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1.
Pediatr Infect Dis J ; 39(8): e206-e207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32639461

RESUMO

Pediatric inflammatory multisystem syndromes associated with Severe Acute Respiratory Syndrome Coronavirus 2 are emerging in recent reports. We describe a patient with critical illness consistent with atypical Kawasaki disease with cardiac dysfunction and abdominal involvement presenting weeks after Severe Acute Respiratory Syndrome Coronavirus 2 infection. Our patient showed unique central nervous system involvement with small vessel vasculitis and profound hypocomplementemia, both not previously reported in case descriptions and may hint at possible disease mechanisms.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Adolescente , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Glomerulonefrite Membranoproliferativa , Hemossiderose/diagnóstico por imagem , Hospitalização , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Sistema Nervoso , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/terapia
2.
BMC Infect Dis ; 20(1): 396, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503442

RESUMO

BACKGROUND: Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients. METHODS: A matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia. RESULTS: The 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p <  0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421-3.217, p <  0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719-0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group. CONCLUSIONS: DNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.


Assuntos
Candidemia/diagnóstico , Neutrófilos/citologia , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Candida/isolamento & purificação , Candidemia/complicações , Candidemia/microbiologia , Candidemia/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
5.
Tumori ; 106(4): 312-318, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32326835

RESUMO

OBJECTIVE: To determine the effect of systemic inflammation indexes and fluorine-18 fluorodeoxyglucose (18FDG) positron emission tomography (PET) metabolic parameters on survival in advanced lung adenocarcinoma. METHODS: A total of 133 patients who underwent 18FDG PET for initial staging were investigated retrospectively. Baseline patient characteristics, routine blood test results, 18FDG PET metabolic parameters, and treatment history were examined. Overall survival (OS) was demonstrated by Kaplan-Meier analysis, and the curves were compared by the log-rank test. Systemic inflammation response index (SIRI) was defined as neutrophil x monocyte/lymphocyte count. RESULTS: Lymphocyte/monocyte ratio (LMR) and SIRI were found to be significant for OS. The cutoff point was 2.25 for LMR. Median OS was 8 months for ⩽2.25 and 14 months for >2.25 (p = 0.005). For SIRI, the cutoff point was 2. SIRI ⩽2 was associated with a median OS of 16 months compared to 10 months for patients with SIRI >2 (p = 0.043). Maximum of standardized uptake value, total lesion glycolysis, and metabolic tumor volume were not found to be significant for OS (p = 0.225, p = 0.061, p = 0.355, respectively). No correlation was found between inflammatory indexes and PET metabolic parameters. CONCLUSION: Age and LMR parameters were prognostic for survival in Cox regression analysis. There was no correlation between 18FDG PET parameters and inflammatory indexes.


Assuntos
Adenocarcinoma de Pulmão/metabolismo , Linfócitos/metabolismo , Monócitos/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Idoso , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Estimativa de Kaplan-Meier , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Tomografia por Emissão de Pósitrons , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/patologia , Carga Tumoral
6.
Support Care Cancer ; 28(2): 653-659, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31119460

RESUMO

PURPOSE: We aimed to assess the prognostic accuracy of SOFA and qSOFA scores in cancer patients with sepsis, and also to determine if the addition of hyperlactatemia to qSOFA increases the accuracy in predicting the 30-day mortality. MATERIAL AND METHOD: We consecutively included adult active cancer patients (age ≥ 18 years) with sepsis defined by SIRS who visited the emergency department (ED) from May 1st to July 30th, 2017. Data were collected retrospectively through reviewing medical records. The SOFA and qSOFA scores were calculated with the initial variables at the time of ED admission. The primary endpoint was 30-day mortality. RESULT: Of 1137 screened, 301 were included. The 30-day mortality was 14.3% (43 patients). Among the total 301, the SOFA score was ≥ 2 in 168 and qSOFA ≥ 2 in 23. For those with SOFA ≥ 2 and < 2, the mortality was 23.2% and 3%, respectively (P < 0.001). For those with qSOFA ≥ 2 and < 2, the mortality was 47.8% and 11.5%, respectively (P < 0.001). The AUROC of 30-day mortality for qSOFA was lower than that for SOFA (0.66 (95% CI, 0.56-0.75) vs. 0.79 (95% CI, 0.72-0.87), P = 0.004)). However, the combination of qSOFA with lactate ≥ 2 threshold considerably enhanced a discrimination capacity for mortality with an AUROC 0.77 (95% CI, 0.69-0.85), which was similar to SOFA (P = 0.11). CONCLUSION: In cancer patients with sepsis, qSOFA was inferior to SOFA in predicting mortality. However, adding lactate to qSOFA resulted in greater prognostic accuracy for short-term mortality, comparable with SOFA.


Assuntos
Sepse/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/mortalidade , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/patologia
7.
Zhonghua Wai Ke Za Zhi ; 57(11): 862-865, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694136

RESUMO

Pancreatic cancer is a highly malignant gastrointestinal tumor with high invasiveness, easy metastasis, and poor chemoresistance. Surgery is still the preferred treatment for resectable pancreatic cancer. At present, inflammatory scoring systems based on serological indicators in patients with resectable pancreatic cancer can be divided into two types: the inflammatory scoring system based on c-reactive protein albumin and the inflammatory scoring system based on peripheral blood cell count. However, the specific mechanism between these inflammatory markers and the prognostic value of resectable pancreatic cancer remains unclear. This article reviews the correlation between systemic inflammatory response indexes and prognosis of patients with resectable pancreatic cancer, so as to provide help for the comprehensive treatment of pancreatic cancer.


Assuntos
Neoplasias Pancreáticas/cirurgia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Contagem de Células Sanguíneas , Proteína C-Reativa/análise , Indicadores Básicos de Saúde , Humanos , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/complicações , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações
8.
Thromb Res ; 182: 56-63, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31450009

RESUMO

INTRODUCTION: Endotoxemia often results in systemic inflammatory response syndrome (SIRS), coagulation disturbance and acute lung injury (ALI), and such a condition is associated with the activation of platelets, leukocytes and vascular endothelial cells (VECs). P-selectin glycoprotein ligand 1 (PSGL-1) is a key regulatory molecule in the activation of platelets, leukocytes and VECs. However, it still remains largely unexplored whether PSGL-1 plays an important role in SIRS, coagulation dysfunction and ALI of endotoxemia. In the present study, we aimed to study the role of PSGL-1 in above-mentioned situations using endotoxemic mice. MATERIALS AND METHODS: An endotoxemia model was established in BALB/c mice via lipopolysaccharide (LPS) administration. Moreover, the mice were simultaneously injected with PSGL-1 antibody for intervention. The survival rate, morphologic changes of lung tissues, platelet-leukocyte adhesion, tissue factor expression on leukocytes, fibrinogen deposition in lung tissues, serum levels of inflammatory factors and the activation of VECs were determined. RESULTS: The results showed that the aggregation and recruitment of platelets and leukocytes in lung tissues, the expression of tissue factor on leukocytes, the serum levels of inflammatory factors, the activation of VECs, and the fibrinogen deposition in lung tissues were increased in endotoxemic mice, which were significantly alleviated by administration of PSGL-1 antibody. Moreover, blockade of PSGL-1 markedly increased survival rate, and alleviated coagulation disturbance and lung injury in endotoxemic mice. CONCLUSIONS: Taken together, PSGL-1 played an important role in pathogenesis of SIRS and coagulation dysfunction and ALI in endotoxemic mice.


Assuntos
Transtornos da Coagulação Sanguínea/imunologia , Endotoxemia/imunologia , Glicoproteínas de Membrana/imunologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Lesão Pulmonar Aguda/sangue , Lesão Pulmonar Aguda/complicações , Lesão Pulmonar Aguda/imunologia , Animais , Coagulação Sanguínea , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Endotélio Vascular/imunologia , Endotoxemia/sangue , Endotoxemia/complicações , Lipopolissacarídeos/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Agregação Plaquetária , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações
9.
PLoS One ; 14(8): e0220404, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369614

RESUMO

BACKGROUND: Patients experiencing cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) often die or suffer from severe neurological impairment. Post resuscitation syndrome is characterized by a systemic inflammatory response. Toll-like receptor 4 (TLR4) is a major mediator of inflammation and TLR4 has been implicated in the pathogenesis of post-resuscitation encephalopathy. The aim of this study was to evaluate whether TLR4 deficiency or inhibition can modulate survival and neurofunctional outcome after CA/CPR. METHODS: Following intubation and central venous cannulation, CA was induced in wild type (C57Bl/6J, n = 38), TLR4 deficient (TLR4-/-, n = 37) and TLR4 antibody treated mice (5mg/kg MTS510, n = 15) by high potassium. After 10min, CPR was performed using a modified sewing machine until return of spontaneous circulation (ROSC). Cytokines and cerebral TNFalpha levels were measured 8h after CA/CPR. Survival, early neurological recovery, locomotion, spatial learning and memory were assessed over a period of 28 days. RESULTS: Following CA/CPR, all mice exhibited ROSC and 31.5% of wild type mice survived until day 28. Compared to wild type mice, neither TLR4-/- nor MTS510 treated wild type mice had statistically significant altered survival following CA/CPR (51.3 and 26.7%, P = 0.104 and P = 0.423 vs. WT, respectively). Antibody-treated but not TLR4-/- mice had higher IL-1ß and IL-6 levels and TLR4-/- mice had higher IL-10 and cerebral TNFalpha levels. No differences existed between mice of all groups in early neurological recovery, locomotion, spatial learning ability or remembrance. CONCLUSION: Therapeutic strategies targeting TLR4 may not be suitable for the reduction of mortality or neurofunctional impairment after CA/CPR.


Assuntos
Encefalopatias/etiologia , Reanimação Cardiopulmonar , Parada Cardíaca/complicações , Receptor 4 Toll-Like/deficiência , Animais , Encefalopatias/prevenção & controle , Reanimação Cardiopulmonar/efeitos adversos , Citocinas/metabolismo , Modelos Animais de Doenças , Feminino , Parada Cardíaca/mortalidade , Hemodinâmica , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Receptor 4 Toll-Like/antagonistas & inibidores , Receptor 4 Toll-Like/fisiologia , Fator de Necrose Tumoral alfa/metabolismo
10.
J Vet Med Sci ; 81(10): 1492-1495, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31406036

RESUMO

An 11-year-old, castrated male, Yorkshire Terrier was presented with acute vomiting after chicken bone ingestion. The dog had been diagnosed with hyperadrenocorticism previously and showed acute splenomegaly and signs of systemic inflammatory response syndrome during hospitalization. On diagnostic imaging, acute splenic vein thrombosis was found, concurrent with pancreatitis and gastritis. The spleen showed marked enlargement and hypoechoic lacy appearances on ultrasonography, mimicking splenic torsion. On the histopathologic report, only splenic hemorrhage and congestion with large splenic vein thrombosis were identified. After splenectomy, the dog completely recovered and was discharged.


Assuntos
Doenças do Cão , Gastrite/veterinária , Pancreatite/veterinária , Esplenectomia/veterinária , Síndrome de Resposta Inflamatória Sistêmica/veterinária , Trombose Venosa/veterinária , Doença Aguda , Animais , Doenças do Cão/patologia , Doenças do Cão/cirurgia , Cães , Gastrite/complicações , Gastrite/patologia , Masculino , Pancreatite/complicações , Pancreatite/patologia , Veia Esplênica/patologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/cirurgia
12.
Clin Liver Dis ; 23(2): 221-232, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30947873

RESUMO

Critically ill patients frequently present with the systemic inflammatory response syndrome, which is largely a reflection of the liver's response to injury. Underlying hepatic congestion is a major risk factor for hypoxic liver injury, the most common cause for hepatocellular injury. Cholestatic liver injury often occurs in critically ill patients due to inhibition of farnesoid X receptor (FXR), the main regulator of bile acid handling, particularly in the liver and intestines. Additional injury to the liver occurs due to alterations in the bile acid pool with increased cytotoxic forms and disturbance in the typical processing of xenobiotics in the liver.


Assuntos
Colestase Intra-Hepática/etiologia , Hipóxia/complicações , Falência Hepática Aguda/etiologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Colestase Intra-Hepática/fisiopatologia , Estado Terminal , Humanos
13.
J Cardiothorac Surg ; 14(1): 80, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023326

RESUMO

BACKGROUND: Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF). MATERIALS AND METHODS: Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high (> 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data. RESULTS: Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate (P < 0.001), CRP (P = 0.006), creatinine (P = 0.048), and INR (P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival (P = 0.042). CONCLUSIONS: Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Adulto , Idoso , Circulação Assistida/efeitos adversos , Proteína C-Reativa/análise , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Balão Intra-Aórtico , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/etiologia
14.
Food Funct ; 10(4): 2125-2137, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30924473

RESUMO

Systemic inflammation is an important determinant of synaptic dysfunction, but the underlying molecular mechanisms remain elusive. Lycopene (LYC), a major carotenoid present in tomato, is regarded as a nutraceutical that has significant antioxidant and anti-obesity bioactivities. In the current study, we randomly divided 3-month-old C57BL/6J mice into 3 groups: the control, LPS and LPS + LYC groups (LYC, 0.03% w/w, mixed with normal chow) for 5 weeks, and then mice were intraperitoneally injected with LPS (0.25 mg kg-1) for 9 days. Our results demonstrated that LYC supplementation effectively attenuated LPS-elicited neuronal damage and synaptic dysfunction through increasing the expressions of neurotrophic factors and the synaptic proteins SNAP-25 and PSD-95. LYC ameliorated LPS-induced insulin resistance and mitochondrial dysfunction in the mouse brain and liver. LYC alleviated the neuroinflammation and hepatic inflammation. Furthermore, LYC decreased the circulating levels of insulin and proinflammatory mediators LPS, TNF-α, IL-1ß and IL-6. In conclusion, these results indicated that the supplementation of LYC might be a nutritional preventive strategy in systemic inflammation-induced synaptic dysfunction.


Assuntos
Encéfalo/efeitos dos fármacos , Resistência à Insulina , Fígado/efeitos dos fármacos , Licopeno/administração & dosagem , Mitocôndrias/efeitos dos fármacos , Doenças Neurodegenerativas/tratamento farmacológico , Sinapses/fisiologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Animais , Encéfalo/metabolismo , Humanos , Interleucina-1beta/genética , Interleucina-1beta/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Fígado/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Mitocôndrias/metabolismo , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/fisiopatologia , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo
15.
Br J Anaesth ; 122(2): 180-187, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30686303

RESUMO

BACKGROUND: Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury. METHODS: We prospectively recruited 1652 patients aged ≥45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT≥14 ng L-1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals. RESULTS: Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50-2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12-3.30); P=0.017]. Monocyte ROS generation correlated with NLR (r=0.47; P=0.03). CONCLUSIONS: Preoperative NLR>4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury. CLINICAL TRIAL REGISTRATION: NCT01842568.


Assuntos
Traumatismos Cardíacos/etiologia , Procedimentos Cirúrgicos Operatórios/métodos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Idoso , Estudos de Coortes , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Espécies Reativas de Oxigênio/metabolismo , Fatores de Risco , Resultado do Tratamento , Troponina T/sangue
16.
J Asthma ; 56(8): 823-832, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29972330

RESUMO

Introduction: Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. The aim was to investigate paths of assumed causality leading from foetal inflammatory response syndrome (FIRS) to asthma symptoms in preterms. Methods: Demographic, antenatal, delivery and outcome data were collected from 262 infants with less than 32 completed weeks of gestational age over a 10-year period in a prospective cohort study. The presence of symptoms of asthma beyond the age of 5 years was the primary outcome measure. The causal effect of FIRS on childhood asthma was tested with three different logistic regression models and two structural equation models (SEM). Results: FIRS (OR = 4.7) and subsequent chronic lung disease of prematurity (OR = 7.7) and early childhood wheezing (OR = 9.5) are the most important risk factors for development of asthma symptoms in children born with less than 32 weeks of gestational age. The path analysis showed that FIRS has a large direct (0.59), medium indirect (0.11) and large overall (0.70) effect on CLD; large negative direct effect on ECW (-0.34) and a large positive indirect effect (0.74), mediated by CLD. On the occurrence of asthma symptoms, FIRS has a medium negative direct effect (-0.18) and a medium positive indirect effect (0.26), mediated by CLD and ECW. Conclusion: Prenatal inflammation plays an important role in the development of chronic respiratory disturbances in preterm infants. This influence is mainly related to structural and developmental lung abnormalities initiated in utero as consequences of FIRS, resulting in CLD of prematurity, and overcoming the protective mechanisms of chorioamnionitis.


Assuntos
Asma/epidemiologia , Asma/etiologia , Recém-Nascido Prematuro , Síndrome de Resposta Inflamatória Sistêmica/complicações , Fatores Etários , Asma/fisiopatologia , Criança , Pré-Escolar , Estudos de Coortes , Croácia , Feminino , Doenças Fetais , Idade Gestacional , Hospitais Universitários , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores Sexuais , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
17.
Pancreas ; 48(1): 126-130, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30540682

RESUMO

OBJECTIVES: The relative rarity of hypertriglyceridemia (HTG) as the etiology for acute pancreatitis (AP) delays the final diagnosis of hypertriglyceridemia-induced AP (HTG-AP). This study aimed to explore the diagnostic and prognostic value of pseudohyponatremia in this clinical entity. METHODS: We retrospectively compared 140 patients with HTG-AP and 266 patients of AP of other etiologies. The correlation of presenting hyponatremia and a final diagnosis of HTG-AP is evaluated. RESULTS: Presenting hyponatremia had an area under curve of 0.926 for predicting the diagnosis of HTG-AP. After dichotomization by the optimal cutoff value of 130 mEq/dL, patients with hyponatremia had a higher prevalence of acute kidney injury (61.9% vs 38.1%, P < 0.001), systemic inflammatory response syndrome (52.2% vs 47.8%, P < 0.001), a higher Ranson criteria (3.0 vs 1.4, P < 0.001), and a higher Bedside Index for Severity of Acute Pancreatitis score (0.69 vs 0.55, P = 0.011). CONCLUSIONS: Presenting hyponatremia is highly efficient in differentiating hypertriglyceridemia from other etiologies of AP. It also demonstrated promising prognostic values in both AP and HTG-AP patients. Therefore, initial serum sodium could potentially provide the first clue of HTG-AP, as well as facilitate risk-stratifying patients to determine treatment allocation.


Assuntos
Hipertrigliceridemia/complicações , Hiponatremia/diagnóstico , Pancreatite/diagnóstico , Sódio/sangue , Doença Aguda , Lesão Renal Aguda/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Adulto , Feminino , Humanos , Hiponatremia/complicações , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia
18.
Ultrasound Med Biol ; 45(1): 137-147, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30340920

RESUMO

Boiling histotripsy (BH) is an experimental focused ultrasound technique that produces non-thermal mechanical ablation. We evaluated the feasibility, short-term histologic effects and the resulting acute inflammatory response to BH ablation of renal cell carcinoma (RCC) in the Eker rat. Genotyped Eker rats were monitored for de novo RCCs with serial ultrasound (US) imaging. When tumors were ≥8 mm, rats underwent ultrasound-guided extracorporeal ablation of the tumor with BH, a pulsed focused US technique that produces non-thermal mechanical ablation of targeted tissues, or a sham US procedure. Treatments targeted approximately 50% of the largest RCC with a margin of normal kidney. BH treated rats were euthanized at 1 (n = 4) or 48 (n = 4) h, and sham patients (n = 4) at 48 h. Circulating plasma cytokine levels were assessed with multiplex assays before and at 0.25, 1, 4, 24 and 48 h following treatment. Kidneys were collected and processed for histologic assessment, immunohistochemistry and intrarenal cytokine concentration measurements. For statistical analysis Student's t-test was used. US-guided BH treatment was successful in all animals, producing hypoechoic regions within the targeted volume consistent with BH treatment effect. Grossly, regions of homogenized tissue were apparent with evidence of focal intra-parenchymal hemorrhage. Histologically, BH produced a sharply demarcated region of homogenized tumor and non-tumor tissue containing acellular debris. BH treatment was associated with significantly increased relative concentration of plasma TNF versus sham treatment (p < 0.05) and transient elevations in high-mobility group box 1 (HMGB1), IL-10 and IL-6 consistent with acute inflammatory response to trauma. Intrarenal cytokine concentrations followed the same trend. At 48 h, enhanced infiltration of CD8+ T cells was observed by immunohistochemistry in both the treated and un-treated contralateral RCC/kidneys in BH-treated animals versus sham treatment. BH treatment was well tolerated with transient gross hematuria and a perinephric hematoma developing in one subject each. The study demonstrates the feasibility of BH ablation of de novo RCC and suggests activation of the acute inflammatory cascade following treatment that appears to stimulate CD8+ T cell infiltration of both treated and untreated tumors. Longer duration chronic studies are ongoing to characterize the longevity and robustness of this response.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Rim/cirurgia , Ratos
19.
J Matern Fetal Neonatal Med ; 32(23): 3903-3908, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29742943

RESUMO

Background: Neonatal sepsis remains worldwide one of the leading causes of morbidity and mortality in both term and preterm infants. Lower mortality rates are related to timely diagnostic evaluation and prompt initiation of empiric antibiotic therapy. Blood culture, as gold standard examination for sepsis, has several limitations for early diagnosis, so that sepsis biomarkers could play an important role in this regard. This study was aimed to compare the value of the two biomarkers presepsin and procalcitonin in early diagnosis of neonatal sepsis. Methods: This was a prospective cross-sectional study performed in Saiful Anwar General Hospital Malang, Indonesia, in 51 neonates that fulfill the criteria of systemic inflammatory response syndrome (SIRS) with blood culture as diagnostic gold standard for sepsis. Results: At reviewer operating characteristic (ROC) curve analyses, using a presepsin cutoff of 706.5 pg/mL, the obtained area under the curve (AUCs) were sensitivity = 85.7%, specificity = 68.8%, positive predictive value = 85.7%, negative predictive value = 68.8%, positive likelihood ratio = 2.75, negative likelihood ratio = 0.21, and accuracy = 80.4%. On the other hand, with a procalcitonin cutoff value of 161.33 pg/mL the obtained AUCs showed: sensitivity = 68.6%, specificity = 62.5%, positive predictive value = 80%, negative predictive value = 47.6%, positive likelihood ratio = 1.83, the odds ratio negative = 0.5, and accuracy = 66.7%. Conclusions: In early diagnosis of neonatal sepsis, compared with procalcitonin, presepsin seems to provide better early diagnostic value with consequent possible faster therapeutical decision making and possible positive impact on outcome of neonates.


Assuntos
Receptores de Lipopolissacarídeos/sangue , Triagem Neonatal/métodos , Sepse Neonatal/diagnóstico , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Biomarcadores/sangue , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/sangue , Sepse Neonatal/complicações , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
20.
Handb Clin Neurol ; 157: 565-597, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30459026

RESUMO

Systemic inflammation-associated syndromes (e.g., sepsis and septic shock) often have high mortality and remain a challenge in emergency medicine. Systemic inflammation is usually accompanied by changes in body temperature: fever or hypothermia. In animal studies, systemic inflammation is often modeled by administering bacterial lipopolysaccharide, which triggers autonomic and behavioral thermoeffector responses and causes either fever or hypothermia, depending on the dose and ambient temperature. Fever and hypothermia are regulated changes of body temperature, which correspond to mild and severe forms of systemic inflammation, respectively. Mediators of fever and hypothermia are called endogenous pyrogens and cryogens; they are produced when the innate immune system recognizes an infectious pathogen. Upon an inflammatory challenge, hepatic and pulmonary macrophages (and later brain endothelial cells) start to release lipid mediators, of which prostaglandin (PG) E2 plays the key role, and cytokines. Blood PGE2 enters the brain and triggers fever. At later stages of fever, PGE2 synthesized within the blood-brain barrier maintains fever. In both cases, PGE2 is synthesized by cyclooxygenase-2 and microsomal PGE2synthase-1. Mediators of hypothermia are not well established. Both fever and hypothermia are beneficial host defense responses. Based on evidence from studies in laboratory animals and clinical trials in humans, fever is beneficial for fighting mild infection. Based mainly on animal studies, hypothermia is beneficial in severe systemic inflammation and infection.


Assuntos
Febre/complicações , Hipotermia/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Animais , Regulação da Temperatura Corporal , Dinoprostona/sangue , Humanos , Fígado/patologia , Macrófagos/patologia
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