower HGS were associated with a higher risk of mortality during follow-up (risk ratio [RR]: 2.00, 95% confidence interval [CI]: 1.55-2.58, p < .001; I2 = 0%). Subgroup analysis showed that the association was not significantly affected by characteristics such as study country, design, mean age of the patients, HF status (stable or advanced/acute), HF type (reduced or preserved ejection fraction), follow-up duration, and quality score (p for subgroup difference all > 0.05). Further analysis showed that per 1 kgf decrease of HGS was associated with an 8% increased risk of mortality during follow-up (RR: 1.08, 95% CI: 1.05-1.11, p < .001; I2 = 12%). Moreover, HF patients with lower HGS were also related to a higher risk of composite outcome of HF rehospitalization or mortality (RR: 1.67, 95% CI: 1.19-2.35, p = .003; I2 = 53%). CONCLUSION: A low HGS may be associated with poor clinical outcomes of patients with HF.

The Protective Effects of Protease Inhibitor MG-132 on Sepsis-Induced Acute Lung Rats and Its Possible Mechanisms.

BACKGROUND The aim of the present study was to investigate the protective effects of protease inhibitor MG-132 on sepsis-induced acute lung injury rats. MATERIAL AND METHODS Sprague Dawley rats were employed to induce sepsis by cecal ligation and puncture (CLP) method. Rats were divided into 4 groups: control, sham, model (CLP), and MG-132. Histopathology observation was detected by hematoxylin and eosin staining. The ratio of wet lung to dry lung (W/D) was calculated. In addition, the levels of inflammatory factors in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA). Also, superoxide dismutase (SOD) and malondialdehyde (MDA) levels were evaluated. Western blotting was performed to measure the expression of hypoxia-inducible factor-1 alpha (HIF-1alpha). In order to assess the role of HIF-1alpha, YC-1, the inhibitor of HIF-1alpha, was used to treat the rats. The expression of phosphor-mTOR (p-mTOR), p-4EBP1, and p-EIF4E were evaluated by western blotting. RESULTS Obvious pathological injury and increasing ratio of W/D in the model group were observed. Both pathological injury and W/D were improved in the MG-132 group, and the greatest improvement could be seen in the YC-1+MG-132 group. Furthermore, the MDA levels in the MG-132 group was decreased, accompanied by an increase in SOD levels. The level of HIF-1alpha was increased in the model group while a decreased was detected in the MG-132 group. The levels of inflammatory factors were high in the model group, whereas the opposite result was found in the MG-132 group, and the lowest in were in the YC-1+MG-132 group. Furthermore, the expression levels of p-mTOR, p-4EBP1, and p-EIF4E proteins were downregulated in the MG-132 group compared to the model group, and the lowest was in the YC-1+MG-132 group. CONCLUSIONS Our study suggested that MG-132 was able to protect against acute lung injury via inhibition of HIF-1alpha mediated mTOR/4EBP1/EIF4E pathway.

Identification of key pathogenic genes of sepsis based on the Gene Expression Omnibus database.

Sepsis is a life-threatening condition in which an uncontrolled inflammatory host response is triggered. The exact pathogenesis of sepsis remains unclear. The aim of the present study was to identify key genes that may aid in the diagnosis and treatment of sepsis. mRNA expression data from blood samples taken from patients with sepsis and healthy individuals was downloaded from the Gene Expression Omnibus database and differentially expressed genes (DEGs) between the two groups were identified. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein­protein interaction (PPI) network construction, was performed to investigate the function of the identified DEGs. Furthermore, for validation of these results, the expression levels of several DEGs were analyzed by reverse transcription quantitative­polymerase chain reaction (RT­qPCR) in three patients with sepsis and three healthy blood samples to support the results obtained from the bioinformatics analysis. Receiver operating characteristic analyses were also used to analyze the diagnostic ability of the identified DEGs for sepsis. The results demonstrated that a total of 4,402 DEGs, including 1,960 upregulated and 2,442 downregulated genes, were identified between patients with sepsis and healthy individuals. KEGG pathway analysis revealed that 39 DEGs were significantly enriched in toll­like receptor signaling pathways. The top 20 upregulated and downregulated DEGs were used to construct the PPI network. Hub genes with high degrees, including interleukin 1 receptor­associated kinase 3 (IRAK3), S100 calcium­binding protein (S100)A8, angiotensin II receptor­associated protein (AGTRAP) and S100A9, were demonstrated to be associated sepsis. Furthermore, RT­qPCR results demonstrated that IRAK3, adrenomedullin (ADM), arachidonate 5­lipoxygenase (ALOX5), matrix metallopeptidase 9 (MMP9) and S100A8 were significantly upregulated, while ectonucleoside triphosphate diphosphohydrolase 1 (ENTPD1) was upregulated but not significantly, in blood samples from patients with sepsis compared with healthy individuals, which was consistent with bioinformatics analysis results. Therefore, AGTRAP, IRAK3, ADM, ALOX5, MMP9, S100A8 and ENTPD1 were identified to have potential diagnostic value in sepsis. In conclusion, dysregulated levels of the AGTRAP, IRAK3, ADM, ALOX5, MMP9, S100A8 and ENTPD1 genes may be involved in sepsis pathophysiology and may be utilized as potential diagnostic biomarkers or therapeutic targets.

Pentraxin 3, a Predicator for 28-Day Mortality in Patients With Septic Shock.

BACKGROUND: Useful biomarkers that can serve as prognostic predictors are of great value in clinical practice because of the complex individual response to sepsis. Pentraxin 3 (PTX3), as a multifunctional pattern-recognition molecule, has been reported to be closely associated with the severity of infectious diseases in intensive care units (ICU). The aim of this study was to investigate whether PTX3 could serve as a potential prognostic biomarker in patients with septic shock. MATERIALS AND METHODS: This single-center prospective observational study was conducted during May 2012-May 2015 in the ICU of Taizhou People׳s Hospital. We compared the clinical data and laboratory tests in surviving and deceased patients with septic shock within 28 days from admission. Potential independent prognostic factors for septic shock were analyzed by using univariate and multiple Cox proportional hazards regression analyses. RESULTS: A total of 112 patients admitted to the ICU with septic shock were enrolled in our study with an overall 28-day mortality of 25.9% (29 of 112 patients). PTX3 level was the only independent risk factor for the 28-day mortality by univariate and multivariate Cox analysis (hazard ratio = 3.87; 95% CI: 1.66-8.81, P = 0.004). The deceased patients had significant higher levels of PTX3 at the 4 different points (baseline, day 1, day 2 and day 3) versus the survivors (P < 0.001). Results from Kaplan-Meier curves and log-rank test revealed that high PTX3 level (above the median value) was statistically associated with a lower 28-day survival rate (P = 0.014). CONCLUSIONS: The baseline PTX3 level was an independent predictor for 28-day mortality in patients with septic shock.

Perioperative restricted fluid therapy preserves immunological function in patients with colorectal cancer.

AIM: To investigate the effect of perioperative restricted fluid therapy on circulating CD4(+)/CD8(+) T lymphocyte ratio, percentage of regulatory T cells (Treg) and postoperative complications in patients with colorectal cancer. METHODS: A total of 185 patients met the inclusion criteria and were included in the randomized clinical trial. These patients were divided into two groups according to receipt of either perioperative standard (S, n = 89) or restricted (R, n = 96) fluid therapy. Clinical data of these patients were collected in this prospective study. Perioperative complications and cellular immunity changes (CD4(+)/CD8(+) and Treg) were analyzed comparatively between the two groups. RESULTS: Both during surgery and on postoperative days, the total volumes of fluids administered in the R group were significantly lower than those in the S group (1620 ± 430 mL vs 3110 ± 840 mL; 2090 ± 360 mL vs 2750 ± 570 mL; 1750 ± 260 mL vs 2740 ± 490 mL; 1620 ± 310 mL vs 2520 ± 300 mL; P < 0.05). Decreased ratios of circulating CD4(+)/CD8(+) T lymphocytes (1.47 ± 0.28 vs 2.13 ± 0.26; 1.39 ± 0.32 vs 2.21 ± 0.24; P < 0.05) and Treg percentage values (2.79 ± 1.24 vs 4.26 ± 1.04; 2.46 ± 0.98 vs 4.30 ± 1.12; P < 0.05) were observed after surgery in both groups. However, in the R group, these values restored more quickly starting from postoperative day 2 (1.44 ± 0.24 vs 1.34 ± 0.27; 2.93 ± 1.08 vs 2.52 ± 0.96; P < 0.05). The proportion of patients with complications was significantly lower in the restricted group (36 of 89 vs 59 of 96, P < 0.01). CONCLUSION: Perioperative restricted intravenous fluid regimen leads to a low postoperative complication rate and better cellular immunity preservation in patients with colorectal cancer.

[Evaluation of high volume hemofiltration according to pulse-indicated continuous cardiac output on patients with acute respiratory distress syndrome].

OBJECTIVE: To study the effects of high volume hemofiltration (HVHF) according to pulse-indicated continuous cardiac output (PiCCO) on patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective randomly controlled trial was conducted. 163 patients with ARDS admitted to Taizhou People's Hospital, Medical College, Nantong University, between February 2011 and January 2014, were enrolled. The patients were randomly divided into conventional therapy group (n=50), HVHF group (n=55), and PiCCO + HVHF group (n=58) by random number table. The patients in conventional therapy group received routine treatment including mechanical ventilation and drug treatment according to ARDS treatment guideline. The patients in the HVHF group received HVHF treatment of 18 hours per day on 1, 3, 5, 7 days on the basis of conventional therapy. Patients in the PiCCO + HVHF group received HVHF treatment according to PiCCO. The indexes of lung function and PiCCO monitoring were recorded at intensive care unit (ICU) admission (before) and 4 days and 7 days after treatment. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) were determined by enzyme linked immunosorbent assay (ELISA), and the prognosis of patients was recorded. RESULTS: In three groups, oxygenation index (PaO2/FiO2), static lung compliance (Cs) were gradually increased, and respiratory rate (RR), lactic acid (Lac) were gradually decreased. The indicators in HVHF and PiCCO + HVHF groups were significantly improved compared with conventional therapy group. The indexes in PiCCO + HVHF group were significantly increased or decreased compared with those in HVHF group, and the statistical differences were found on the 7th day after treatment [PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa): 189.3 ± 36.8 vs. 166.3 ± 36.1, Cs (mL/cmH2O): 76.7 ± 18.9 vs. 67.0 ± 18.2, RR (times/min): 16.4 ± 5.2 vs. 19.2 ± 5.4, Lac (mmol/L): 1.20 ± 0.41 vs. 1.41 ± 0.43, all P<0.01]. In PiCCO + HVHF group, cardiac index (CI) was gradually increased, and extra vascular lung water index (EVLWI) and intra thoracic blood volume index (ITBVI) were gradually decreased. There were significant differences in the indexes 4 days and 7 days after treatment compared with those before treatment [CI (L × min⁻¹ m⁻²): 4.62 ± 1.13, 4.83 ± 1.10 vs. 4.01 ± 1.02, EVLWI (mL/kg): 7.6 ± 2.7, 6.5 ± 2.6 vs. 12.4 ± 2.9, ITBVI (mL/m²): 801.3 ± 120.9, 785.4 ± 118.7 vs. 980.1 ± 168.6, all P<0.01]. After treatment, the serum levels of TNF-α and IL-1ß in three groups were gradually decreased. Compared with the conventional therapy group, the serum levels of TNF-α and IL-1ß on 4 days and 7 days in the HVHF and PiCCO + HVHF groups were significantly decreased, and the statistical differences were found on 7 days [TNF-α (ng/L): 68.35 ± 12.63, 67.54 ± 12.90 vs. 85.35 ± 13.70; IL-1ß (ng/L): 424.6 ± 142.9, 412.2 ± 140.2 vs. 895.2 ± 187.7, all P<0.01]. Compared with the HVHF group, the serum levels of TNF-α and IL-1ß in the PiCCO + HVHF group were slightly decreased without statistical differences. Compared with the conventional therapy group, the number of organ failure, duration of mechanical ventilation, the length of stay in ICU and hospital mortality in HVHF group and PiCCO + HVHF group were lowered, and the statistical differences were found in PiCCO + HVHF group compared with HVHF group [number of organ failure: 2.41 ± 0.79 vs. 2.72 ± 0.80, duration of mechanical ventilation (days): 4.8 ± 2.0 vs. 5.7 ± 2.1, the length of stay in ICU (days): 11.5 ± 3.4 vs. 13.1 ± 3.6, hospital mortality: 31.0% (18/58) vs. 41.8% (23/55), all P<0.05]. CONCLUSIONS: Levels of inflammatory factors in patients with ARDS could be reduced by HVHF. The oxygenation and compliance of lung can be improved, the number of organ failure can be lowered, the duration of mechanical ventilation and the length of stay in ICU can be shortened, and the hospital mortality could be declined by PiCCO guided HVHF.

Monocyte chemotactic protein-1 as possible prognostic markers of the efficacy of antiviral treatment in chronic hepatitis C.

BACKGROUND/AIMS: Antiviral therapy with interferon and ribavirin had been proved to be effective in Hepatitis C treatment. However, the valuable markers for monitoring the efficacy of antiviral therapy are required clinically. The present study aimed to evaluate the association between pretreatment levels of Monocyte chemoattractant protein-1 levels (MCP-1) and the virological response in treated patients with chronic hepatitis C infection. METHODOLOGY: Concentrations of MCP-1 in serum were determined in 165 patients with chronic hepatitis C (CHC) treated with interferon and ribavirin by enzyme linked immunosorbent assay before and 48 weeks after cessation of therapy. RESULTS: Pretreatment MCP-1 levels in patients with sustained virological response (SVR) were significantly lower than in non-responders (Non-SVR) (220.2 +/- 31.7 vs. 305.6 +/- 50.7 pg/mL, p = 0.009) and MCP-1 significantly decreased in patients with SVR (form 220.2 +/- 31.7 pg/mL to 140.2 +/- 26.7 pg/mL; p <0.01) but not in Non-SVR (form 305.6 +/- 50.7 pg/mL to 286.6 +/- 41.9 pg/mL; p = 0.17) after 48 weeks of treatment. By multivariate analysis, non-1 genotype was independent predictors of SVR in all patients. When multivariate analysis was restricted to patients with non-1 genotype, only pretreatment MCP-1 levels were identified as predictive factors of SVR. CONCLUSIONS: MCP-1 may be a prognostic marker of the efficacy of antiviral therapy in CHC patients.

Changes of ammonia levels in patients with acute on chronic liver failure treated by plasma exchange.

BACKGROUND/AIMS: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) is useful to bridge AoCLF patients to liver transplantation. The aim of this study was to assess the effects of PE on plasma ammonia levels (PAL) in AoCLF patients. METHODOLOGY: Seventy patients with AoCLF in 2 groups (PE plus standard medical treatment group, n = 32; and standard medical treatment group, n = 38) were enrolled in study. PAL was detected on admission and on days 7, 14, 21, and 30 during hospitalization. RESULTS: All AoCLF patients showed PAL more than the upper limit of the normal range. More dramatic decreased in the PE survivors (form 116.8 +/- 36.3 to 44.8 +/- 16.3, p < 0.01) than the medical survivors (form 105.7 +/- 30.2 to 57.1 +/- 20.3, p < 0.05) after 30 days of treatment. Furthermore, PAL after medical treatment were still higher than those of PE treatment in the survivors (57.1 +/- 20.3 vs. 44.8 +/- 16.3, p < 0.05). Among the non-survivors in the medical group, PAL remained at high levels throughout the examination period. Importantly, an increased PAL associated with high mortality and reduced survival time of AoCLF patients. CONCLUSIONS: Ammonia may be important in the pathogenesis of the AoCLF and PE may represent a reliable hepatic support device for AoCLF.

Critical illness-related corticosteroid insufficiency after multiple traumas: a multicenter, prospective cohort study.

BACKGROUND: Given that the observed prevalence and time course of critical illness-related corticosteroid insufficiency (CIRCI) remain inconsistent in trauma patients, the present study was designed to investigate the prevalence, time course, and effect of CIRCI on the outcome of critically ill patients with multiple injuries. METHODS: In this multicenter, prospective cohort study, patients with multiple injuries in seven intensive care units in China were enrolled. Adrenocorticotropic hormone (ACTH) stimulation tests were performed by administering intravenously 250 µg of synthetic ACTH on Days 1, 2, 3, 5, and 7 after traumatic injury. CIRCI was defined as baseline cortisol level of less than 10 µg/dL or a Δcortisol (difference baseline and highest cortisol level at 30 or 60 minutes after ACTH stimulation) less than 9 µg/dL. The incidence and time course of CIRCI and 28-day mortality were recorded. RESULTS: CIRCI occurred in 54.3% (38 of 70) of the patients with multiple injuries, including 10 patients with total cortisol level of less than 10 µg/dL and 28 patients with Δcortisol of less than 9 µg/dL. Most (94.7%) diagnosis of CIRCI was made in the first 48 hours after traumatic injury. The CIRCI patients had significantly more severe illness on the day of admission. At each time point, the baseline cortisol level was comparable between the CIRCI and non-CIRCI patients, while Δcortisol in the CIRCI group was significantly lower compared with the non-CIRCI group. The CIRCI patients with a Δcortisol of less than 9 µg/dL had a significantly higher 28-day mortality (39.3%) compared with those with a baseline cortisol level of less than 10 µg/dL (10.0%) and non-CIRCI patients (6.3%). Only Δcortisol of less than 9 µg/dL but not baseline cortisol level of less than 10 µg/dL seemed to be an independent risk factor for death (odds ratio, 1.19; p = 0.023). CONCLUSION: CIRCI is common in critically ill trauma population and usually occurs in the early stages. Only the results of the ACTH stimulation test but not baseline cortisol level was associated with poor prognosis. LEVEL OF EVIDENCE: Prognostic study, level II.

[The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia in septic shock].

OBJECTIVE: To explore the use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia due to septic shock. METHODS: In this prospective randomized, double-blind, controlled clinical trial, a total of 65 patients of hypoperfusion induced lactic acidemia due to septic shock admitted between April 2006 and April 2010 were assigned to two groups. Thirty-five patients of "stage" group sodium bicarbonate was used in two stages: in first stage sodium bicarbonate was given by venous drip until pH≥7.15, and in second stage sodium bicarbonate was given by intravenous drip till pH≥7.25 after 6 hours. Thirty patients in control group intravenous drip of sodium bicarbonate was used till pH≥7.15. Early goal-directed therapy(EGDT) was used in the first 6 hours of fluid resuscitation. The number of dysfunction organ, time of mechanical ventilation, maximum sequential organ failure assessment (SOFA) score, delta SOFA score, durations of stay in intensive care unit (ICU) and in hospital, and mortality were recorded in two groups. Blood gas analysis and index of hemodynamics were monitored at 0 hour and 8 hours in both groups. RESULTS: Compared with control group, "stage" group was associated with a lower number of dysfunction organ, time of mechanical ventilation, maximum SOFA score, delta SOFA score, durations of stay in ICU and in hospital, and mortality (number of dysfunction organ: 2.68±0.79 vs. 3.28±0.80, time of mechanical ventilation: 10.32±2.26 days vs. 13.80±2.56 days, maximum SOFA score: 11.01±2.26 vs. 13.11±2.26, delta SOFA score: 1.71±1.25 vs. 3.43±1.27, duration of stay in ICU: 14.0±3.6 days vs. 20.0±3.7 days, duration of stay in hospital: 28.3±12.9 days vs. 41.9±13.2 days, mortality: 34.28% vs. 60.00%, P<0.05 or P<0.01). There were no significant differences in blood gas analysis and index of hemodynamics at 0 hour, and they were improved at 8 hours. Compared with control group, in "stage" group, lactic acid (Lac) was significantly lowered (1.50±1.08 mmol/L vs. 2.93±1.09 mmol/L), and pH, mixed venous oxygen saturation (SvO2), oxygen extraction ratio (O2ER), cardiac index (CI), oxygen delivery (DO2) were significantly increased (pH:7.29±0.05 vs. 7.20±0.05, SvO2: 0.75±0.18 vs. 0.66±0.17, O2ER: 0.32±0.06 vs. 0.25±0.06, CI: 113.36±13.34 ml×s(-1)×m(-2) vs. 83.35±13.34 ml×s(-1)×m(-2), DO2: 840±170 ml×min(-1)×m(-2) vs. 630±171 ml×min(-1)×m(-2), all P<0.01). CONCLUSION: The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia as a result of septic shock can lower the occurrence rate of multiple organ dysfunction syndrome, time of mechanical ventilation, durations of stay in ICU and in hospital, and mortality.

Analysis of peripheral blood lymphocyte subsets and prognosis in patients with septic shock.

The purpose of the study is to study the relationship between peripheral blood lymphocyte subset proportion and prognosis in patients with septic shock. Fifty-two patients with septic shock, admitted to the intensive care unit between March 2007 and December 2010, were enrolled in this study. Peripheral blood lymphocyte subset proportions were measured using flow cytometry. The percentage of CD3⁺CD4⁺ T lymphocytes and CD19⁺ lymphocytes, CD4⁺/CD8⁺ T cell ratio were substantially lower in patients with septic shock compared to the control group (P < 0.01). The percentage of CD3⁺CD8⁺ T lymphocytes did not differ significantly between the two groups (P > 0.05). The percentage of CD16⁺CD56⁺ lymphocytes was higher in patients with septic shock than in the control group (P < 0.01). Compared with the survivor group, the percentage of CD3⁺CD4⁺ T lymphocytes and CD19⁺ lymphocytes, CD4⁺/CD8⁺ T cell ratio were clearly lower in the non-survivor group (P < 0.01). There was no difference in the percentage of CD3⁺CD8⁺ T lymphocytes between the non-survivor and survivor groups (P > 0.05). The percentage of CD16⁺CD56⁺ lymphocytes was higher in the non-survivor group than in the survivor group (P < 0.05). The total maximum SOFA score and the delta SOFA score were much higher in the non-survivor group than in the survivor group (P < 0.01). Immune imbalance occurs in patients with septic shock. Peripheral blood lymphocyte subset proportion and SOFA scores can be used to assess the treatment and prognosis of septic shock.

A defensin antimicrobial peptide from the venoms of Nasonia vitripennis.

Although many antimicrobial components (i.e. antimicrobial peptides) have been found in many social Hymenoptera venoms, no antimicrobial compound is purified and characterized from parasitic Hymenoptera. From the venoms of the ectoparasitic wasp, Nasonia vitripennis, a defensin-like antimicrobial peptide named defensin-NV was purified and characterized. Defensin-NV is composed of 52 amino acid residues including 6 cysteines forming 3 disulfide bridges. Its amino acid sequence is VTCELLMFGGVVGDSACAANCLSMGKAGGSCNGGLCDCRKTTFKELWDKRFG. By BLAST search, defensin-NV showed significant sequence similarity to other insect defensin antimicrobial peptides. Defensin-NV exerted strong antimicrobial activity against tested microorganisms including Gram-positive bacteria, Gram-negative bacteria and fungi. The cDNA encoding defensin-NV was cloned from the venom reservoir cDNA library of N. vitripennis. The current work firstly purified and characterized an antimicrobial peptide from parasitic Hymenoptera.

[Efficacy and safety of non-invasive positive pressure ventilation in the care of dyspnea after cardiac surgery].

OBJECTIVE: To study the efficacy and safety of non-invasive positive pressure ventilation (NPPV) in the care of dyspnea after cardiac surgery. METHODS: Among patients who underwent cardiac surgery with cardiopulmonary bypass from December 2004 to December 2006,58 patients developed dyspnea (respiratory rate>25 breaths per minute with "three depressions" sign) and acute respiratory failure after extubation. Among them 30 patients underwent NPPV and 28 patients were treated with face mask oxygen therapy. Intubation and invasive mechanical ventilation were begun when the treatment failed or still hypoxemic [partial pressure of oxygen in artery (PaO(2))<60 mm Hg (1 mm Hg=0.133 kPa)], ventricle arrhythmia, or other indications for endotracheal intubation. RESULTS: No significant differences were found between two groups in age,acute physiology and chronic health evaluation II (APACHE II) score,duration of cardiopulmonary bypass and aortic cross-clamp, and New York Heart Association class (all P>0.05). Compared with face mask oxygen therapy group, NPPV was associated with a lower incidence of arrhythmia (P<0.05) at 120 minutes after treatment, a lesser necessity for reintubation (P<0.01), a shorter length of stay in intensive care unit (ICU) (P<0.01), a lower mortality (P<0.05). Arterial pH and arterial CO(2) partial pressure (PaCO(2)) of two groups began to rise significant at 480 minutes (P<0.05 or P<0.01), PaCO(2) began to rise at 120 minutes (P<0.05). At 30 minutes, significant differences in PaO(2), HCO(-)(3), respiratory rate, heart rate and arterial systolic blood pressure in NPPV group began to appear (P<0.05 or P<0.01). The time of significant differences in PaO(2), HCO(-)(3), respiratory rate, heart rate and arterial systolic blood pressure in face mask oxygen therapy group were respectively 120, 60, 120, 480 and 480 minutes (P<0.05 or P<0.01). Lactate concentration showed a significant drop at 60 minutes in NPPV (P<0.05), but at 480 minutes in face mask oxygen therapy group (P<0.05). CONCLUSION: These results suggest that NPPV is an effective and safe means for improving dyspnea and tissue perfusion, decreasing arrhythmia and necessity for reintubation, shortening the length of stay in ICU and decreasing mortality in dyspneic patients after cardiac surgery.