无创血流动力学监测指导严重脓毒症患者血管活性药物的应用

目的:探讨无创血流动力学监测技术在严重脓毒症患者液体复苏后指导血管活性药物使用的意义。方法:选择2014年6月至2016年6月我院急诊处收治的严重脓毒症患者56例为研究对象,分为观察组和对照组,每组各28例。对照组进行常规对症治疗,观察组在对照组治疗基础上使用无创血流动力学监测仪指导治疗。观察两组患者在治疗前及治疗后6 h血流动力学及微循环灌注指标、液体复苏6 h后液体平衡量及血管活性药物使用量,及在重症监护病房(EICU)的入住时间。结果:治疗后两组患者尿量均大于30 m L/h,提示复苏成功。两组患者治疗后血液动力学指标和微循环灌注指标较治疗前均明显好转(均P0.05);治疗后,两组间血液动力学指标和微循环灌注指标比较无明显差异(P0.05)。观察组液体复苏6 h后液体平衡量明显少于对照组(P0.05),观察组血管活性药物用量均明显高于对照组(P0.05),观察组患者在EICU病房住院时间明显短于对照组(P0.05)。结论:无创血流动力学监测对严重脓毒症患者的液体恢复管理和治疗过程具有指导意义,使血管活性药物得到有效利用,精确进行液体管理,减少盲目补液,缩短病程,减少患者的住院时间,经济高效,是指导治疗和评估治疗疗效的重要手段。     

前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响

目的:分析前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响。方法:98例糖尿病肾病患者按抽签法分为对照组与实验组,各49例,对照组予以前列地尔治疗,实验组基于对照组加用益肾化湿颗粒治疗,比较两组疗效,糖化血红蛋白(Hb A1c)、血糖(FPG)、餐后2 h血糖低(2h PG),甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),血尿素氮(BUN)、肌酐(Cr)、β2微球蛋白(β2-MG)、胱抑素(Cys-C),尿足细胞标志蛋白(PCX)nephrin,安全性。结果:实验组总有效率高于对照组(P0.05)。治疗后,两组Hb Alc、FPG、2h PG比较无差异(P0.05)。实验组TG、TC、LDL-C、BUN、Cr、β2-MG、Cys-c、PCX、尿nephrin/尿Cr低于对照组(P0.05)。实验组HDL-C高于对照组(P0.05)。结论:前列地尔联合益肾化湿颗粒治疗对糖尿病肾病的疗效确切,可利于血糖、血脂、肾功能的改善,降低尿足细胞相关蛋白的浓度。     

Targeting myeloid differentiation protein 2 by the new chalcone L2H21 protects LPS‐induced acute lung injury

Acute inflammatory diseases are the leading causes of mortality in intensive care units. Myeloid differentiation 2 (MD‐2) is required for recognizing lipopolysaccharide (LPS) by toll‐like receptor 4 (TLR4), and represents an attractive therapeutic target for LPS‐induced inflammatory diseases. In this study, we report a chalcone derivative, L2H21, as a new MD2 inhibitor, which could inhibit LPS‐induced inflammation both in vitro and in vivo. We identify that L2H21 as a direct inhibitor of MD‐2 by binding to Arg⁹⁰ and Tyr¹⁰² residues in MD‐2 hydrophobic pocket using a series of biochemical experiments, including surface plasmon response, molecular docking and amino acid mutation. L2H21 dose dependently inhibited LPS‐induced inflammatory cytokine expression in primary macrophages. In mice with LPS intratracheal instillation, L2H21 significantly decreased LPS‐induced pulmonary oedema, pathological changes in lung tissue, protein concentration increase in bronchoalveolar lavage fluid, inflammatory cells infiltration and inflammatory gene expression, accompanied with the decrease in pulmonary TLR4/MD‐2 complex. Meanwhile, administration with L2H21 protects mice from LPS‐induced mortality at a degree of 100%. Taken together, this study identifies a new MD2 inhibitor L2H21 as a promising candidate for the treatment of acute lung injury (ALI) and sepsis, and validates that inhibition of MD‐2 is a potential therapeutic strategy for ALI.     

Neutrophil dysregulation during sepsis: an overview and update

Sepsis remains a leading cause of death worldwide, despite advances in critical care, and understanding of the pathophysiology and treatment strategies. No specific therapy or drugs are available for sepsis. Neutrophils play a critical role in controlling infection under normal conditions, and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated mediators and signal pathways involved which govern the survival, migration and antimicrobial function of neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically diagnose and/or predict the outcome of sepsis.     

Oxygenation dynamics of sepsis patients undergoing far‐infrared intervention based on near‐infrared spectroscopy

Near‐infrared spectroscopy (NIRS; continuous wave type) is a noninvasive tool for detecting the relative change of oxyhemoglobin and deoxyhemoglobin. To make this change, intervention methods must be applied. This study determined the hemodynamics of 44 healthy participants and 35 patients with sepsis during exposure to FIR as a novel physical intervention approach. Local microcirculation of their brachioradialis was monitored during exposure and recovery through NIRS. The variations in blood flow and microvascular reaction were determined by conducting paired and unpaired t tests. The oxyhemoglobin levels of the healthy participants increased continuously, even during recovery. In contrast to expextations, the oxyhemoglobin levels of the patients plateaued after only 5 min of FIR illumination. The proposed method has potential applications for ensuring efficient treatment and facilitating doctors in diagnosing the functions of vessels in intensive care units.

Mapping diagrams of HbO₂ in healthy males and males with sepsis illustrated unique scenarios during the process.     

重组人组蛋白H3和H4的表达纯化及其细胞毒性分析

细胞外组蛋白在脓毒症、类风湿性关节炎、急性肺损伤等多种疾病的发生发展中起关键作用,但由于缺乏合适的标准品,至今无法对患者体内的胞外组蛋白进行精确定量,导致在多种感染性疾病中无法根据血清组蛋白含量对疾病进行精确分级,也无法据此合理用药。同时,对患者体内胞外组蛋白精确定量也有助于确定细胞毒性机制研究的使用剂量。本研究用大肠杆菌表达单体变性组蛋白H3和H4,亲和纯化后用梯度稀释和透析方法,可以得到复性的组蛋白单体H3、H4以及H3/H4复合物。通过对蛋白质在纯化过程中稳定性的比较,发现H3/H4复合物较单体更为稳定。 以该复合物（50 μg/mL）处理HUVEC细胞,细胞存活率约为20%,与小牛胸腺组蛋白（200 μg/mL）的毒性类似。 该复合物引起的细胞毒性可被人血清白蛋白以浓度依赖的形式（0.625~10 mg/mL）缓解,提示其构象基本正确。 因此,重组组蛋白H3/H4复合物可以作为精确定量组蛋白的标准品,对基于组蛋白含量的疾病分级和组蛋白毒性机制的研究均有应用价值。     

Effects of lanthanum on rumen fermentation, urinary excretion of purine derivatives and digestibility in steers

The objective of this study was to evaluate the effects of LaCl₃ supplementation on rumen fermentation, urinary excretion of purine derivatives and feed digestibility in the total tract of steers. Eight ruminally cannulated Simmental steers (420 ± 20 kg) were used in a replicated 4 × 4 Latin square experiment. The treatments were control (without LaCl₃); La-low; La-medium and La-high with 450, 900 and 1800 mg LaCl₃ per steer per day, respectively. Diet consisted of 600 g/kg corn stover and 400 g/kg concentrate (dry matter [DM] basis). Dry matter intake (averaged 9 kg/day) was restricted to a maximum of 90% of ad libitum intake. Ruminal pH (range of 6.59–6.42) was quadratically (P<0.04) changed, whereas total volatile fatty acids (VFA) concentration (range of 74.16–88.61 mM) was linearly (P<0.01) and quadratically (P<0.01) increased with increasing La supplementation. Ratio of acetate to propionate decreased linearly (P<0.01) from 3.28 to 1.79 as La supplementation increased due to the increased in propionate production. In situ ruminal neutral detergent fibre (aNDF) degradation of corn stover was improved but the crude protein (CP) degradability of soybean meal was decreased with increasing La supplementation. Urinary excretion of purine derivatives was quadratically (P<0.01) changed with altering La supplementation (75.5, 81.0, 82.4 and 70.6 mmol/day for control, low-, medium- and high-LaCl₃ supplementation, respectively). Similarly, digestibilities of organic matter, aNDF and CP in the total tract were also linearly and quadratically increased with increasing La supplementation. The present results indicate that supplementation of diet with LaCl₃ improved rumen fermentation and feed digestion in beef cattle. It was suggested that the La stimulated the digestive microorganisms or enzymes in a dose-dependent manner. In the experimental conditions of this trial, the optimum La dose was about 900 mg LaCl₃ per steer per day.     

Integrated gut/liver microphysiological systems elucidates inflammatory inter‐tissue crosstalk

A capability for analyzing complex cellular communication among tissues is important in drug discovery and development, and in vitro technologies for doing so are required for human applications. A prominent instance is communication between the gut and the liver, whereby perturbations of one tissue can influence behavior of the other. Here, we present a study on human gut‐liver tissue interactions under normal and inflammatory contexts, via an integrative multi‐organ platform comprising human liver (hepatocytes and Kupffer cells), and intestinal (enterocytes, goblet cells, and dendritic cells) models. Our results demonstrated long‐term (>2 weeks) maintenance of intestinal (e.g., barrier integrity) and hepatic (e.g., albumin) functions in baseline interaction. Gene expression data comparing liver in interaction with gut, versus isolation, revealed modulation of bile acid metabolism. Intestinal FGF19 secretion and associated inhibition of hepatic CYP7A1 expression provided evidence of physiologically relevant gut‐liver crosstalk. Moreover, significant non‐linear modulation of cytokine responses was observed under inflammatory gut‐liver interaction; for example, production of CXCR3 ligands (CXCL9,10,11) was synergistically enhanced. RNA‐seq analysis revealed significant upregulation of IFNα/β/γ signaling during inflammatory gut‐liver crosstalk, with these pathways implicated in the synergistic CXCR3 chemokine production. Exacerbated inflammatory response in gut‐liver interaction also negatively affected tissue‐specific functions (e.g., liver metabolism). These findings illustrate how an integrated multi‐tissue platform can generate insights useful for understanding complex pathophysiological processes such as inflammatory organ crosstalk. Biotechnol. Bioeng. 2017;114: 2648–2659. © 2017 Wiley Periodicals, Inc.