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1.
BMJ Open ; 11(8): e045031, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373293

RESUMO

OBJECTIVES: To conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional 'step-up' strategy based on percutaneous catheter drainage (PCD). DESIGN: Systematic review and meta-analysis. METHODS: PubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional 'step-up' strategy based on PCD were included. OUTCOMES: The primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay. RESULTS: Five cohort studies and three RCTs were included in the analysis. Compared with the conventional 'step-up' method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) -0.31, 95% CI -0.53 to -0.10 and p=0.005; RCTs: SMD -0.45, 95% CI -0.64 to -0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD -2.49, 95% CI -4.46 to -0.51 and p<0.001; RCTs: SMD -0.67, 95% CI -0.89 to -0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04). CONCLUSIONS: The findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the 'step-up' strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials. PROSPERO REGISTRATION NUMBER: CRD42020168537.


Assuntos
Pancreatite , Paracentese , Drenagem , Hospitalização , Humanos , Tempo de Internação , Pancreatite/terapia , Paracentese/efeitos adversos
2.
Arch Dermatol Res ; 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33649909

RESUMO

The present study aims to explore the roles of calcitonin gene-related peptide (CGRP) in the hypertrophic scar and its underlying mechanism. The levels of CGRP were determined in human hypertrophic scar and mouse cutaneous scar using ELISA and Western blot. In in vivo studies, A cutaneous excision mouse model was established and treated with exogenous CGRP or CGRP antagonist. In in vitro studies, bone marrow-derived macrophages (BMDMs) were isolated and treated with exogenous CGRP in the presence of lipopolysaccharide (LPS). qRT-PCR and Western blot were applied to determine the mRNA and protein levels of scar formation and inflammation-related genes, respectively. Flow cytometry was operated to determine the populations of macrophages in the scar. Elevated levels of CGRP were observed in the hypertrophic scar. In the cutaneous excision mouse model, treatment of exogenous CGRP or CGRP antagonist-affected scar formation-related genes including Col1, Tgfb1, and α-SMA, inflammation-related genes including Il1b, Il6, Tnfa, and Ccl2, and CD45+F4/80+ macrophage. In LPS-induced BMDMs, treatment of exogenous CGRP also altered inflammation-related genes by regulating NF-κB and ERK signaling pathways. The ameliorated effects of CGRP on inflammation in hypertrophic scar formation are associated with its regulative effects on NF-κB and ERK signaling pathways.

4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(7): 785-791, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32788010

RESUMO

OBJECTIVE: To explored the progress of intensive care unit (ICU) delirium between 2010 and 2020 based on knowledge visualization analysis. METHODS: The literatures related to ICU delirium included in Web of Sciences (WOS) and China National Knowledge Infrastructure (CNKI) databases from 2010 to 2020 were collected. A bibliometric analysis was performed. The growth trend was showed by Excel 2019 software. The information about country, institution and author were extracted by VOSviewer 1.6.15 for generating cooperative network, to find the main research power and each cooperative relation. At the same time, Citespace 5.0.R1 was used to analyze those high frequency keywords and bursting keywords and build the map of co-citation reference, in order to explore the evolution of research in the field of ICU delirium and the hotspots about this field in recent 10 years. RESULTS: A total of 1 102 Chinese journal articles and 2 422 English "Articles" or "Reviews" from 2010 to 2020 were collected preliminarily, and the number of published literatures increased steadily. In the respect of quality, the impact factors of most articles were concentrated between 2 and 3, and the literatures with impact factor over 5 accounted for 27.9% (337/1 209). According to the knowledge visualization analysis, the United States published most of the related articles (total 1 152) in this field, while the England and Canada ranked second and third respectively, totaling 220 and 204. In terms of the distribution of research institutions, the Vanderbilt University School of Medicine was not only far ahead in the number of publication (n = 149), but more importantly, top three high-impact authors located in this institution. The amount of domestic publications was lower than developed countries, however, the burst index, which reflected the sudden increase, ranked first (7.09), suggesting that the interest and investment of Chinese researchers was increasing recently. The most productive institution in China was Capital Medical University School of Nursing with totaling 23 articles. Wu Ying, who published most Chinese papers (n = 14), belongs to this institution. However, it was a pity that there was no large scientific community be constructed in China, and the cooperation between institutions was deficient. By generating the co-occuring keyword mapping, the research hotpots mainly focused on the prevention, treatment and prevention of delirium in mechanically ventilated patients, the effect of dexmedetomidine and exploring the risk factor of ICU delirium. Finally, the results of co-citation reference analysis showed that Cluster 4 (risk assessment) was still in the process of development, in hence it was the frontier in this domain. CONCLUSIONS: There was a big gap between China and leading countries in the field of ICU delirium research. The main research power was located in the United States, and the trending of future studies mainly focus on delirium-related risk assessment.


Assuntos
Delírio , Unidades de Terapia Intensiva , Publicações , Bibliometria , China , Humanos , Estados Unidos
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(6): 658-663, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32684208

RESUMO

Out-of-hospital cardiac arrest (OHCA) is a global medical challenge. Early case recognition and initiating the chain of survival is associated with good prognosis of these patients. On the basis of former research, American Heart Association (AHA) published a policy statement related to telecommunicator cardiopulmonary resuscitation (T-CPR) in March 2020, and introduced its specific procedures, standards and precautions. To assist Chinese doctors in better understanding of the T-CPR, and give a reference for the emergency curing of OHCA, the guideline was translated and interpreted in this paper.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , American Heart Association , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Humanos , Estados Unidos
6.
Front Pharmacol ; 11: 940, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714186

RESUMO

Background: The efficacy and safety of the administration of recombinant human thrombopoietin (rhTPO) in sepsis patients with thrombocytopenia were still inconclusive. Objectives: To investigate whether rhTPO is a benefit for sepsis patients with thrombocytopenia. Methods: PubMed, Cochrane library, Embase, China National Knowledge Infrastructure, and Wanfang Database were electronically searched to the randomized controlled trials (RCTs) from inception to March 4, 2020. The primary outcome was the level of platelet (PLT) on the 7th day of treatment, and secondary outcomes were 28-d mortality, the level of coagulation indicators, hepatic and renal function indicators, blood transfusion, and length of intensive care unit (ICU) stay. Results: Ten RCTs involving 681 patients were included. For compared with conventional antibiotic therapy, rhTPO could significantly increase platelet counts (PCs) [standardized mean difference (SMD), 2.61; 95% confidence interval (CI), 1.28-3.94; P < 0.001], decreased 28-d mortality [relative risk (RR), 0.66; 95%CI, 0.46-0.97; P=0.03], transfusion volume of blood products and length of ICU stay. Additionally, for compared with conventional antibiotic therapy combined with intravenous immunoglobulin, the pooled results shown that rhTPO also associated with an improvement of PCs on 7th of treatment (SMD, 0.86; 95%CI, 0.54-1.17; P < 0.001), and a reduced transfusion volume of blood products. However, there were no differences in 28-d mortality and the length of ICU stay. Conclusions: Current evidence shown that rhTPO could increase PCs on 7th day of treatment and reduce the transfusion volume of blood products in sepsis-related thrombocytopenia during hospitalization. The conclusions are needed to be verified indeed by more multicenter RCTs due to the limitation of the included studies.

7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(3): 287-293, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32385991

RESUMO

OBJECTIVE: To explore the progress of microcirculation research in shock and sepsis from 2000 to 2019 based on knowledge visualization analysis. METHODS: The literatures related to microcirculation of shock and sepsis published in Web of Science and Wanfang databases were collected from 2000 to 2019. Then, data collected was sorted out and used to make bar charts and curves reflecting the growth trend of the literatures using Excel software. The information about country, institution and author were extracted by CiteSpace 5.0 R1 for generating co-occurring network, to find the main research power and each cooperative relation. This software was also used to analyze the related-keywords and cited reference, so that the map of co-citation reference was drawn subsequently to explore the frontiers and hot spots in this field. RESULTS: There were a total of 2 000 Chinese "papers" or "dissertations", 1 823 English "articles" or "reviews", collected preliminarily. The Chinese literatures were only statistically described for the amounts, institutions and authors, however, all retrieved English literatures were enrolled in the visualization analysis eventually. From 2009 to 2019, the number of English literatures rose steadily; however, the number of Chinese literatures had been sliding since 2011. On terms of quality, the impact factors of most literatures were under 6, lacking high quality ones, and the number remained stable every year. According to the analysis of English literatures, the top three countries that published related papers around the world were Germany (n = 430), the United States (n = 401) and Netherlands (n = 223). In the aspect of research institutions, the University of Amsterdam (Netherlands) ranked first in the Web of Science (n = 113), while the institution in China with the most publications was the Southern Medical University (n = 71). According to the analysis of co-occurring author network, there were three major globe scientific groups in which Can Ince, Daniel De Backer and Jean-Louis Vincent contributed most to this research field. The top three authors who published most Chinese papers were Niu Chunyu (n = 20), Zhao Zigang (n = 18) and Duan Meili (n = 13). By generating the co-occurring keyword mapping, the research hot spots mainly focused on "blood flow", "nitric oxide", "hemorrhagic shock" and "perfusion". However, these burst keywords, including "cardiogenic shock", "acute kidney injury", "fluid resuscitation", "sublingual microcirculation", "mortality", "oxidative stress", and "critically ill patient", represented the frontiers in microcirculation research of shock and sepsis field. Finally, the results of co-citation reference analysis showed that "sublingual microcirculation" and "mottling score" were most active, indicating that the research of microcirculation monitoring technology could be considered as a hot spot and also the frontier in this field, which was consistent with the results of co-occurring keywords network. CONCLUSIONS: Knowledge visualization analysis can visually exhibit the hot spot and trend of microcirculation research in shock and sepsis. The power was mainly focused on a few developed countries in Europe, and the trend was more inclined to the related microcirculation monitoring technology.


Assuntos
Microcirculação , Sepse , Choque , China , Europa (Continente) , Humanos
8.
Biomed Res Int ; 2020: 6969053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32149124

RESUMO

Purpose: We investigated the protective effects and the underlying mechanisms through which recombinant human brain natriuretic peptide (rhBNP) acts on postresuscitation myocardial dysfunction (PRMD) in the cardiac arrest (CA) model. Methods: Ventricular fibrillation was induced and untreated for 6 min. And the time of cardiopulmonary resuscitation was 8 min, after which defibrillation was attempted in this rat model. 24 Sprague Dawley rats (450-550g) were randomized into cardiopulmonary resuscitation (CPR) + rhBNP and CPR + placebo groups after restoration of spontaneous circulation (ROSC). rhBNP was infused at PR 30 min (loading dose: 1.5 µg/kg, 3 min; maintenance dose: 0.01 µg/kg, 3 min; maintenance dose: 0.01 α (TNF-α (TNF-α (TNF-κB (NF-κB (NF. Results: The administration of rhBNP attenuated the severity of PRMD and myocardial tissue injuries, with improvement of MAP (mean arterial blood pressure), ETCO2 (end-tidal CO2), serum level of NT-proBNP, EF, CO, and MPI values. The serum levels and protein expression levels in myocardial tissue of IL-6 and TNF-α (TNF-κB (NF. Conclusion: Our research demonstrated that the administration of rhBNP attenuated the severity of PRMD and myocardial tissue injuries and increased the 24 h survival rate in this CA model. rhBNP administration also reduced the serum and myocardial tissue levels of IL-6 and TNF-α after ROSC, likely due to the suppression of the TLR4/NF-κB signaling pathway and the regulation of inflammatory mediator secretion.α (TNF-κB (NF.


Assuntos
Parada Cardíaca , Coração/efeitos dos fármacos , Peptídeo Natriurético Encefálico/farmacologia , Substâncias Protetoras/farmacologia , Animais , Modelos Animais de Doenças , Coração/fisiopatologia , Parada Cardíaca/metabolismo , Parada Cardíaca/fisiopatologia , Humanos , Interleucina-6/metabolismo , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/farmacologia , Transdução de Sinais/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismo
9.
Shock ; 53(5): 630-636, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31274829

RESUMO

BACKGROUND: Ivabradine selectively inhibits the If current, reducing the heart rate and protecting against myocardial ischemia/reperfusion injury. We investigated the effects of ivabradine on post-resuscitation myocardial function in a porcine model of cardiopulmonary resuscitation. METHODS AND RESULTS: Ventricular fibrillation was induced and untreated for 8 min while defibrillation was attempted after 6 min of cardiopulmonary resuscitation in anesthetized domestic swine. Then the animals were randomized into ivabradine and placebo groups (n = 5 each). Ivabradine and saline were administered at the same volume 5 min after Return of Spontaneous Circulation, followed by continuous intravenous infusion at 0.5 mg/kg for 480 min. Hemodynamic parameters were continuously recorded. Myocardial function was assessed by echocardiography at baseline and at 60, 120, 240, 480 min and 24 h after resuscitation. The serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) were measured by commercial enzyme-linked immunosorbent assay kits. Animals were killed 24 h after resuscitation, and all myocardial tissue was removed for histopathological analysis. The heart rate was significantly reduced from 1 h after resuscitation in the ivabradine group (all P < 0.05). The post-resuscitation mitral E/A and E/e' velocity ratios and left ventricular ejection fraction were significantly better in the ivabradine than placebo group (P < 0.05). The serum levels of myocardial injury biomarkers (NT-proBNP, cTnI) and the myocardial biopsy scores were significantly lower in the ivabradine than placebo group (P < 0.05). Neurological deficit scores were lower in the IVA group at PR 24 h (P < 0.05). CONCLUSIONS: Ivabradine improved post-resuscitation myocardial dysfunction, myocardial injury, and post-resuscitation cerebral function, and also slowed the heart rate in this porcine model.


Assuntos
Cardiomiopatias/tratamento farmacológico , Reanimação Cardiopulmonar/efeitos adversos , Fármacos Cardiovasculares/uso terapêutico , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Ivabradina/uso terapêutico , Animais , Cardiomiopatias/etiologia , Modelos Animais de Doenças , Masculino , Volume Sistólico , Suínos , Função Ventricular Esquerda
10.
Biomed Res Int ; 2019: 2476252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467875

RESUMO

Severe hemorrhagic shock and resuscitation (HS/R) can lead to lung injury, resulting in respiratory insufficiency. We investigated whether treatment with Alda-1, an ALDH2 activator, decreased lung injury induced by severe HS/R in a rat model. Male Sprague-Dawley rats were randomized into three groups, hemorrhagic shock + placebo, hemorrhagic shock + Alda-1, and sham. All animals were heparinized, and then 50% of the total calculated blood volume was collected over 60 minutes. After 40 minutes of hemorrhagic shock, animals were reinfused with the shed blood over 40 minutes and then observed for an additional 2 hours. Concentrations of 4-HNE, TNF-α, IL-6, and ALDH2 activity were detected; lung injury and lung wet-to-dry weight ratios were assessed. Expression of occludin and ZO-1 proteins in lung tissues was also determined. At 2 hours after resuscitation, lung injury was significantly reduced and the wet-to-dry weight ratio was notably decreased in the Alda-1 group compared with placebo (P<0.05). Alda-1 treatment also significantly increased the activity of ALDH2 and decreased the levels of toxic 4-HNE (P<0.05). In the Alda-1 group, IL-6 and TNF-α were dramatically decreased compared with placebo-treated animals (P<0.05). Expression of occludin and ZO-1 proteins was significantly decreased in the placebo group compared with the Alda-1 group (P<0.05). Thus, in a rat model of severe HS/R, treatment with Alda-1 increased the activity of ALDH2, significantly accelerated the clearance of reactive aldehydes, and concomitantly alleviated lung injury through improvement of pulmonary epithelial barrier integrity resulting in decreased alveolar epithelial tissue permeability, lung edema, and diffuse infiltration of inflammatory cells.


Assuntos
Aldeídos/metabolismo , Benzamidas/farmacologia , Benzodioxóis/farmacologia , Lesão Pulmonar/tratamento farmacológico , Pulmão/efeitos dos fármacos , Choque Hemorrágico/tratamento farmacológico , Aldeído-Desidrogenase Mitocondrial/genética , Animais , Modelos Animais de Doenças , Epitélio/efeitos dos fármacos , Epitélio/metabolismo , Epitélio/patologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Pulmão/metabolismo , Pulmão/patologia , Lesão Pulmonar/metabolismo , Lesão Pulmonar/patologia , Ocludina/genética , Ratos , Choque Hemorrágico/genética , Choque Hemorrágico/patologia , Fator de Necrose Tumoral alfa/genética , Proteína da Zônula de Oclusão-1/genética
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(4): 393-396, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31109407

RESUMO

OBJECTIVE: The European Society of Intensive Care Medicine (ESICM) issued the second consensus on the assessment of sublingual microcirculation in critically ill patients. This paper interprets the consensus for clinicians about: what is microcirculation, how to observe microcirculation, and the details of microcirculation images collection and parameters analysis. Besides, this paper illustrates the relationship between microcirculation alternation and shock, it also evaluates the present situation and future development of microcirculation monitoring.


Assuntos
Estado Terminal , Microcirculação , Soalho Bucal/irrigação sanguínea , Consenso , Cuidados Críticos , Europa (Continente) , Humanos , Sociedades Médicas
12.
Shock ; 51(5): 667-673, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30986796

RESUMO

Neurotensin is an endogenous tridecapeptide that binds to neurotensin receptors in the brain, which induce hypothermia. The aim of this study was to investigate whether the receptor agonist ABS 201 could induce therapeutic hypothermia and improve postresuscitation outcomes in a ventricular fibrillation cardiac arrest (VFCA) rat model. VF was electrically induced in 12 rats. Defibrillation was achieved after 6 min of cardiopulmonary resuscitation. After successful resuscitation, animals were randomized to receive ABS 201 (8 mg/kg/h) or placebo. Postresuscitation myocardial function and neurological deficit scores (NDS) were assessed, and postresuscitation survival duration was observed for up to 72 h. After administration of ABS 201, blood temperature decreased significantly from 37°C to 34°C, and was maintained for 2.5 h. There was a significant improvement of postresuscitation myocardial dysfunction, NDS, and survival duration in animals treated with ABS 201. These results demonstrated that ABS 201 induces therapeutic hypothermia in a VFCA rat model, ameliorates postresuscitation myocardial-neurological dysfunction, and prolongs survival duration. ABS 201 may therefore be an alternative method to induce therapeutic hypothermia with current cooling methods and improve postresuscitation outcomes.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Oligopeptídeos/farmacologia , Receptores de Neurotensina/agonistas , Animais , Temperatura Corporal , Modelos Animais de Doenças , Parada Cardíaca/patologia , Masculino , Ratos , Ratos Sprague-Dawley , Ressuscitação , Resultado do Tratamento , Fibrilação Ventricular/fisiopatologia
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 30(9): 888-893, 2018 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-30309417

RESUMO

OBJECTIVE: To investigate the protective function of endovascular cooling method on post-resuscitation syndrome (PRS) in porcine cardiac arrest (CA) model and its mechanism. METHODS: Ventricular fibrillation (VF) was electrically induced and untreated for 8 minutes in 15 healthy male porcines, cardiopulmonary resuscitation (CPR) was then initiated. All successful recovery animals were randomly divided into two groups by random number table. In normal temperature group, the core temperature was maintained at (38.0±0.5) centigrade for 12 hours. In mild hypothermia group, the mild hypothermia treatment was initiated at 5 minutes after successful resuscitation, the treatment of rapid endovascular cooling was performed to reach the target cooling temperature of (33.0±1.0) centigrade, and then maintained until 6 hours after resuscitation. Rewarming was implemented at the rate of 0.7 centigrade/h until the body temperature reached (38.0±0.5) centigrade. Hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO) were continually monitored. Right femoral vein blood was collected before VF and 1, 2, 4, 6, 12 and 24 hours after resuscitation, respectively, and the serum concentrations of E-selectin, soluble thrombomodulin (sTM), and interleukin-1ß (IL-1ß) were determined with enzyme linked immunosorbent assay (ELISA). The survival of porcines at 24 hours after resuscitation was observed, and the neurological deficit score (NDS) was calculated for the surviving porcines. All animals were sacrificed, and brain, heart and lung tissues were collected, after hematoxylin and eosin (HE) staining, the histopathology changes were evaluated under a light microscopy. RESULTS: After 8-minute VF, 14 porcines were resuscitated successfully, 7 porcines in normal temperature group and 7 in mild hypothermia group respectively, with the resuscitation success rate of 93.3%. There was no significant difference in body weigh, core temperature, hemodynamics, or blood lactate as well as duration of CPR and the number of defibrillations between the two groups. The core temperature of normal temperature group was maintained at (38.0±0.5) centigrade, while in mild hypothermia group, the hypothermia was reduced to the hypothermia range (33.0±1.0) centigrade until 6 hours, then rewarmed to normothermia gradually [(38.0±0.5) centigrade]. Compared with those before VF, HR was significantly increased after resuscitation in both groups, and MAP and CO were decreased, then they tended to normal. There was no significant difference in hemodynamic parameter at all time points between the two groups. Compared with those before VF, the levels of E-selectin and sTM in serum of the two groups were increased significantly at 1 hour after resuscitation, and they were decreased gradually after reaching the peak at 6 hours, and IL-1ß was increased continuously with time. There was no significant difference in E-selectin (µg/L: 1.34±0.52 vs. 1.60±0.61), sTM (µg/L: 19.13±0.34 vs. 19.24±0.73), or IL-1ß (ng/L: 25.73±0.87 vs. 25.32±0.25) before VF between normal temperature group and mild hypothermia group (all P > 0.05). The levels of E-selection, sTM and IL-1ß in mild hypothermia group were significantly lower than those in normal temperature group from 2 hours after resuscitation [E-selection (µg/L): 11.15±2.73 vs. 16.04±3.23, sTM (µg/L): 49.67±3.32 vs. 62.22±1.85, IL-1ß (ng/L): 140.51±6.66 vs. 176.29±18.51, all P < 0.05], and E-selection decreased to the baseline level at 12 hours (µg/L: 1.17±0.65 vs. 1.60±0.61, P > 0.05). The 24-hour survival rates of two groups were both 100%. The NDS score of mild hypothermia group was obviously lower than that of normal temperature group (150.0±6.6 vs. 326.4±12.3, P < 0.05). In normal temperature group, neuronal cell necrosis was observed in the cerebral cortex at 24 hours after resuscitation, and nucleus was deeply stained. The myocardial necrosis and alveolar collapse was found. Meanwhile the infiltration of inflammatory cell could be found in the myocardium and alveolar. The brain, lung and myocardium injury were significantly milder in mild hypothermia group as compared with those in normal temperature group. CONCLUSIONS: The intravascular cooling therapy was a safe and effective method for inducing mild hypothermia after resuscitation. This cooling effect was fast and reliable, and the rewarming speed was controllable and stable. The protective mechanism of mild hypothermia on PRS may be related to inhibiting systemic inflammatory response and reducing vascular endothelial cell injury.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Hipotermia Induzida , Animais , Modelos Animais de Doenças , Cardioversão Elétrica , Masculino , Suínos , Resultado do Tratamento , Fibrilação Ventricular
14.
J Am Heart Assoc ; 7(6)2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29572320

RESUMO

BACKGROUND: Epinephrine administered during cardiopulmonary resuscitation (CPR) is associated with severe post-resuscitation myocardial dysfunction. We previously demonstrated that therapeutic hypothermia reduced the severity of post-resuscitation myocardial dysfunction caused by epinephrine; however, the relationship between myocardial adrenoceptor expression and myocardial protective effects by hypothermia remains unclear. METHODS AND RESULTS: Rats weighing between 450 and 550 g were randomized into 5 groups: (1) normothermic placebo, (2) normothermic epinephrine, (3) hypothermic placebo, (4) hypothermic epinephrine, and (5) sham (not subject to cardiac arrest and resuscitation). Ventricular fibrillation was induced and untreated for 8 minutes for all other groups. Hypothermia was initiated coincident with the start of CPR and maintained at 33±0.2°C for 4 hours. Placebo or epinephrine was administered 5 minutes after the start of CPR and 3 minutes before defibrillation. Post-resuscitation ejection fraction was measured hourly for 4 hours then hearts were harvested. Epinephrine increased coronary perfusion pressure during CPR (27±6 mm Hg versus 21±2 mm Hg P<0.05). Post-resuscitation myocardial function was impaired in the normothermic epinephrine group compared with other groups. The concentration of myocardial cAMP doubled in the normothermic epinephrine group (655.06±447.63 µmol/L) compared with the hypothermic epinephrine group (302.51±97.98 µmol/L; P<0.05). Myocardial ß1-adrenoceptor expression decreased with normothermia cardiac arrest but not with hypothermia regardless of epinephrine. CONCLUSIONS: Epinephrine, administered during normothermic CPR, increased the severity of post-resuscitation myocardial dysfunction. This adverse effect was inhibited by intra-arrest hypothermia resuscitation. Declined cAMP with more preserved ß1-adrenoceptors in hypothermia-resuscitated myocardium is associated with improved post-resuscitated myocardial function in vivo.


Assuntos
Agonistas Adrenérgicos/toxicidade , Reanimação Cardiopulmonar/efeitos adversos , AMP Cíclico/metabolismo , Epinefrina/toxicidade , Parada Cardíaca/terapia , Hipotermia Induzida , Miocárdio/metabolismo , Receptores Adrenérgicos beta 1/metabolismo , Função Ventricular/efeitos dos fármacos , Agonistas Adrenérgicos/administração & dosagem , Animais , Reanimação Cardiopulmonar/métodos , Modelos Animais de Doenças , Epinefrina/administração & dosagem , Parada Cardíaca/metabolismo , Parada Cardíaca/fisiopatologia , Masculino , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Fatores de Tempo
15.
Shock ; 49(5): 591-595, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28731900

RESUMO

Microcirculation is the motor of sepsis. In the present study, we investigated whether microcirculatory alterations occur before changes of systemic hemodynamics in a rat model of cecum ligation and puncture (CLP)-induced sepsis. We further investigated renal microcirculatory changes during sepsis and compared those with buccal microcirculation. Twelve male Sprague-Dawley rats were randomized into a sham control group (n = 6) and a CLP group (n = 6). Perfused microvessel density (PVD) and microvascular flow index (MFI) were evaluated using sidestream dark field (SDF) video microscopy at baseline-60, 120, 180, 240, 300, and 360 min following CLP. A semiquantitative score was calculated for vessels of less than 20 µm, primarily representing the capillaries. Hemodynamic measurements such as cardiac output (CO), aortic pressure (AP), heart rate (HR), end-tidal CO2 (ETCO2), blood pH, and lactate were measured simultaneously. The serum cytokine interleukin 6 (IL-6) was measured at baseline-120, 240, and 360 min. In the CLP group, buccal PVD and MFI were reduced at 180 min (P < 0.05 vs. baseline); renal PVD and MFI were reduced at 180 min (P < 0.05 vs. baseline), but MAP and CO did not change until 300 min after CLP. In the rat model of peritonitis-induced sepsis, microcirculatory alterations of both peripheral mucosa and kidney occurred earlier than global hemodynamics. Monitoring the microcirculation may provide a means of early detection of circulatory failure during sepsis. The changes of renal microcirculation correlate with that of buccal during sepsis and septic shock.


Assuntos
Microcirculação/fisiologia , Sepse/fisiopatologia , Choque Séptico/fisiopatologia , Animais , Pressão Arterial/fisiologia , Débito Cardíaco/fisiologia , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
16.
Neuro Endocrinol Lett ; 36(5): 407-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26707037

RESUMO

Acute pancreatitis (AP) is a frequent and potentially life-threatening disease with high morbidity and mortality. The overall mortality of AP is approximately 5%. Alcohol consumption and gallstones are the main etiology of AP. Hypertriglyceridemia, idiosyncratic reactions to drugs, anatomic alterations and ascaris lumbricoides can also give rise to AP. Although spinal cord injury (SCI) can cause AP, however, the case of induced by cervical spine surgery has not been reported. A 61-year-old man with quadriplegic and respiratory distress received cervical spine surgery for spinal cervical spondylosis and multi-stage longitudinal ligament. He was admitted to intensive care unit (ICU) after tracheotomy for progressive dyspnea, one day after the cervical spine surgery. The patient was diagnosed with AP, in the absence of any identifiable causes of pancreatitis. He was treated with intravenous fluids, no oral feeding, enteral and parenteral nutrition, antibiotic and mechanical ventilation. The patient's condition gradually improved after the treatment. This case describes a case of postoperative cervical spondylosis that led to AP. In this report, we highlight the importance of early diagnosis and subsequent appropriate treatment. We conclude that the outcome can be favorable, if the treatment is appropriate.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Pancreatite/etiologia , Traumatismos da Medula Espinal/etiologia , Espondilose/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Mol Biol Rep ; 36(6): 1475-81, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18763053

RESUMO

BACKGROUND: It has been reported lately that Toll-like receptors (TLRs) play an essential role in the activation of innate immunity, and TLRs are expressed in a large number of immune cells like B-lymphocytes, monocytes, plasmacytoid dendritic cells and at low levels in human respiratory cells as well as epithelial cells. In the present study, we investigated whether there is a relationship between the expression of TLR4 or TLR9 and the clinical or pathological changes in human lung cancer. METHOD: Protein expression of TLR4 and TLR9 was assessed by using immunohistochemistry and western blotting. mRNA expressions of TLR4 and TLR9 were detected by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: High TLR4 and TLR9 mRNA signal intensity was found in the majority of lung cancer specimens. In contrast, tumor-free lung tissue showed lower signal intensity. Consistently, the low amount of TLR4 and TLR9 protein expression was found in tumor-free lung tissue, while they were strongly expressed in lung cancer tissue. In addition, we found for the first time that the differentiation degree of tumor cells was positively correlated with the expression level of TLR4. There was no relationship between the expressions of TLR4 or TLR9 and patients' age, gender, smoking, the histological type of tumor, lymph node metastasis, and tumor node metastases (TNM) stage. CONCLUSIONS: We found that both mRNA and protein levels of TLR4 and TLR9 were strongly expressed in lung cancer tissue. In addition, we reported for the first time a positive correlation between the expression level of TLR4 and malignancy of lung cancer. These results suggested that TLR4 and TLR9 may be involved in the development of lung cancer which may have the potentials for the treatment of this malignant tumor.


Assuntos
Regulação Neoplásica da Expressão Gênica , Neoplasias Pulmonares/genética , Receptor 4 Toll-Like/genética , Receptor Toll-Like 9/genética , Diferenciação Celular , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/análise
18.
Zhonghua Yi Xue Za Zhi ; 88(40): 2848-53, 2008 Nov 04.
Artigo em Chinês | MEDLINE | ID: mdl-19080496

RESUMO

OBJECTIVE: To investigate the regulation of leptin expression in human lung adenocarcinoma cells by hypoxia inducible factor-1 (HIF-1alpha) and the mechanism thereof. METHODS: Lung adenocarcinoma tissues were collected from 42 patients during operation and samples of corresponding adjacent lung tissue were obtained from 16 of the 42 specimens. The expression levels of HIF-1alpha and leptin were detected by immunohistochemical staining. Human lung adenocarcinoma cells of the line A549 cells were cultured for 0, 12, 24, and 48 h respectively, exposed to hypoxia induced by CoCl2. Other A549 cells were treated with GL331, a kind of HIF-1alpha inhibitor, of the concentrations of 0, 5, 10, or 20 micromol/L under normoxic condition for 24 h, and then were exposed to hypoxia induced by CoCl2 for 24 h. RT-PCR and Western-blotting were used to examine the mRNA and protein expression levels of HIF-1alpha and leptin in different groups. RESULTS: Immunohistochemistry showed that the positive rates of HIF-1alpha and leptin in the lung adenocarcinoma tissue were 57.1% and 69.0% respectively, both significantly higher than those in the adjacent normal lung tissues (18.8% and 25.0% respectively, both P<0.01). The protein expression levels of HIF-1alpha in the hypoxia 0, 12, 24, and 48 h groups were 0.314+/-0.030, 0.552+/-0.027, 0.743+/-0.015, and 0.799+/-0.010 respectively, and the protein expression levels of leptin were 0.398+/-0.016, 0.633+/-0.036, 0.796+/-0.008, and 0.942+/-0.088 respectively, increasing in a time dependent manner too. The mRNA expression levels of leptin in the 4 hypoxia groups were 0.144+/-0.009, 0.336+/-0.017, 0.524+/-0.013, and 0.671+/-0.021 respectively, increasing in a time dependent manner, however, there was no significant differences in the mRNA expression levels of HIF-1alpha among the groups exposed to hypoxia for different courses of time (all P>0.05). The protein expression levels of HIF-1alpha and leptin, and the mRNA expression levels of leptin in the groups exposed to hypoxia for different courses of time were all significantly higher than those of the control (0 h hypoxia) group (all P<0.01). The mRNA and protein expression levels of leptin in the A549 cells exposed to GL331 and hypoxia were decreased dose-dependently. CONCLUSION: The expression of leptin is up-regulated by hypoxia and regulated by HIF-1alpha.


Assuntos
Adenocarcinoma/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Leptina/metabolismo , Neoplasias Pulmonares/metabolismo , Adenocarcinoma/patologia , Idoso , Hipóxia Celular , Linhagem Celular Tumoral , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
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