脉冲式高容量血液滤过联合血液灌流治疗脓毒性休克并发肾损伤的临床研究

目的评估脉冲式高容量血液滤过(PHVHF)联合血液灌流(HP)治疗脓毒性休克并发肾损伤患者的临床疗效。方法 2015年1月至2018年12月在江南大学附属医院明确诊断为脓毒性休克并发肾损伤住院患者36例,随机分为连续性血液滤过(CVVH)组(n=18)及PHVHF联合HP组(n=18)。对比两组病人治疗前后生命体征、生化指标、急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分以及去甲肾上腺素用量。采用ELISA方法检测治疗0h、2h、24h后血液及滤液白细胞介素(IL)-10,IL-6以及肿瘤坏死因子(TNF)-α的浓度。记录两组病人28 d病死率及90 d肾功能恢复情况。结果联合治疗组治疗后心率、WBC、C反应蛋白(CRP)、降钙素原(PCT)、APACHEⅡ评分、SOFA评分及去甲肾上腺素量下降优于CVVH组(P<0.05)。24 h后两组血液IL-10,IL-6以及TNF-α均有下降(P<0.05),联合治疗组效果更佳(P<0.05),HP治疗2h后即有明显下降(P<0.05),两组滤过液中均检测到以上炎症因子。联合治疗组28 d病死率为27.7%,有7例患者90 d内肾功能恢复,CVVH组病死率为38.8%,4例患者肾功能恢复。结论PHVHF联合HP可有效治疗脓毒性休克并发肾损伤。     

高容量血液滤过治疗脓毒症并发多器官功能障碍综合征RIFLE标准应用研究

目的探讨RIFLE标准衡量高容量血液滤过(HVHF)治疗脓毒症并发多器官功能障碍综合征(MODS)的治疗时机及其对预后的影响。方法回顾性分析成都军区总医院2006年1月至2010年12月行HVHF治疗的脓毒症并发MODS患者52例,采用RIFLE标准分A组(AKIⅠ期)、B组(AKIⅡ期)和C组(AKIⅢ期),比较各组的病死率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间,并将HVHF治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆白介素(IL)-6、氧合指数、血肌酐(Scr)及平均动脉压(MAP)等指标。结果 (1)C组HVHF治疗前APACHEⅡ评分、SOFA评分、血浆IL-6及病死率均明显高于A、B组(P<0.01);(2)A、B组HVHF治疗前APACHEⅡ评分、SOFA评分及病死率比较差异无统计学意义(P>0.05),但B组HVHF治疗前IL-6及平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间明显高于或长于A组(P<0.01);(3)HVHF治疗24 h后血浆IL-6、氧合指数、Scr、MAP均明显改善,但C组IL-6仍高于A、B组(P<0.01),B组IL-6仍高于A组(P<0.01);A、B组HVHF治疗24 h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),C组无变化(P>0.05)。结论 HVHF能有效辅助治疗脓毒症并发MODS;RIFLE标准及IL-6对判断预后有指导意义;早期(AKIⅠ期和Ⅱ期)行HVHF可明显改善脓毒症并发MODS的预后,而AKIⅠ期行HVHF的疗效更好。     

配对血浆滤过吸附治疗脓毒症合并多器官功能障碍综合征的临床研究

目的比较高容量血液滤过(HVHF)与配对血浆滤过吸附(CPFA)治疗脓毒症并多器官功能障碍综合征(MODS)及老年多器官功能衰竭(multiple organ failure in the elderly,MOFE)的临床疗效。方法选择脓毒症并MODS的患者14例,随机分为HVHF治疗组及CPFA治疗组,在常规治疗基础上分别予HVHF或CPFA治疗10 h,观察两种方式治疗前后的血流动力学、电解质及酸碱平衡、急性生理学及慢性健康状况评分Ⅱ(acute physiologyand chronic health evaluationⅡ,APACHEⅡ)及序贯器官衰竭估计评分(SOFA)、短期存活率等变化。结果 (1)两种治疗均能降低血尿素氮、肌酐水平,维持电解质、酸碱平衡,对白细胞、血小板、血细胞比容无明显影响。(2)CPFA治疗后氧合指数(PaO2/FiO2)明显改善(P0.05)、平均动脉压(MAP)明显升高(P0.05)、SOFA评分及APACHEⅡ评分均明显下降(P0.05);而HVHF治疗后仅见SOFA评分明显下降(P0.05),PaO2/FiO2、MAP、及APACHEⅡ评分均无明显改变(P0.05)。(3)两种方法治疗过程中均未出现出血、栓塞、过敏等并发症,老年患者耐受性好。(4)治疗7 d后HVHF组4例存活,CPFA组6例存活。结论 HVHF和CPFA治疗对脓毒症合并MODS及MOFE患者均有一定临床疗效,且后者更具优势。     

连续性血液净化在ICU多器官功能障碍综合征合并急性肾衰竭患者的应用及预后分析

目的探讨连续性血液净化治疗（CBPT）在ICU多器官功能障碍综合征（MODS）合并急性肾衰竭（APF）患者的疗效及影响预后的相关因素。方法回顾性分析2004年1月至2008年2月该院ICU中行连续性静-静脉血液滤过（CVVH）治疗的245例MODS合并ARF患者一般资料、血液生化检查、疾病严重程度评分等，对比分析CVVH治疗前后临床参数的变化及影响预后的因素。结果CVVH对容量负荷、溶质清除效果明显；反映疾病严重程度如氧合指数、APACHEⅡ评分、MODS评分、SOFA评分CVVH治疗前后比较无明显差异；全部患者死亡率为64．9％，病死率随着衰竭器官数目的增加而显著升高。多因素回归分析显示，患者CVVH治疗前衰竭器官数、医院获得性ARF、CVVH前APACHEⅡ评分、平均动脉压是独立危险因素。结论对于MODS合并ARF患者，CVVH治疗前患者疾病的严重程度是影响预后的重要因素，依据患者临床病情早期积极CBPT可能改善MODS合并ARF患者的预后。     

Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience

Background. Continuous veno-venous haemofiltration (CVVH) could be reasonable for attenuation of systemic complications in severe acute pancreatitis (SAP). The aim of the study was implementation and feasibility assessment of the CVVH in the treatment protocol of SAP. Patients and methods. CVVH was applied to 111 SAP patients during 2000–2005. APACHE II, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), serum lipase, C-reactive protein (CRP), complication rate and main outcomes were analysed comparing two periods. Results. Overall, 39 patients corresponded to Balthazar grade E SAP and 72 patients to necrotizing SAP (NSAP), with an average APACHE II score of 7 and 8.5, respectively, on admission. CVVH was started within 48 h in 82% of patients. Duration of CVVH was significantly augmented in NSAP patients during the routine period, comprising 92 h (p=0.006). The clinical presentation of SIRS and MODS was similar in both periods, with more initial pulmonary dysfunctions in NSAP (p=0.048). Peripancreatic infection decreased in the routine period; surgical interventions were performed in 34.8% vs 72.4% of patients. Hospital stay comprised on average 15.9 days for grade E SAP and 29.4 days for NSAP in the routine period, with overall mortality of 10.26% and 30.5%, respectively. Discussion. Application of CVVH in the treatment protocol of SAP is obscure due to relative invasiveness, a poorly understood mechanism of action and scarce clinical experience. We conclude that early pre-emptive application of CVVH is safe and feasible in the treatment of SAP. Duration of the procedure seems to be essential. Randomized clinical trials are justified. Our results are in favour of clinical application of CVVH in the treatment of SAP.     

持续血液滤过治疗高脂血症性急性胰腺炎24例

目的:观察早期连续血液滤过(continuous veno-venous hemofiltration,CVVH)对高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLP)的治疗效果.方法:49例HLP患者随机分为2组:连续血液滤过组(A组,n=24)和对照组(B组,n=25).在常规治疗的基础上,A组加用连续血液滤过.观察治疗前后两组患者的心率(HR)、呼吸(R)、氧合指数(PO2/FiO2)、血氧饱和度(SaO2)、血清甘油三酯(TG)、白介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)等指标的变化;并行APACHE~ 动态评分;比较两组治疗前后急性并发症的变化及治愈率.结果:经CVVH治疗后72h,患者临床症状改善明显,HR、R降至正常,APACHE~评分下降明显(10.8±5.1vs15.5±6.9,P<0.05);血清TG、IL-6及TNF-α亦明显下降(6.8±3.7vs18.5±6.3,39.8±16.7vs72.4±25.1,37.5±14.1vs61.2±16.1,P<0.05).治疗7d后,两组休克均获纠正(P<0.05).A组ARDS和急性肾功能障碍控制迅速,发生率下降明显(5.0%vs37.5%,5.0%vs25%,P<0.05).A组治愈22例,死亡2例,死亡率8.3%;B组治愈20例,死亡5例,死亡率20%,治疗效果显著.结论:CVVH治疗HLP有明显的效果,能有效改善患者病情,降低病死率.     

早期持续高容量血液滤过治疗重症急性胰腺炎的临床研究

 目的 研究早期持续高容量血液滤过（HVHF）对重症急性胰腺炎(SAP)患者的临床疗效。方法 以2005年1月至2011年7月南昌大学第一附属医院重症医学科收治的SAP患者60例为研究对象,随机分为血液滤过 (血滤) 组和对照组,血滤组在采用常规治疗方法的同时,使用HVHF进行早期干预,比较两组患者的腹部症状、生命体征、氧合指数、肝肾功能、急性生理与慢性健康（APACHEⅡ）评分变化。结果 与对照组相比,血滤组早期HVHF治疗后患者发热、心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解,APACHEⅡ评分［(13.3±1.0)分比(14.1±1.2)分］、血TBil［(20.4±11.3) μmol/L比 (28.1±10.9) μmol/L］、血肌酐［(178.7±71.8) μmol/L比 (215.6±51.3) μmol/L］、血尿素氮［(10.1±5.6) mmol/L比 (13.2±3.8) mmol/L］、血ALT［(51.3±13.2) U/L比(62.5±14.3) U/L］均显著下降(P值均<0.05),氧合指数(PaO₂/FiO₂)（197.3±32.4 比 178.3±31.7）有显著提高(P<0.05),且在血滤治疗过程中患者平均动脉压逐渐上升,心率逐渐下降,与对照组相比差异有统计学意义(P<0.05)。结论 早期持续性HVHF治疗SAP能早期缓解症状,改善病情,阻止全身炎症反应综合征发展为多器官功能障碍综合征;并能改善脏器功能,减少并发症,在SAP早期治疗中具有重要地位。     

Effects of Different Blood Purification Methods on Serum Cytokine Levels and Prognosis in Patients With Acute Severe Organophosphorus Pesticide Poisoning

The aim of the present study was to investigate the impact of three different blood purification methods, hemoperfusion (HP), continuous blood purification (CBP), and on‐line high‐volume hemodiafiltration (OL‐HDF), on the survival rate of patients with acute severe organophosphorus pesticide poisoning (ASOPP), as well as on major pro‐inflammatory (interleukin [IL]‐1, IL‐6, tumor necrosis factor‐α [TNF‐α]) and anti‐inflammatory (IL‐10) cytokines in the serum. Eighty‐one ASOPP patients were randomly divided into three groups: HP (N = 23), HP + CBP (N = 26), HP + OL‐HD (N = 32). Serum IL‐1, IL‐6, TNF‐α, and IL‐10 levels were assessed by ELISA before treatment and at 24 and 48 h post‐treatment and survival rates were determined. Patient survival rate was significantly higher in OL‐HDF and CBP treated patients compared with HP group (P < 0.05). A significantly greater clearance effect in serum IL‐1, IL‐6, and TNF‐α levels at 24 and 48 h post‐treatment was observed in CBP and OL‐HDF groups compared with the HP group (P < 0.05). The levels of serum anti‐inflammatory cytokine IL‐10 increased significantly in CBP and OL‐HDF groups compared with the HP group (P < 0.05 at 48 h post‐treatment). In addition, OL‐HDF treatment achieved similar changes in serum TNF‐α, IL‐1, IL‐6 and IL‐10 levels as CBP (P > 0.05). Compared with the HP method, CBP or OL‐HDF combined with HP can rapidly clear inflammatory cytokines, reduce systemic inflammatory response syndrome, and improve the survival of ASOPP patients. Compared with CBP, OL‐HDF is an economical and effective method to treat ASOPP with less technical difficulty and more suitability for rural areas and primary hospitals.     

Adjunctive continuous high-volume hemofiltration in acute severe pancreatitis patients: A retrospective study

Abstract

Objective. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. Material and methods. A total of 63 patients diagnosed with severe acute pancreatitis between January 2005 and July 2007 were retrospectively analyzed: 34 accepted adjunctive continuous high-volume hemofiltration (HVHF group); and 29 only accepted conventional recommended treatments (control group). Results. There were no differences in physiological characteristics between the two groups when entering the intensive care unit. After treatment, the percentages of patients successfully weaned from mechanical ventilation (p = 0.004) and who experienced renal function recovery (p = 0.046) were significantly higher in the HVHF group than in the control group. The 28-day survival rate was 91.2% in the HVHF group, compared with 65.5% in the control group (p = 0.014). For patients with APACHE II scores > 15, survival was significant higher in the HVHF group than in the control group (87.5% vs 50%; p = 0.044). No difference in survival was found in patients with APACHE II scores ≤ 15 between the two groups (94.4% vs 76.5%; p = 0.177). After HVHF therapy, APACHE II score, body temperature, urine volume and laboratory indices, including serum creatinine, base excess and blood calcium, were significantly improved. Conclusions. Adjunctive continuous HVHF was beneficial for the survival of severe acute pancreatitis patients. Survival improvement was significant in patients with APACHE II score > 15.     

连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值

目的 观察在传统治疗重症急性胰腺炎(SAP)的同时行连续性静脉-静脉血液滤过(CVVH)的疗效。方法 53例SAP患者在接受传统治疗的同时行CVVH,每次至少持续24h。监测CVVH前后病情及血清淀粉酶、脂肪酶的变化,行动脉血气分析和APACHlE Ⅱ评分,测血中内毒素水平。结果 CVVH治疗后患者心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解,APACHEⅡ评分明显降低,淀粉酶、脂肪酶、尿素氮、肌酐明显降低,酸中毒、低氧血症纠正。CVVH治疗6h后,血中内毒素水平下降,24h后又恢复至治疗前的水平。53例患者中38例痊愈出院,存活率为71．7％。结论 在传统治疗SAP的同时行CVVH,能提高抢救的成功率,降低病死率。     

Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation

Background and objective

Chronic obstructive pulmonary disease (COPD) represents an increasing healthcare concern as a leading cause of morbidity and mortality worldwide. Our objective was to predict the outcome of COPD patients associated with multiple organ dysfunction syndrome (MODS) by scoring models.

Methods

A retrospective study was performed on severe COPD patients within 24 hours of the onset of MODS. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score II (SAPS II), and Sepsis-related Organ Failure Assessment (SOFA) scores were calculated for patients.

Results

A total of 153 elderly patients were recruited. Compared to 30-day survivors, the number of failing organs and all of the scoring models were significantly higher in 30-day non-survivors. The SOFA showed the highest sensitivity and area under the curve (AUC) for predicting the prognosis of patients with MODS induced by acute exacerbation of COPD. The results of logistic regression indicated that factors that were correlated with the prognosis of COPD included the exacerbation history, SOFA score, number of failing organs, and duration of ICU stay. The value of exacerbation frequency for predicting the outcome of COPD was excellent (AUC: 0.892), with a sensitivity of 0.851 and a specificity of 0.797.

Conclusions

The SOFA score, determined at the onset of MODS in elderly patients with COPD, was a reliable predictor of the prognosis. The exacerbation frequency, number of failing organs, and the SOFA score were risk factors of a poor prognosis, and the exacerbation frequency could also effectively predict the outcome of COPD.     

Audit of patients with severe acute pancreatitis admitted to an intensive care unit

Background

Severe acute pancreatitis (SAP) is a disease with high morbidity and mortality. We undertook a study of patients with SAP admitted to the intensive care unit (ICU) of a tertiary referral hospital.

Methods

Between 2002 and 2007, 50 patients with SAP were admitted in our intensive care unit (ICU). Data were collected from their medical records and their clinical profile, course and outcome were retrospectively analyzed. Patients were categorized into survivor and nonsurvivor groups, and were further classified based on interventions such as percutaneous drainage and surgical necrosectomy.

Results

SAP contributed 5?% of total ICU admissions during the study period. Median age of survivors (n?=?20) was 34 against 44?years in nonsurvivors (n?=?30). Median Acute Physiology and Chronic Health Evaluation (APACHE) II score in nonsurvivors was 16.5 (8?C32) vs. 12.5 (5?C20) in survivors (p?=?0.002). Patients with APACHE II score ??12 had mortality >80?% compared to 23?% with score <12 (p?<?0.001). Median Sequential Organ Failure Assessment (SOFA) scores on admission and on days 3, 7, 14, and 21 were significantly higher in nonsurvivors compared to survivors (p?<?0.05). Mean (SD) intraabdominal pressure was 23 (3.37) mmHg in nonsurvivors vs. 19.05 (2.51) in survivors (p?<?0.05). Patients with renal failure had significant mortality (p?<?0.001). Length of ICU stay, requirement for vasopressor, total parenteral nutrition, and the amount of blood and blood product transfusions differed significantly between patients with and without intervention.

Conclusions

APACHE II and SOFA scores and other clinical data correlated with outcome in SAP admitted to ICU.     

Histological analysis of synovium by treatment of etanercept for rheumatoid arthritis

Aims: In order to investigate the histological change in effect attenuation cases of etanercept compared with methotrexate (MTX), we performed immunohistochemical examination by seven different molecules. Methods: We histologically assessed synovial tissue from five MTX‐treated rheumatoid arthritis (RA) patients as control and six etanercept and MTX‐treated RA patients after synovectomy by arthroscopy. The synovium of both groups were assessed by hematoxylin and eosin (HE) and we also analysed the expression of tumour necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), matrix metalloproteinase‐3 (MMP‐3), B‐cell precursors and mature B‐cell transmembrane protein, CD20, macrophage marker, CD68, bromodeoxyuridine (BrdU) and vascular endothelial growth factor (VEGF) by immunohistochemistry. Results: HE staining showed vascular and cell proliferations of the synovium of the RA patients who received etanercept compared with the control MTX group. TNF‐α and IL‐6 were expressed in both groups.MMP‐3 and CD68 expressed less significantly in the etanercept group compared with the control (P < 0.05). CD20 strongly expressed in the etanercept group significantly (P < 0.05). BrdU expressed in the synovium in the etanercept group significantly (P < 0.05). VEGF was not found overall in both group. Conclusion: Based on the histological change of synovium, treatment by etanercept may be involved in vascular and cell proliferations with inhibition of the expression of CD68 and MMP‐3 in synovium of RA patients. These findings indicate immunohistochemical change of synovium with etanercept is one of the mechanism of efficacy of etanercept.     

以提高肾脏病整体预后工作组诊断标准分析脓毒症相关急性肾损伤患者的临床特点

  目的 以提高肾脏病整体预后工作组（KDIGO）诊断标准分析重症监护病房（ICU）内脓毒症相关急性肾损伤（AKI）患者的临床特征和预后。方法 应用KDIGO推荐的AKI诊断标准,收集2007年6月—2012年6月江苏省无锡市人民医院ICU收治的符合入选标准的AKI患者资料,回顾性分析脓毒症相关AKI患者的临床特征、预后和影响患者死亡的主要危险因素。结果 在收治的703例AKI患者中,脓毒症相关AKI 395例（56.2%）,脓毒症是发生AKI最主要的原因。脓毒症相关AKI患者中,AKI Ⅰ期146例（37.0%）,Ⅱ期154例（39.0%）,Ⅲ期95例（24.1%）。与非脓毒症相关AKI患者比较,脓毒症相关AKI组急性生理与慢性健康评分Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）更高(25.1±4.9比20.5±6.4,12.9±2.6比10.4±4.5;P值均<0.05)。两组基础血肌酐值差异无统计学意义［(82.9±22.2)μmol/L比(83.1±30.0)μmol/L,P>0.05］,但ICU期间脓毒症相关AKI组血肌酐更高［(143.5±21.6)μmol/L比(96.2±15.5) μmol/L,P<0.05］,进展为AKI Ⅱ期和Ⅲ期的比例更高（63.0%比33.1%,P<0.05）,接受肾脏替代治疗的比例更高（22.3%比6.2%,P<0.05）,而肾功能完全恢复的患者比例更少(74.4%比82.8%,P值均<0.05)。脓毒症相关AKI患者90 d病死率高于非脓毒症相关AKI患者(52.2%比34.1%,P<0.05)。随着KDIGO分期的增加,脓毒症相关AKI患者病死率增加。Logistic回归分析显示APACHEⅡ(OR=5.451,95%CI：3.095~9.416)、SOFA(OR=2.166,95%CI：1.964~4.515)和肾脏替代治疗(OR=4.021,95%CI：2.975~6.324)均是脓毒症相关AKI患者死亡的独立危险因素。结论 脓毒症相关AKI 患者全身疾病严重程度高、肾功能差、病死率高。APACHEⅡ、SOFA和肾脏替代治疗是脓毒症相关AKI患者死亡的独立危险因素。        

Calcitonin therapy in postmenopausal osteoporosis: effects on serum levels of interleukin‐1, interleukin‐6 and tumor necrosis factor‐α

Background: It has been suggested that the effects of calcitonin (CT) therapy for senile and postmenopausal osteoporosis were due to its modulatory effects on bone‐related cytokines. A significantly increased release of IL‐1, IL‐6 and TNF‐α, which have bone resorptive effects, has been reported in osteoporotic patients. Aim: In this study we investigated the effects of CT therapy on the levels of IL‐1, IL‐6 and TNF‐α. Method: Forty postmenopausal osteoporotic women were included to the study. The first group consisting of 20 patients were given 100 IU CT subcutaneously and 1000 mg elemental calcium for 15 consecutive days. The second group or the control group also consisting of 20 patients were only given 1000 mg elemental calcium and both of the groups were not allowed to take any other medication. Results: In the first group the mean serum TNF‐α level significantly decreased from 16.9 ± 24.2 pg/mL to 8.6 ± 13 pg/mL after 1500 IU CT therapy (P < 0.05). The control group's mean serum level of IL‐1, IL‐6 and TNF‐α did not reveal any statistically significant differences (P > 0.05). Conclusion: Our results suggest that CT therapy for osteoporosis may partially be due to its inhibitory effects on TNF‐α, and probably IL‐1. However, further in‐vitro and ex‐vivo studies are needed to clarify this hypothesis.     

Sirtuin 1 activator SRT1720 suppresses inflammation in an ovalbumin‐induced mouse model of asthma

Background and objective: In asthma, reduced histone deacetylase activity and enhanced histone acetyltransferase activity in the lungs have been reported. However, the precise function of Sirtuin 1 (Sirt1), a class III histone deacetylase, and the effect of the Sirt1 activator SRT1720 on allergic inflammation have not been fully elucidated. Methods: The effect of SRT1720, a synthetic activator of Sirt1, in an ovalbumin (OVA)‐induced asthma mouse model was investigated. The effect of SRT1720 and resveratrol on OVA stimulation in splenocytes from OVA‐sensitized and challenged mice was also examined. Results: In OVA‐sensitized and challenged mice (OVA mice) compared with saline‐sensitized and challenged mice (control mice), Sirt1 messenger RNA expression in the lungs was decreased (P = 0.02), while cellular infiltration, airway eosinophilia and bronchoalveolar lavage (BAL) fluid levels of interleukin (IL)‐4, IL‐5 and IL‐13 were increased (P < 0.01). In OVA mice, SRT1720 treatment decreased total and eosinophil cell counts and IL‐5 and IL‐13 levels in the BAL fluid compared with the vehicle treatment (P < 0.05). In OVA mice, SRT1720 treatment also decreased inflammatory cell lung infiltrates histologically (P = 0.002). Both SRT1720 and resveratrol suppressed OVA‐induced cell proliferation and IL‐6 (P < 0.05) and tumour necrosis factor‐α (TNF‐α) (P < 0.05) production in splenocytes (P < 0.01). Conclusions: The Sirt1 activator SRT1720 suppressed inflammatory cell infiltration and cytokine production in an OVA‐induced mouse model of asthma. SRT1720 and resveratrol suppressed OVA‐induced splenocyte proliferation and TNF‐α and IL‐6 production. Sirt1 activators might have beneficial effects in asthmatics by suppressing inflammation.     

Effect of the regulation of retinoid X receptor‐α gene expression on rat hepatic fibrosis

Aim: To study the effect of retinoid X receptor‐α (RXR‐α) expression on rat hepatic fibrosis. Methods: Rat hepatic fibrosis was induced by CCl₄, and the rats were randomly divided into an early‐phase hepatic fibrosis group (2 weeks) and a sustained hepatic fibrosis group (8 weeks). They were then divided into four groups (normal control, hepatic fibrosis, negative control and RXR‐α groups). A recombinant lentiviral expression vector carrying the rat RXR‐α gene was injected into the rats to induce RXR‐α expression by intraportal infusion, hepatic tissue pathological examination was performed, and hydroxyproline content was detected. Hepatic stellate cells (HSC) were cultured in vitro, an RXR‐α lentivirus vector was used to activate HSC, and 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) activation was assayed to detect HSC proliferation. Results: In vivo experiments indicated that in the sustained hepatic fibrosis group, there were significant differences in the hydroxyproline content, and expression of RXR‐α, α‐smooth muscle actin (α‐SMA) and type I collagen (P < 0.01). However, in the early‐phase hepatic fibrosis group, hydroxyproline content and the protein level of RXR‐α showed no significant difference compared with the normal control group (P > 0.05). In vitro studies revealed that expression of RXR‐α significantly inhibited expression of α‐SMA and type I collagen in activated HSC (P < 0.01), as well as HSC proliferation (P < 0.01). Conclusion: The increased RXR‐α gene expression inhibited HSC activation and proliferation and the degree of hepatic fibrosis.     

The Effectiveness of Scoring Systems in the Prediction of Diagnosis‐Based Mortality

Scoring systems are used for mortality and morbidity rating in intensive care conditions, prognosis prediction, standardization of scientific data and the monitoring of clinical quality. The aim of this study was to retrospectively analyze the efficacy of APACHE II (Acute Physiology and Chronic Health Evaluation), APACHE IV and SAPS (Simplified Acute Physiology Score) III prognostic scorings in the prediction of mortality and disease severity of patients admitted to the Anesthesia and Reanimation Clinic Intensive Care Unit (ICU) in Bak?rköy Dr. Sadi Konuk Training and Research Hospital according to general and specific diagnoses. A total of 1896 patient files were included in the study. With the exception of single system or head trauma patient groups, a statistically significant difference was found in the mortality prediction rates in all other diagnosis groups (P < 0.05). The discrimination calculated with AUROC fields was sufficient in all groups, and calibration was evaluated as good except for the neurological and neurosurgical patient group. In respect of standard mortality prediction, APACHE II and IV were good in cases of sepsis, and SAPS III made almost exact predictions for cardiovascular diseases, APACHE II for neurological diseases, and APACHE IV for gastrointestinal system diseases. From the results of this study, it was seen that different scoring systems vary in predictions according to the diagnoses, therefore, it can be recommended that the diagnosis should be taken into account more when applying scoring systems.     

Association of the CagA status of Helicobacter pylori and serum levels of interleukin (IL)‐17 and IL‐23 in duodenal ulcer patients

OBJECTIVE: It has been reported that the cytotoxin‐associated gene A (cagA+) H. pylori strains induce severe gastric mucosal inflammation. The aim of this study was to investigate the association of the virulence factor CagA with IL‐17 and IL‐23 serum levels in duodenal ulcer (DU) patients and H. pylori‐infected asymptomatic (AS) carriers. METHODS: In total, 45 H. pylori‐infected DU patients were enrolled to study: 23 tested positive for the anti‐CagA antibody (anti‐CagA+) and 22 tested negative for the anti‐CagA antibody (anti‐CagA‐), 30 were AS carriers (15 were anti‐CagA+ and 15 were anti‐CagA‐) and 15 were healthy uninfected participants (as a control group). The IL‐17 and IL‐23 serum levels of participants were measured by enzyme‐linked immunosorbent assay method. RESULTS: The mean IL‐17 levels in DU patients were significantly higher than those in AS and control groups (P < 0.001 and P < 0.0001 respectively). In the DU group, the mean IL‐17 levels in participants testing positive for anti‐CagA (10.84 ± 5.79 pg/mL) were significantly higher than those observed in participants testing negative for anti‐CagA (7.65 ± 4.74 pg/mL; P < 0.05). The mean IL‐23 levels in the DU and AS groups were significantly higher than in the control group (P < 0.02 and P < 0.03 respectively) but were not significantly different in participants testing positive and negative for anti‐CagA. CONCLUSION: These results showed higher IL‐17 and IL‐23 serum levels in H. pylori‐infected participants than in the control group. In the DU group the expression of IL‐17 was influenced by the CagA factor.