Prevalence of Acute Kidney Injury and Prognostic Significance in Patients with Acute Myocarditis

Objective

Myocarditis is an inflammation of the myocardium. The condition is commonly associated with rapid disease progression and often results in profound shock. Impaired renal function is the result of impairment in end-organ perfusion and is highly prevalent among critically ill patients. The aim of this study was to evaluate the incidence of acute kidney injury (AKI) and identify the relationship between AKI and the prognosis of patients with acute myocarditis.

Design, Measurements and Main Results

This retrospective study reviewed the medical records of 101 patients suffering from acute myocarditis between 1996 and 2011. Sixty of these patients (59%) developed AKI within 48 hours of being hospitalized. AKI defined as AKIN stage 3 (p = 0.007) and SOFA score (p = 0.03) were identified as predictors of in-hospital mortality in multivariate analysis. The conditional effect plot of the estimated risk against SOFA score upon admission categorized according to the AKIN stages showed that the risk of in-hospital mortality was highest among patients in AKIN stage 3 with a high SOFA score.

Conclusions

Among patients with acute myocarditis, AKI defined as AKIN stage 3 and elevated SOFA score were associated with unfavorable outcomes. AKIN classification is a simple, reproducible, and easily applied evaluation tool capable of providing objective information related to the clinical prognosis of patients with acute myocarditis.     

急性肾损伤患者血清胱抑素-C及尿NGAL 水平的变化及其临床意义

目的:观察急性肾损伤(Acute kidney injury,AKI)患者血清胱抑素-C(Cystatin-C,CysC)及尿中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)水平的变化及其临床意义。方法:选择60例AKI患者为实验组,50例正常健康人作为对照组,应用酶联免疫吸附法测定两组人群血清胱抑素-C和尿NGAL水平。结果:实验组与对照组相比血清胱抑素-C和尿NGAL水平显著升高,差异有统计学意义(P<0.05)。实验组尿NGAL检出率高于血清胱抑素-C、血肌酐,差异有统计学意义(P<0.05)。结论:急性肾损伤患者血清胱抑素-C和尿NGAL均升高,其中尿NGAL是反映AKI较敏感的生物学标志物,值得临床进一步研究。     

Potential Prognostic Significance of Decreased Serum Levels of TRAIL after Acute Myocardial Infarction

Background

Since soluble TRAIL exhibits anti-inflammatory and anti-atherosclerotic activities both in vitro and in animal models, this study was designed to assess the relationship between the serum levels of TRAIL and clinical outcomes in patients with acute myocardial infarction (AMI).

Methodology/Principal Findings

Levels of TRAIL were measured by ELISA in serial serum samples obtained from 60 patients admitted for AMI, both during hospitalization and in a follow-up of 12 months, as well as in 60 healthy control subjects. Serum levels of TRAIL were significantly decreased in patients with AMI at baseline (within 24 hours from admission), compared with healthy controls, and showed a significant inverse correlation with a series of negative prognostic markers, such as CK, CK-MB and BNP. TRAIL serum levels progressively increased at discharge, but normalized only at 6–12 months after AMI. Of note, low TRAIL levels at the patient discharge were associated with increased incidence of cardiac death and heart failure in the 12-month follow-up, even after adjustment for demographic and clinical risk parameters (hazard ratio [HR] of 0.93 [95% CI, 0.89 to 0.97]; p = 0.001).

Conclusions/Significance

Although the number of patients studied was limited, our findings indicate for the first time that circulating TRAIL might represent an important predictor of cardiovascular events, independent of conventional risk markers.     

Hospital Admissions for Drug-Induced Liver Injury: Clinical Features, Therapy, and Outcomes

We investigated clinical features, therapy, and outcomes of patients hospitalized for drug-induced liver injury (DILI). DILI resolution was defined as liver biochemistry values back to normal or lower than CIOMS laboratory criteria; Chronicity was defined as persistent biochemical abnormality for >6?months after drugs?? withdrawal. Three-hundred cases were reviewed retrospectively; mean age 51 (13?C86) years, and 204 (68?%) were females. It included 267 (89?%) hepatocellular injury, 16 (5.3?%) cholestatic injury, and 17 (5.7?%) mixed injury cases. In hepatocellular injury group, 197 (73.8?%) patients with TBIL?<?10× ULN included 142 (72.1?%) females and 70 (26.2?%) patients with TBIL????10× ULN included 39 (55.7?%) females (P?=?0.012). Of 70 patients (TBIL????10× ULN), 20 were treated with steroid step-down therapy (79?±?26?days) and others with non-steroid therapy. The steroid therapy group showed higher DILI resolution rate (P?=?0.029) and shorter recovery time (P?=?0.012). Notably, 274/300 (91.3?%) patients resolved, 18/300 (6?%) developed chronic liver injury, 7/300 (2.3?%) died, and one patient received liver transplantation. In death group, TBIL, ALB, PT, and PTA revealed more severe abnormality than in recovery group. In 121/300 (40.3?%) patients, use of herbal medicines was the leading cause of liver injury, followed by antibiotics, cardiovascular drugs, and endocrine drugs. We concluded that step-down steroid therapy for DILI improved curative effect, shortened disease course, and was safe.     

Polymorphisms in CTLA4 Influence Incidence of Drug-Induced Liver Injury after Renal Transplantation in Chinese Recipients

Genetic polymorphisms in cytotoxic T lymphocyte-associated antigen 4 (CTLA4) play an influential role in graft rejection and the long-term clinical outcome of organ transplantation. We investigated the association of 5 CTLA4 single-nucleotide polymorphisms (SNPs) (rs733618 C/T, rs4553808 A/G, rs5742909 C/T, rs231775 A/G, and rs3087243 G/A) with drug-induced liver injury (DILI) in Chinese renal transplantation (RT) recipients. Each recipient underwent a 24-month follow-up observation for drug-induced liver damage. The CTLA4 SNPs were genotyped in 864 renal transplantation recipients. A significant association was found between the rs231775 genotype and an early onset of DILI in the recipients. Multivariate analyses revealed that a risk factor, recipient rs231775 genotype (p = 0.040), was associated with DILI. Five haplotypes were estimated for 4 SNPs (excluding rs733618); the frequency of haplotype ACGG was significantly higher in the DILI group (68.9%) than in the non-DILI group (61.1%) (p = 0.041). In conclusion, CTLA4 haplotype ACGG was partially associated with the development of DILI in Chinese kidney transplant recipients. The rs231775 GG genotype may be a risk factor for immunosuppressive drug-induced liver damage.     

Sake Yeast Suppresses Acute Alcohol-Induced Liver Injury in Mice

Brewer’s and baker’s yeasts appear to have components that protect from liver injury. Whether sake yeast, Saccharomyces cerevisiae Kyokai no. 9, also has a hepatoprotective effect has not been examined. Here we show that sake yeast suppresses acute alcoholic liver injury in mice. Male C57BL/6 mice that had been fed a diet containing 1% sake yeast for two weeks received three doses of ethanol (5 g/kg BW). In the mice fed sake yeast, ethanol-induced increases in triglyceride (TG) and glutamate pyruvate transaminase (GPT) were significantly attenuated and hepatic steatosis was improved. In addition, sake yeast-fed mice showed a smaller decrease in hepatic S-adenosylmethionine (SAM) level and a smaller increase in plasma homocysteine (Hcy) level after ethanol treatment than the control mice, suggesting that a disorder of methonine metabolism in the liver caused by ethanol was relieved by sake yeast. These results indicate that sake yeast protects against alcoholic liver injury through maintenance of methionine metabolism in the liver.     

细胞因子与肝脏再生

肝脏再生是肝在受到损伤时产生的重要反应,该从细胞因子的角度,阐述了细胞因子和肝脏再生之间的关系。     

Oroxylin A Accelerates Liver Regeneration in CCI4-Induced Acute Liver Injury Mice

Introduction

Based on the previous research that oroxylin A can suppress inflammation, we investigated the hepatoprotective role of oroxylin A against CCl₄-induced liver damage in mice and then studied the possible alteration of the activities of cytokine signaling participating in liver regeneration. Wild type (WT) mice were orally administrated with oroxylin A (60 mg/kg) for 4 days after CCl₄ injection, the anti-inflammatory effects of oroxylin A were assessed directly by hepatic histology and indirectly by measuring serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Albumin. Proliferating cell nuclear antigen (PCNA) staining was performed to evaluate the role of oroxylin A in promoting hepatocyte proliferation. Serum IL-1β, TNF-α, IL-6 and IL-1Ra levels were measured by enzyme-linked immunosorbent assay (ELISA) and liver HGF, EGF, TNF-α, IL-6, IL-1Ra and IL-1β gene expression was determined by quantitative real-time PCR. The data indicated that the IL-6 and TNF-α mRNA of oroxylin A administered group significantly increased higher than the control within 12 hours after CCl₄ treatment. Meanwhile, oroxylin A significantly enhanced the expression of IL-1Ra at the early phase, which indicated that oroxylin A could facilitate the initiating events in liver regeneration by increasing IL-1Ra which acts as an Acute-Phase Protein (APP). In addition, a lethal CCl₄-induced acute liver failure model offers a survival benefit in oroxylin A treated WT mice. However, oroxylin A could not significantly improve the percent survival of IL-1RI^−/− mice with a lethal CCl₄-induced acute liver failure.

Conclusions

Our study confirmed that oroxylin A could strongly promote liver structural remodeling and functional recovery through IL-1Ra/IL-1RI signaling pathway. All these results support the possibility of oroxylin A being a therapeutic candidate for acute liver injury.     

C 反应蛋白、白细胞计数与脑梗死体积及近期预后的关系

目的:研究血清C反应蛋白水平、白细胞计数与急性脑梗死患者的梗死灶体积大小以及预后的关系。方法:检测70例急性脑梗死患者(CI组)、64例腔隙性脑梗死患者(LCI组)和80例健康人(对照组)的血浆CRP水平,并进行白细胞计数。在CI及LCI组人院当天和4周时进行临床神经功能缺损程度评分(NDS)评定以判断预后。结果:CI组血浆CRP水平高于LCI组及对照组(P<0.01),LCI组高于对照组(P<0.01);CI组白细胞计数高于LCI组及对照组(P<0.01),LCI组高于对照组(P<0.05);血浆CRP水平及白细胞计数正常组患者住院4周时显著进步和进步的比率明显高于血浆CRP水平及白细胞计数异常组(均P<0.01),而无变化和死亡的比率明显低于异常组(均P<0.01)。结论:ACI患者血浆CRP水平和白细胞计数均明显升高;脑梗死急性期血清CRP水平、白细胞计数可能与脑梗死患者梗死体积大小以及近期预后有密切的关系。     

Proteomic Profiling of LPS‐Induced Macrophage‐Derived Exosomes Indicates Their Involvement in Acute Liver Injury

Exosomes are typically involved in cellular communication and signaling. Macrophages play a key role in lipopolysaccharide (LPS)‐induced sepsis. However, the molecular comparison of exosomes derived from LPS‐induced macrophage has not been well analyzed. The macrophage‐exosomes are validated and the protein composition of those exosomes are investigated by isobaric tags for relative and absolute quantification (iTRAQ) mass spectrometry. A total of 5056 proteins are identified in macrophage‐exosomes. We discovered 341 increased proteins and 363 reduced proteins in LPS‐treated macrophage‐exosomes compared with control exosomes. In addition, gene ontology analysis demonstrates that macrophage‐exosomes proteins are mostly linked to cell, organelle, extracellular region, and membrane. The bioinformatics analysis also indicates that these proteins are mainly involved in cellular process, single‐organism process, metabolic process, and biological regulation. Among these 341 upregulated proteins, Kyoto Encyclopedia of Genes and Genomes analysis reveals that 22 proteins are involved in the NOD‐like receptor signaling pathway. Finally, hepatocytes can uptake macrophage‐exosomes and subsequently NLRP3 inflammasome is activated in vitro and in vivo. These data emphasize the fundamental importance of macrophage‐exosomes in sepsis‐induced liver injury. Therefore, the iTRAQ proteomic strategy brings new insights into macrophage‐derived exosomes. It may improve our understanding of macrophage‐exosomes’ functions and their possible use as therapeutic targets for sepsis.     

Pharmacogenetic Study of Drug-Metabolising Enzyme Polymorphisms on the Risk of Anti-Tuberculosis Drug-Induced Liver Injury: A Meta-Analysis

Background

Three first-line antituberculosis drugs, isoniazid, rifampicin and pyrazinamide, may induce liver injury, especially isoniazid. This antituberculosis drug-induced liver injury (ATLI) ranges from a mild to severe form, and the associated mortality cases are not rare. In the past decade, many investigations have focused the association between drug-metabolising enzyme (DME) gene polymorphisms and risk for ATLI; however, these studies have yielded contradictory results.

Methods

PubMed, EMBASE, ISI web of science and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. A meta-analysis was performed to examine the association between polymorphisms from 4 DME genes (NAT2, CYP2E1, GSTM1 and GSTT1) and susceptibility to ATLI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Heterogeneity among articles and their publication bias were also tested.

Results

38 studies involving 2,225 patients and 4,906 controls were included. Overall, significantly increased ATLI risk was associated with slow NAT2 genotype and GSTM1 null genotype when all studies were pooled into the meta-analysis. Significantly increased risk was also found for CYP2E1*1A in East Asians when stratified by ethnicity. However, no significant results were observed for GSTT1.

Conclusions

Our results demonstrated that slow NAT2 genotype, CYP2E1*1A and GSTM1 null have a modest effect on genetic susceptibility to ATLI.     

Changes in Metabolic Profiles during Acute Kidney Injury and Recovery following Ischemia/Reperfusion

Changes of metabolism have been implicated in renal ischemia/reperfusion injury (IRI). However, a global analysis of the metabolic changes in renal IRI is lacking and the association of the changes with ischemic kidney injury and subsequent recovery are unclear. In this study, mice were subjected to 25 minutes of bilateral renal IRI followed by 2 hours to 7 days of reperfusion. Kidney injury and subsequent recovery was verified by serum creatinine and blood urea nitrogen measurements. The metabolome of plasma, kidney cortex, and medulla were profiled by the newly developed global metabolomics analysis. Renal IRI induced overall changes of the metabolome in plasma and kidney tissues. The changes started in renal cortex, followed by medulla and plasma. In addition, we identified specific metabolites that may contribute to early renal injury response, perturbed energy metabolism, impaired purine metabolism, impacted osmotic regulation and the induction of inflammation. Some metabolites, such as 3-indoxyl sulfate, were induced at the earliest time point of renal IRI, suggesting the potential of being used as diagnostic biomarkers. There was a notable switch of energy source from glucose to lipids, implicating the importance of appropriate nutrition supply during treatment. In addition, we detected the depressed polyols for osmotic regulation which may contribute to the loss of kidney function. Several pathways involved in inflammation regulation were also induced. Finally, there was a late induction of prostaglandins, suggesting their possible involvement in kidney recovery. In conclusion, this study demonstrates significant changes of metabolome kidney tissues and plasma in renal IRI. The changes in specific metabolites are associated with and may contribute to early injury, shift of energy source, inflammation, and late phase kidney recovery.     

急性颅脑损伤血凝检查的临床意义

目的：探讨急性颅脑损伤后血凝检查的临床意义。方法：对85例急性颅脑损伤患者伤后不同时间分别测定六项血凝指标,进行比较分析。结果：损伤24小时后血凝指标检测结果与伤后1周、3周比较有显著差异,有统计学意义（P〈0.05）。结论：急性颅脑损伤后的血凝检测结果异常,可对疾病的诊断和治疗提供理论依据。     

急性颅脑损伤血凝检查的临床意义

目的:探讨急性颅脑损伤后血凝检查的临床意义。方法:对85例急性颅脑损伤患者伤后不同时间分别测定六项血凝指标,进行比较分析。结果:损伤24小时后血凝指标检测结果与伤后1周、3周比较有显著差异,有统计学意义(P<0.05)。结论:急性颅脑损伤后的血凝检测结果异常,可对疾病的诊断和治疗提供理论依据。     

血清胱抑素C在百草枯中毒所致急性肾功能损伤中的早期诊断意义

目的:探讨急性百草枯中毒(acute paraquat poisoning,APP)患者血清胱抑素C(ScysC)水平对百草枯所致急性肾功能损伤(acute renal injury,AKI)早期诊断的意义和临床价值.方法:以43例急性百草枯中毒患者和20例健康体检者为研究对象,通过紫外分光光度法检测患者入院时百草枯的血药浓度,并据此将患者分为0～5mg·L-1组、5～10mg·L-1组、＞ 10mg·L-1组,检测患者入院第1天内血肌酐(SCr)、尿素氮(Urea)、ScysC的水平.结果:不同的百草枯血药浓度组SCr和Urea的水平与对照组比较均无显著性差异(P＞0.05);0～5mg· L-1组ScysC的水平与对照组比较无显著性差异(P＞0.05),但5～10mg·L-1组及＞10mg·L-1组ScysC的水平均显著高于对照组(P＜0.05),且与血药浓度呈显著正相关;入院第1天内5～10mg· L-1组及＞10mg· L-1组的ScysC异常检出率均显著高于各组SCr和Urea异常检出率(P＜0.05).结论:ScysC能更早地反映APP所致AKI,且与中毒程度呈正相关性,可能是APP发病早期一个较SCr、Urea更敏感反映患者病情的指标.     

对乙酰氨基酚诱导的小鼠药物性肝损伤的模型研究

改良对乙酰氨基酚（acetaminophen,APAP）单独诱导小鼠急性肝损伤的模型和致死模型。随机将小鼠分为4组：空白对照组、APAP3h组、APAP6h组和APAP12h组,每组5只。饥饿15h后用对乙酰氨基酚诱发小鼠肝损伤。测定各组血清ALT、AST及胆红素含量,HE染色观察各组肝组织损伤情况。观察生存率时,小鼠随机分为对照组、禁食＋APAP（500mg／kg）组、禁食＋APAP（300mg／kg）组和不禁食＋APAP（500mg／kg）组,四组同时给药,然后记录各组小鼠的生存情况,绘制四组小鼠的生存曲线。小鼠注射APAP后,随时间的延长,ALT、AST水平逐渐升高,均明显高于空白对照组（P〈0．05）。小鼠肝脏HE染色可见,APAP中毒组小鼠肝细胞坏死及炎性细胞浸润。禁食＋APAP（500mg／kg）组小鼠自16h开始出现死亡,72h时全部死亡,死亡率明显高于不禁食组和禁食＋APAP（300mg/kg）组小鼠。该研究对APAPI起的C57／BL6小鼠药物性肝损伤模型进行改良,使其更加稳定和便于研究,为进一步探究APAP诱导肝毒性的机制及防治措施奠定了基础。     

Cytokines in Acute Chikungunya

Introduction

Acute chikungunya (CHIKV) is predominantly an acute onset of excruciatingly painful, self-limiting musculoskeletal (MSK) arbovirus illness and this was further reported by us during the 2006 Indian epidemic [Chopra et al. Epidemiol Infect 2012]. Selected serum cytokines profile in subjects within one month of onset of illness is being presented.

Methods

Out of 509 clinical CHIKV cases (43% population) identified during a rural population survey, 225 subjects consented blood investigations. 132 examined within 30 days of febrile onset are the study cohort. Anti-CHIKV IgM and IgG antibodies tested by immunochromatography and indirect immunofluorescence respectively. Interferons (IFN)-α, -β and -γ, Interferon Gamma-Induced Protein-10 (CXCL-10/IP-10), Tumor Necrosis Factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-13 (IL-13), Monocyte Chemoattractant Protein-1 (MCP-1), Interleukin–4 (IL-4) and Interleukin–10 (IL-10) performed by ELISA. Samples collected from neighboring community a year prior to the epidemic used as healthy controls.

Results

Seropositivity for anti-CHIKV IgM and IgG was 65% and 52% respectively. IFN-α, IFN-β, IFN-γ, CXCL10/IP-10 and IL-1β showed intense response in early acute phase. Cytokines (particularly TNF-α, MCP-1, IL-4, IL-6 and IL-10) was maximum in extended symptomatic phase and remained elevated in recovered subjects. Higher (p<0.05) IFN and IL-4 seen in patients seropositive for anti-CHIKV IgG. Elderly cases (≥65 years) showed elevated cytokines (except IFN) and anti-CHIKV antibodies near similar to younger subjects. Significant correlations (p<0.05) found between cytokines and clinical features (fatigue, low back ache, myalgia) and anti-CHIKV antibodies.

Conclusion

An intense cytokine milieu was evident in the early and immediate persistent symptomatic phase and in recovered subjects. Early persistent IgM and lower IgG to anti-CHKV and intense Th2 cytokine phenotype seem to be associated with delay in resolution of MSK symptoms. Intriguingly, maximum TNF-α, IL-6 and IL-13 with low anti-CHIKV IgM response found in subjects recovered from CHIKV within one month of illness.     

急性药物性肝损伤65例临床分析

目的:探讨急性药物性肝损伤的致病药物、临床特点及预后.方法:回顾性分析近年来本院确诊的急性药物性肝损伤患者的临床情况.结果:本组引起急性药物性肝损伤的最常见药物为抗结核药,占47.69％,其次为中草药、抗肿瘤药、滋补药、抗真菌药,分别占16.92％、9.23％、7.69％、3.61％.引起肝损伤发生时间因所用药物不同而差异较大,用药后出现药物性肝损伤的时间分别为用药2周内(36.92％)、2-4周内(32.31％)、4周-12周内(23.08％)、大于12周(7.69％),大多数病例出现于服药后12周内(92.31％.本组急性药物性肝损伤的临床表现主要为消化道症状明显,乏力、食欲下降,占89.23％;巩膜黄染、尿黄,占43.08％;皮肤瘙痒38.46％;恶心、呕吐,占35.38％;药物性肝损伤临床分型以肝细胞损伤型多见,占61.54％,其次为胆汁淤积型(29.23％),混合型较少(9.23％).结论:引起急性药物性肝损伤的药物种类繁多,很多临床常见的药物可引起肝损伤,早期诊断并停止用药、积极治疗是阻止疾病进展和改善预后的关键.     

急性肝损伤时肝脏内Pink1/Parkin的表达变化及意义

目的:观察C57小鼠急性肝损伤(Acute liver injury, ALI)中线粒体自噬相关蛋白Pink1/Parkin表达的变化及意义。方法:领取28只小鼠,随机分为对照组、ALI 1 d组、ALI 4 d组、ALI 7 d组。分别检测血清谷氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)的变化;肝组织病理变化用HE染色观察;Real Time quality PCR检测Pink1/Parkin在m RNA水平的表达变化;进一步利用Western Blot方法分别检测肝组织中Pink1/Parkin蛋白水平的表达变化。结果:ALI组1 d、4 d、7 d组与对照组相比,ALT、AST表达显著升高,具有统计学意义(P0.05);肝组织病理学检查ALI组1 d和4 d组中,释放出大量的炎性细胞,肝细胞出现大面积坏死,7 d组肝细胞坏死与1 d和4 d比较明显缓解;m RNA水平检测Pink1/Parkin在ALI 1 d(4.79/1.82倍)、4 d(1.74/4.17倍)和7 d(2.91/1.25倍)与对照组相比表达水平明显升高(P0.05);Pink1/Parkin在蛋白水平检测时ALI 1 d(2.03/1.82倍)、4 d(1.78/4.17倍)和7 d(1.25/1.25倍)时肝组织内表达也显著增加,差异具有统计学意义(P0.05)。结论:急性肝损伤状态下Pink1/Parkin在m RNA和蛋白水平表达升高,且其表达量随着肝脏的损伤缓解而表达水平降低,提示Pink1/Parkin可能对于治疗急性肝损伤具有重要意义。