Vital signs of the systemic inflammatory response syndrome in adult patients with acute infections presenting in out-of-hours primary care: A cross-sectional study

BackgroundSigns of the systemic inflammatory response syndrome (SIRS) – fever (or hypothermia), tachycardia and tachypnoea – are used in the hospital setting to identify patients with possible sepsis.ObjectivesTo determine how frequently abnormalities in the vital signs of SIRS are present in adult out-of-hours (OOH) primary care patients with suspected infections and assess the association with acute hospital referral.MethodsWe conducted a cross-sectional study at the OOH GP cooperative in Nijmegen, the Netherlands, between August and October 2015. GPs were instructed to record the body temperature, heart rate and respiratory rate of all patients with suspected acute infections. Vital signs of SIRS, other relevant signs and symptoms, and referral state were extracted from the electronic registration system of the OOH GP cooperative retrospectively. Logistic regression analysis was used to evaluate the association between clinical signs and hospital referral.ResultsA total of 558 patients with suspected infections were included. At least two SIRS vital signs were abnormal in 35/409 (8.6%) of the clinic consultations and 60/149 (40.3%) of the home visits. Referral rate increased from 13% when no SIRS vital sign was abnormal to 68% when all three SIRS vital signs were abnormal. Independent associations for referral were found for decreased oxygen saturation, hypotension and rapid illness progression, but not for individual SIRS vital signs.ConclusionAlthough patients with abnormal vital signs of SIRS were referred more often, decreased oxygen saturation, hypotension and rapid illness progression seem to be most important for GPs to guide further management.     

PD-1/PD-L1与脓毒症的免疫紊乱

 脓毒症（sepsis）在1991年初次被定义为感染所致的机体全身炎症反应综合征（SIRS）。2016年脓毒症国际共识更新至Sepsis 3.0,即由感染所致宿主免疫反应失调引起的威胁生命的器官功能障碍。在脓毒症免疫抑制阶段,程序性死亡受体1（programmed cell death protein-1,PD-1）与程序性死亡受体-配体1（programmed cell death 1 ligand 1,PD-L1）相结合能够抑制部分免疫细胞活化增殖从而达到负性调节免疫系统的作用。本综述主要围绕脓毒症中PD-1/PD-L1在T细胞、树突状细胞（DCs）、单核细胞、巨噬细胞等免疫细胞发挥免疫功能中的作用,以及对抗PD-1/PD-L1抗体疗法的应用前景进行阐述。     

基于多途径联合效应的甘草防治脓毒血症活性成分筛选及作用机制研究

目的 研究甘草中有效组分对脓毒血症的防治作用及机制。方法 采用小鼠骨髓来源巨噬细胞(bone marrow-derived macrophages,BMDM)构建体外NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)炎症小体激活模型及H2O2诱导的氧化应激模型筛选出甘草抗炎、抗氧化应激的有效组分,采用ip脂多糖(lipopolysaccharide,LPS,20 mg/kg)诱导C57BL/6小鼠脓毒血症致死模型以及脓毒血症模型,评价致死模型中小鼠的生存率及脓毒血症模型小鼠腹腔灌洗液中巨噬细胞和中性粒细胞在渗出细胞中的占比以及外周血和腹腔灌洗液中白细胞介素-1β(interleukin-1β,IL-1β)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平。结果 基于BMDM细胞NLRP3炎症小体激活模型筛选出甘草中有效组分刺甘草查耳酮,可显著抑制半胱氨酸天冬氨酸蛋白酶-1(cystein-asparate protease-1,Ca...     

T淋巴细胞亚群及Th1/Th2细胞因子谱早期鉴别细菌尿源性脓毒症

目的探究尿源性脓毒症患者T淋巴细胞亚群及辅助性T细胞1(Th1)/Th2细胞亚群细胞因子谱水平变化及其对革兰阳性菌、革兰阴性菌的鉴别价值。方法选择2015年2月-2020年3月遵义医科大学附属医院收治的98例尿源性脓毒症患者、80例常规泌尿系统感染患者及100名查体的健康志愿者作为研究对象,分别纳入脓毒症组、局部感染组、对照组。对脓毒症组患者进行病原菌分析,检测T淋巴细胞亚群比例及白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF-α)、干扰素-γ(IFN-γ)等细胞因子水平。结果入组脓毒症患者中,革兰阴性菌引起的尿源性脓毒症患者共53例(检出革兰阴性菌53株),以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主;革兰阳性菌引起的尿源性脓毒症患者共45例(检出革兰阳性菌45株),以表皮葡萄球菌、粪肠球菌、金黄色葡萄球菌、溶血葡萄球菌为主。脓毒症组患者CD₃⁺T淋巴细胞亚群比例、CD₄⁺T淋巴细胞亚群比例、CD₄⁺/CD₈⁺分别为(59.84±7.41)%、(34.84±5.26)%、(1.42±0.65),低于局部感染组、对照组,而IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ分别为2.69(0.98,16.23)pg/ml、2.49(0.74,22.74)pg/ml、88.41(10.24,188.52)pg/ml、25.63(1.74,74.15)pg/ml、3.25(1.01,16.96)pg/ml、7.11(1.22,15.63)pg/ml,高于局部感染组、对照组(P<0.05)。革兰阳性菌感染患者CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺分别为(64.15±4.71)%、(37.41±5.41)%、(1.53±0.34),高于革兰阴性菌感染患者,IL-6、IL-10、TNF-α分别为70.12(15.26,152.37)pg/ml、10.89(2.22,35.96)pg/ml、2.88(1.01,15.27)pg/ml,低于革兰阴性菌感染患者(P<0.05)。CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺、IL-6、IL-10等指标鉴别革兰阳性菌感染及革兰阴性菌感染的曲线下面积分别为0.651、0.681、0.656、0.769、0.758,当截点值为61.70%、35.10%、1.47、77.41 pg/ml、17.16 pg/ml时约登指数最大。结论尿源性脓毒症患者存在T细胞亚群及Th1/Th2细胞因子谱水平的失衡,且革兰阳性菌及革兰阴性菌脓毒症患者存在一定差异,临床可根据这些指标进行早期诊断及病原菌类型的鉴别。     

鱼油对大鼠细胞膜脂流动性的影响

研究了鱼油对脓毒症大鼠细胞膜脂流动性的影响。结果，正常大鼠肝、心、脾、肺、肾、脑、胸大肌及红细胞膜脂的流动性明显不同。脓毒症组大鼠肝、肺和红细胞膜脂的流动性明显降低（ｐ〈０．０５），肝细胞膜脂相变温度升高，当预先给脓毒症大服用４周鱼油时，肝、肺、肾、脑及红细胞膜的流动性明显增加（Ｐ〈０．０１和Ｐ〈０．０５），肝细胞膜脂相变温度降低。提示鱼油有降低炎症大鼠膜脂相变温度，改善膜脂流动状态的作用，推测鱼     

肠道菌群介导生脉方对脓毒症小鼠的治疗作用

探究生脉方（Shengmai formula,SMF）对脓毒症小鼠组织损伤、血清炎症因子和外周血固有免疫细胞比例的作用;考察肠道菌群在SMF治疗脓毒症中的作用。灌胃0.3,0.6,1.2 g/kg或腹腔注射0.6 g/kg SMF 4 d后腹腔注射20 mg/kg脂多糖（LPS）建立脓毒症模型,考察小鼠生存率,通过H&E染色观察小鼠肝、肺、肾组织病理改变,检测血清IL-6、TNF-α、谷丙转氨酶（ALT）、谷草转氨酶（AST）、尿素氮（BUN）和肌酐（Cr）水平;建立LPS和盲肠结扎穿刺（CLP）脓毒症模型,通过流式细胞术检测SMF灌胃或腹腔注射对外周血单核细胞、巨噬细胞和中性粒细胞比例的影响;考察抗生素（ABX）处理对SMF灌胃治疗脓毒症的影响;考察SMF灌胃小鼠的粪菌对脓毒症的治疗作用。结果表明,SMF灌胃显著提高LPS模型小鼠生存率,减轻肝、肺、肾损伤和炎性浸润,降低血清IL-6、ALT、AST、BUN、Cr水平;显著降低LPS模型24 h外周血巨噬细胞比例,下调CLP模型24 h外周血单核、巨噬细胞和中性粒细胞比例。SMF腹腔注射对脓毒症模型上述指标均无显著作用。ABX...     

Maternal colonization and early-onset neonatal bacterial sepsis in the Gambia,West Africa: a genomic analysis of vertical transmission

ObjectivesTo define bacterial aetiology of neonatal sepsis and estimate the prevalence of neonatal infection from maternal genital tract bacterial carriage among mother-newborn pairs.MethodsWe carried out a cross-sectional study of newborns with clinical sepsis admitted to three hospitals in the Gambia neonatal wards. Neonatal blood cultures and maternal genital swabs were obtained at recruitment. We used whole-genome sequencing to explore vertical transmission for neonates with microbiologically confirmed bloodstream infection by comparing phenotypically-matched paired neonatal blood cultures and maternal genital tract bacterial isolates.ResultsWe enrolled 203 maternal-newborn pairs. Two-thirds (67%; 137/203) of neonates presented with early-onset sepsis (days 0–6 after birth) of which 26% (36/137) were because of a clinically-significant bacterial pathogen. Blood culture isolates from newborns with early-onset sepsis because of Staphylococcus aureus (n = 5), Klebsiella pneumonia (n = 2), and Enterococcus faecalis (n = 1), phenotypically matched their maternal genital tract isolates. Pairwise single-nucleotide variants comparisons showed differences of 12 to 52 single-nucleotide variants only between maternal and newborn S. aureus isolates, presumably representing vertical transmission with a transmission rate of 14% (5/36).ConclusionsWe found a low prevalence of vertical transmission of maternal genital tract colonization in maternal-newborn pairs for early-onset neonatal sepsis in the West African context. Identifying infection acquisition pathways among newborns is essential to prioritize preventive interventions, which could be targeted at the mother or infection control in the hospital environment, depending on the major pathways of transmission.     

Paediatric intestinal transplantation: where are we now?

Intestinal transplantation (ITx) is the only curative treatment option for children with irreversible intestinal failure (IF) and complications of parenteral nutrition (PN). ITx is an immunologically difficult transplant due to the immune load of the donor gut; therefore, main causes of death and graft loss are immunological complications like sepsis or acute and chronic rejection. This article aims to help paediatricians in training understand when children should be referred for ITx, the different types of ITx, the complications these children might present with, and to learn about the journey a candidate for ITx must take with the support of the IF and ITx multidisciplinary teams (MDT).