Systemic immunologic and inflammatory response after laparoscopic versus open nephrectomy: a prospective cohort trial

Abstract Purpose: To compare the dynamics of systemic inflammatory indices during laparoscopic nephrectomy (LN) and standard open donor nephrectomy. Patients and Methods: Participants in this cohort study were 54 adults without a history of renal surgery and no evidence of urinary tract infection who underwent transperitoneal LN (n=29) and open donor nephrectomy (n=25, control group). We recorded demographic characteristics, intraoperative parameters, and changes 24 hours postoperatively in systemic inflammatory and immunologic values (body temperature, concentrations of white blood cell count [WBC], C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α), and compared the mean changes between groups. Results: Mean age was older in the LN group (45.6 vs 30.9 years; P<0.0001), and mean operative time was significantly shorter (83.1?min vs 101.6?min; P=0.004). Mean postoperative increase in IL-6 and body temperature in LN was significantly less than in control: For IL-6, 15.87 vs 29.09?pg/mL, P=0.03; for body temperature, +0.22°C vs +0.71°C, P=0.001). Mean postoperative increases in levels of other inflammatory markers (CRP, TNF-α, WBC) did not differ significantly. No statistical correlation was found between operative time and changes in IL-6, CRP, TNF-α, WBC, or body temperature. Conclusion: Based on the smaller increase in serum IL-6 as the most important indicator of surgical stress, the surgical trauma-induced immune dysfunction may be less intense after LN than open surgery. This may explain the smooth convalescence after LN.     

��-Defensin Expression of Inflammatory Response in Open and Laparoscopic Colectomy for Colorectal Cancer

Background  

Surgical procedures are related to the activation of the inflammatory reaction. This is called surgical stress. It is believed that diminished surgical trauma reduces surgical stress. The laparoscopic approach reduces trauma, but the systemic immune responses are still invariably activated. Cytokines and C-reactive protein (CRP) are the main markers in the study of inflammatory or stress response. α-Defensins play an important role in host defense, acting early in phagocytosis. α-Defensins, as early markers—earlier than cytokines—of the inflammatory response, have been used, together with high-sensitivity CRP (hs-CRP) and interleukin-6 (IL-6), to determine the inflammatory response in laparoscopic and open colectomy for cancer.     

Serum interleukin-6 response after spinal surgery: estimation of surgical magnitude

Background Serum interleukin-6 (IL-6) has been used for quantitative estimation of the surgical magnitude of major cardiac and thoracoabdominal surgery, but there have been few studies assessing IL-6 as a marker of surgical magnitude of spinal surgery. Methods We investigated the changes in IL-6 response in comparison to other parameters of surgical magnitude and spinal surgery procedures. The study included 40 patients electively undergoing spinal surgery. The patients were divided into four groups: lumbar laminectomy with posterolateral fusion (PLF), lumbar laminotomy, lumbar open discectomy, and cervical laminoplasty. Serum IL-6, C-reactive protein (CRP), creatine kinase (CK), and the white blood cell (WBC) count were determined in venous blood before surgery, at the end of surgery, and 6 h and the first, third, and seventh days after surgery. Results Serum IL-6 peaked on the first day and returned to a normal value by the seventh day. The peak IL-6 concentrations on the first day after surgery significantly correlated with CRP, CK, duration of surgery, and estimated blood loss. Regarding lumbar surgeries, the peak IL-6 for laminectomy/PLF was significantly higher than that for laminotomy/open discectomy or for cervical laminoplasty. Conclusions Serum IL-6 on the first day varied depending on the surgical procedure used. Therefore, it might be a quantitative marker of surgical magnitude following spinal surgery. An erratum to this article is available at .     

Serum C-Reactive Protein and White Blood Cell Count in Morbidly Obese Surgical Patients

Background  Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein (CRP) and white blood cell count (WBC). Recent studies have shown elevated CRP or WBC is a significant risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients. This study is aimed at the clinical significance of WBC and CRP in morbidly obese patients and the change after bariatric surgery. Methods  The study was a prospectively controlled clinical study. From December 1, 2001 to January 31, 2006, of 640 (442 females and 198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year’s follow-up were examined. Results  Of the patients, 476 (74.4%) had elevated CRP and 100 (15.6%) had elevated WBC at preoperative study. CRP and WBC were significantly related and both increased with increasing body mass index (BMI). CRP is also increased with increasing waist, glucose level, hemoglobin, albumin, Ca, insulin, C-peptide, and metabolic syndrome while WBC is increased with metabolic syndrome but decreased with increasing age. Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC. Both WBC and CRP levels decreased rapidly after obesity surgery. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery. Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg; p = 0.000) and achieved a lower BMI (27.8 ± 4.6 vs. 35.0 ± 5.5; p = 0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated CRP 1 year after surgery (95.9% vs. 84.5%; p = 0.169) and WBC (99.4% vs. 98.3%; p = 0.323). Conclusions  Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC.     

血清感染指标对颈后路单开门椎管扩大成形术后早期感染的诊断价值

目的：探讨白细胞计数（WBC）、C-反应蛋白（CRP）、血清降钙素原（PCT）及红细胞沉降率（ESR）水平对颈后路单开门椎管扩大成形术后早期感染的诊断价值,及时发现、预防和治疗术后感染患者。方法：回顾性分析2010年1月至2019年4月颈后路单开门椎管扩大成形术后早期发热的患者120例;按照患者伤口渗出液细菌学培养的结果将其分为感染组（53例）和未感染组（67例）,感染组中,男32例,女21例,年龄48～63（52.28±6.36）岁;未感染组中,男37例,女30例,年龄46～62（51.63±5.82）岁。并根据感染组患者术后感染类型将其分为深部手术部位感染组（30例）和浅表手术部位感染组（23例）,深部手术部位感染组中,男19例,女11例,年龄50～63（53.16±5.62）岁;浅表手术部位感染组中,男13例,女10例,年龄48～61（52.15±5.68）岁。比较组间患者及组内患者手术前后WBC计数、CRP、PCT及ESR血清感染指标。收集纳入的120例患者血清感染学指标数据并根据血清感染指标诊断感染的灵敏度及特异性,以1-特异性为横坐标,灵敏度为纵坐标绘制受试者工作特征（ROC）曲线对WBC计数、CRP、PCT以及ESR感染指标进行早期感染诊断的准确性评估。结果：术前：感染组和未感染组患者的WBC计数、CRP、PCT、ESR血清感染指标水平相近（P>0.05）;术后：感染组患者的WBC计数、CRP、PCT、ESR感染指标较未感染组高（P<0.05）。在术后感染的患者中,WBC计数、CRP、PCT以及ESR血清感染指标水平在不同术后感染类型的患者中存在差异（P<0.05）。未感染组患者的WBC计数、CRP、PCT以及ESR血清感染指标总体呈现出先升后降的趋势。WBC计数感染指标的受试者曲线下面积（AUC）为0.637（P<0.05）;CRP感染指标的AUC为0.792（P<0.05）;PCT感染指标的AUC为0.774（P<0.05）;ESR感染指标的AUC为0.783（P<0.05）。结论：WBC计数、CRP、PCT、ESR血清感染指标可用于颈后路单开门椎管扩大成形术后早期感染的诊断,除此之外,上述4种感染指标变化的综合分析可用于不同术后感染类型的鉴别。WBC计数指标对于早期感染诊断的准确性较低,CRP、PCT以及ESR指标对于早期感染诊断的准确性较好。总体上来说,CRP、PCT以及ESR血清感染指标对于颈后路单开门椎管扩大成形术后早期感染的诊断来说具有重要的临床意义,有助于临床工作者尽早发现术后早期感染以利于随后的相应治疗。     

Effect of Perioperative Allogeneic Red Blood Cell Transfusion on the Immune-Inflammatory Response After Colorectal Cancer Resection

Cytokines play an important role in the acute-phase response to trauma. Few studies have analyzed the effects of allogeneic blood transfusion containing packed red blood cells (RBCs) on the early postoperative immune/inflammatory response after colorectal resection for cancer This study investigated whether allogeneic RBC transfusion influences the postoperative immune/inflammatory response of patients submitted to large bowel resection due to cancer. A total of 26 patients—15 men and 11 women, with a median age of 56.5 years (range 24–87 years)—were prospectively studied. Blood samples were obtained preoperatively and on the first and fourth postoperative days for C-reactive protein (CRP), interleukin-6 (IL-6), and IL-10 assays and for CD4 and CD8 lymphocyte counts. Transfused (≥3 and <3 units), and nontransfused patients were compared. Both IL-6 and IL-10 increased postoperatively in transfused patients (p < 0.01). The serum IL-6 level was higher in patients receiving ≥3 units of RBCs (p < 0.01). CRP increased postoperatively unrelated to blood transfusion. The CD8 count decreased (p < 0.04) in transfused subjects, whereas CD4 decreased (p < 0.01) only in major-transfusion patients. Perioperative allogeneic RBC transfusion enhances the inflammatory systemic response and decreased immunity in patients submitted to colorectal resection for cancer.     

不同病原菌所致重症肺炎患者白细胞计数、降钙素原、C-反应蛋白及白细胞介素-6水平

目的探讨白细胞（WBC）计数、降钙素原（PCT）、C-反应蛋白（CRP）及白细胞介素-6（IL-6）水平在不同病原菌所致重症肺炎患者中的差异,为重症肺炎的诊治提供理论依据。 方法选取2014年10月至2017年3月在惠州市第一人民医院接受治疗且满足纳入标准的重症肺炎患者78例,根据病原菌种类将患者随机分为单一感染组：真菌组（F）、革兰阳性菌组（G⁺）、革兰阴性菌组（G^－）和复合感染组：真菌+革兰阳性菌组（F + G⁺）、真菌+革兰阴性菌组（F + G^－）,共5组。比较各组患者PCT、CRP、WBC计数和IL-6水平。 结果各组患者基础疾病、收缩压、体温、心率、红细胞沉降率差异均无统计学意义（P均> 0.05）;各组患者血清PCT水平差异有统计学意义（F = 9.781、P = 0.007）;各组患者血清WBC水平差异均有统计学意义（F = 8.373、P = 0.005）。各组患者CRP和IL-6水平变化范围小,差异均无统计学意义（F = 1.203、P = 0.115,F = 4.572、P = 0.248）。 结论低水平PCT和高水平CRP提示重症肺炎患者为真菌感染,降钙素原显著上升表明重症肺炎患者为革兰阴性杆菌感染或为复合感染。     

No Effect of Rosuvastatin in the Zoledronate-Induced Acute-Phase Response

The acute-phase response (APR) is frequently observed in patients treated with intravenous (iv) zoledronate (ZOL). We investigated whether a short course of rosuvastatin (ROSU) could attenuate the ZOL-induced APR through blocking the mevalonate pathway at a proximal level. Twenty-eight osteoporotic postmenopausal women with no prior bisphosphonate use (mean age 65.3 ± 1.9 years) were subjected to ZOL iv infusion. Patients were randomly assigned into either a ROSU+ group (n = 12), which received ROSU 10 mg/day starting 5 days before the infusion of ZOL for a total period of 11 days, or a ROSU− group (n = 16), which did not receive ROSU. The visual analog pain scale (VAS) for musculoskeletal symptoms and body temperature was used to define clinically APR. In addition, white blood cell (WBC) count, leukocytic subpopulations, and C-reactive protein (CRP) were obtained before and 48 h following the infusion. Seven (58.3%) patients in the ROSU+ group and 13 (81.3%) in the ROSU− group experienced APR (P = not significant). No difference was found in fever and VAS measurements. CRP and granulocytes increased significantly in both groups; WBC count increased, while lymphocytes and eosinophils decreased significantly only in the ROSU− group. In a post hoc analysis of only patients with an APR, all laboratory parameters exhibited a similar significant change solely within the ROSU− group. In conclusion, our data suggest that a short course of ROS at this dose cannot prevent the ZOL-induced APR among osteoporotic women. Milder changes in acute-phase laboratory parameters in ROSU+ patients suggest that studies with higher doses may be warranted.     

微通道经皮肾镜与逆行性输尿管软镜碎石术治疗直径<2.0 cm肾下盏结石的效果分析

目的 探讨微通道经皮肾镜碎石术（mPCNL）与逆行性输尿管软镜碎石术治疗直径<2.0 cm肾下盏结石的效果。方法 选取2015年1月至2017年10月在本院行肾结石碎石手术的105例直径<2.0 cm的肾下盏结石患者,其中45例采用逆行性输尿管软镜碎石术治疗（A组）,另外60例患者采用mPCNL治疗（B组）。对比两组患者的一期结石清除率、总结石清除率、手术时间、手术出血量、住院时间及手术并发症发生率;对比两组患者术前、术后24 h的血清白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、C反应蛋白（CRP）和白细胞（WBC）等指标。结果 B组患者的一期结石清除率、手术时间、手术出血量均低于A组（P<0.05）,但总结石清除率与A组比较,差异无统计学意义（P>0.05）;B组的住院时间长于A组（P<0.05）;术前,两组患者的IL-6、IL-10、CRP、WBC水平比较,差异无统计学意义（P>0.05）;术后24 h,B组患者的IL-6、IL-10、CRP、WBC水平均显著高于A组,差异有统计学意义（P<0.05）;B组患者的并发症发生率[10.00%（6/60）]与A组[15.56%（7/45）]比较,差异无统计学意义（P=0.392）。结论 mPCNL与逆行性输尿管软镜碎石术治疗直径<4.0 cm肾下盏结石患者的效果差异不大,且mPCNL手术引起的炎症应激反应更小,手术创伤更小。     

Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis

Background: Debate around the value of laboratory tests in establishing the diagnosis of acute appendicitis (AA) still continues. This prospective study aimed to investigate the changes in mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) with the diagnosis of acute appendicitis. Method: 200 patients who underwent emergency appendectomy were included. According to postoperative histology, patients were divided into three groups: acute non-complicated, acute complicated appendicitis (positive appendicectomy groups), and negative appendectomy group. White blood cell (WBC), neutrophil, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelets (PLT) count, MPV, PDW, RDW, and C-reactive protein (CRP) were compared among the groups. Results: One hundred twenty-five (62.5%) patients had non-complicated acute appendicitis, 20 (10%) had complicated acute appendicitis, while 55 (27.5%) had normal appendix. WBC (p <.001), neutrophil (p <.001), NLR (p <.001), PDW (p =.003), and CRP (p =.001) were higher, while lymphocyte (p <.001) and PLT counts (p =.020) were lower in positive appendectomy compared with negative appendectomy patients. MPV levels were insignificantly different across the groups. RDW level was significantly higher in complicated compared with non-complicated acute appendicitis (p =.006); however, no significant difference was found between positive and negative appendectomy groups. Using receiver operating characteristic analysis, sensitivity, specificity, and diagnostic accuracy respectively were 44.83, 100.0, and 72.415% for WBC count, 72.41, 81.82, and 77.115% for neutrophil count, 48.28, 90.91, and 69.595% for PDW, 89.66, 63.64, and 76.65% for CRP. Conclusions: Increased PDW combined with elevated WBC and neutrophil counts maybe used as diagnostic tests in the cases of acute appendicitis, while MPV and RDW levels were not useful diagnostic markers.     

The influence of percutaneous nephrolithotomy on human systemic stress response, SIRS and renal function

The objective of this study is to investigate the influences of percutaneous nephrolithotomy (PNL) and open surgery nephrolithotomy on the systemic stress response, SIRS and renal function. Forty patients with kidney calculi were enrolled in the study. Twenty cases were randomized to the PNL group and the other twenty cases to the open surgery group. Levels of C-reactive protein (CRP), interleukin-6(IL-6), β₂-microglobulin (β₂-MG), respiration rate, heart rate, body temperature and white blood cell counts were examined. CRP and IL-6 were measured in all patients pre-operatively and on post-operative days 1, 3 and 6, respectively. There was significant difference in their pre- and post-operation levels (P < 0.05), with the peak of CRP and IL-6 observed at post-operative days 3 and 1, respectively. There was significant difference in both CRP and IL-6 between the two groups (P < 0.05). At post-operative day 1, there were 5 cases of SIRS in PNL group and 12 cases in open surgery group; there was significant difference between the two groups (P < 0.05). Serum β₂-MG levels were measured as the same time as CRP and no significant changes were observed within or between the groups (P > 0.05). Urine β₂-MG levels were also measured. There was significant difference between pre- and the first day post-PNL (P < 0.05); there was no significant difference between pre- and the third and sixth day post-PNL (P > 0.05). There was significant difference between pre- and first and third day post-open surgery (P < 0.05); but there was no significant difference between pre- and the sixth day post-open surgery (P > 0.05). There was significant difference between two groups at the first, third and sixth days (P < 0.05). Conclusions: The systemic stress response is activated both in PNL group and open surgery group to some extent. The degree of stress response of PNL is lower than that of open surgery, proving the advantages of PNL with reference to serum immunology. There were cases in both the groups with SIRS, but the degree of SIRS in PNL group was lesser than the other group. Both the groups have no obvious effect on glomerular filtration function after operation and have effect on renal tubular reabsorption in the early stage after operation; but the recovery of the PNL group is faster than the open surgery group. It is thus shown that PNL is much safer and more feasible and has lesser effect on renal function.     

The Acute-Phase Response in Differentiating Sepsis from Inflammation in Neonates Who Require Abdominal Surgery

Introduction : In neonates, the influence of surgery on the inflammatory response has not been fully characterized and it remains difficult to differentiate an inflammatory response from sepsis. In this study, we evaluated changes in interleukin-6 (IL-6) and C-reactive protein (CRP) in neonates undergoing different major abdominal surgeries who had a normal postoperative course without infection.

Material and Methods : In total, 43 neonates undergoing major abdominal surgery owing to congenital malformations involving the gastrointestinal tract, and who did not show blood culture positivity were enrolled in the study. As a control group, 40 neonates with proven sepsis were enrolled in the study over the same period. Blood samples for IL-6, CRP, and white blood cell count (WBC) determination were drawn before surgery and 48, 96, and 144 h [postoperative days (POD) 2, 4, and 6] after surgery.

Results : There was a statistically significant increase in IL-6 concentrations on POD 2 compared with preoperative levels (p < 0.05). After POD 2, IL-6 levels decreased to preoperative levels. There was a statistically significant increase in CRP concentrations on POD 2, 4, and 6 (p < 0.05). Levels of CRP tended to be higher after surgery, and began to fall by the 6th day, but were still statistically higher than preoperative levels. In the sepsis group, CRP concentrations on day 6 were lower than in the surgery group (p < 0.05). White blood cell counts did not show statistically significant differences preoperatively versus postoperatively.

Conclusions : In contrast to previous studies, our results show high levels of IL-6 on POD 2 and CRP on POD 6. It is important to differentiate between the diagnoses of sepsis and postoperative inflammation, because of the need to treat the infection. High levels of IL-6 and CRP are not always associated with sepsis after major abdominal surgeries, but may instead be associated with the inflammatory response and multiorgan dysfunction. Further studies are needed to better differentiate sepsis from inflammatory responses in patients undergoing other surgeries.     

Natural orifice translumenal endoscopic drainage for pancreatic abscesses

Background  Few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis, peritonitis, or both. This report describes the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. Methods  This study reviewed 35 consecutively treated patients for the period 1994–2007. The approaches alone or in combination were transmural (transgastric or transduodenal) and transpapillary. The criteria for abscesses were two or more of the following: fever, abdominal pain, elevated white blood count (WBC), and positive fluid cultures. Results  The 35 patients (19 men and 16 women) had a mean age of 49 years. The abscesses had idiopathic (37%), gallstone (32%), alcohol (20%), and divisum (11%) etiologies. The presenting signs were abdominal pain (80%), positive cultures (69%), fever (57%), elevated WBC (51%), and nausea/vomiting (39%). The approaches for abscess drainage were as follows: transgastric (n = 15, 43%), transduodenal (n = 4, 11%), transgastric combined with transpapillary (n = 8, 23%), transduodenal combined with transpapillary (n = 1, 3%), and transpapillary alone (n = 7, 20%). A total of 28 patients (80%) achieved successful endoscopic pancreatic abscess drainage, whereas 7 (20%) required surgery. Of these seven patients, two (6%) required emergent laparotomy to control bleeding, and the remaining five (14%) were explored after failure to demonstrate clinical improvement from endoscopic drainage. Three patients required internal drainage, and two patients required distal pancreatectomy. The mean follow-up period was 15 months, and the complication rate was 6%. No one died from the procedure. Conclusion  Endoscopic surgery for pancreatic abscess is feasible and effective. It is an alternative to surgery that currently can be considered a primary treatment option for selected pancreatic abscesses.     

腹腔镜肾囊肿去顶术不同入路对机体应激反应的影响

目的：探讨经腹腔途径（trans-peritoneal laparoscopy,TPL）和腹膜后途径行腹腔镜（retro-peritoneal laparoscopy,RPL）肾囊肿去顶术对机体应激反应的影响机制。方法：选择肾囊肿患者60例,分别行TPL手术（30例）和RPL手术（30例）。于术前、术终、术后第1、3天分别检测体温、白细胞计数（white blood cell,WBC）、C反应蛋白（C-reactive protein,CRP）、白细胞介素-6（interleukin-6,IL-6）、血糖及皮质醇水平,比较两组应激反应程度。结果：术终及术后第1天体温TPL组高于RPL组（P=0.023、P=0.002）。两组WBC术后第1、3天高于术前（P〈0.05）,且术后第1天TPL组明显高于RPL组（P〈0.01）。两组CRP术后第1、3天明显高于术前（P〈0.01）,TPL组均高于RPL组（P=0.032、P=0.045）。两组血糖和IL-6在术后第1、3天均升高（P〈0.05）,但差异无统计学意义（P〉0.05）。皮质醇在术终及术后第1、3天均升高（P〈0.05）,但差异无统计学意义（P〉0.05）。结论：两种入路的腹腔镜手术患者创伤程度均较小,应激水平较低,但在肾囊肿去顶术中,经后腹腔入路对机体的应激反应小于经腹腔入路。     

Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis

We performed endoscopic transpapillary gallbladder drainage (ETGBD) in 21 patients with acute cholecystitis, utilizing a guidewire coated with a hydrophilic polymer. Endoscopic sphincterotomy was not performed. The clinical efficacy of ETGBD was evaluated in terms of reduction of white blood cell count (WBC) and C-reactive protein (CRP) level. ETGBD was successful in 17 (81%) of the 21 patients, in terms of early disappearance of clinical symptoms, and significant decrease of both WBC and CRP after ETGBD (P< 0.001). In patients with the Mirizzi syndrome (n=2), accurate diagnosis was made by endoscopic retrograde cholangiography (ERC), facilitating proper drainage (ETGBD) immediately afterward. With ETGBD, emergency operation was avoided even in critically ill patients complicated with disseminated intravascular coagulopathy (n=2). There were no significant complications. ETGBD may be an effective and safe alternative to percutaneous transhepatic gallbladder drainage in the management of acute cholecystitis, and may be more suitable for patients with a strong bleeding tendency.     

The effects of continuous renal replacement therapy with different anticoagulation methods on the expression of cytokines in severe acute pancreatitis

ObjectiveSevere acute pancreatitis (SAP) is a highly morbid condition in general population as well as in solid organ transplant (SOT) recipients. The present study aimed to investigate the effect of continuous renal replacement therapy (CRRT) with different anticoagulation methods on the expression levels of cytokines in SAP.MethodsA total of 120 patients with SAP, admitted into our hospital between September 2017 and July 2020, were enrolled as the research subjects and randomly divided into a control group (60 cases) and a study group (60 cases). CRRT with low molecular weight (LMW) heparin‑calcium anticoagulation was conducted on patients in the control group, and CRRT with topical citrate + low-dose LMW heparin‑calcium anticoagulation was conducted on patients in the study group. The expressions of cytokines in the two groups were compared after treatment.ResultsThere was no significant difference in white blood cells (WBC), C-reactive proteins (CRP), and procalcitonin (PCT) before treatment between the two groups (P > 0.05). After treatment, the levels of WBC (P = 0.006), CRP (P < 0.001), and PCT (P < 0.001) were significantly lower in the study group when compared with those in the control group. There was no significant difference in the concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) between the two groups before treatment (P > 0.05). After treatment, the concentrations of IL-6, IL-8, and TNF-α were significantly lower in the study group when compared with those in the control group. The APACHEII, SOFA and Ranson scores of the two groups were analyzed, and there was no difference between the two groups before treatment (P > 0.05). After treatment, the score of the study group was lower than that of the control group (P < 0.05).ConclusionCRRT with topical citrate + low-dose LMW heparin‑calcium anticoagulation in the treatment of patients with SAP reduces the levels of WBC, CRP, and PCT and the concentrations of cytokines, including IL-6, IL-8, and TNF-α. This inhibits the release of inflammatory mediators in patients with SAP and reduces damage to the body caused by the inflammatory response, thus effectively improving the patients' condition.     

Th1/Th2 cytokine levels: A potential diagnostic tool for patients with necrotizing fasciitis

IntroductionNecrotizing fasciitis (NF) has emerged as rare but rapidly progressive, life-threatening severe skin and soft tissue infection. We conducted a study to investigate whether Th1/Th2 cytokines could serve as biomarkers to distinguish NF from class III skin and soft tissue infections (SSTIs).MethodsA retrospective review was performed for 155 patients suffering from serious skin and soft tissue infections from October 2020 to February 2022. Th1/Th2 cytokines were obtained from peripheral blood and wound drainage fluid samples. Data on demographic characteristics, causative microbiological organisms, Th1/Th2 cytokines, c-reactive protein, procalcitonin and white blood cell (WBC) were extracted for analysis. Factors with statistical difference(p < 0.1) were included in the multivariate logistic regression model. The clinical differential diagnostic values of interleukin-2(IL-2), IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-r (IFN-r) were analyzed by receiver operating characteristic (ROC) curve.ResultsAmong the 155 patients, 66(43%) patients were diagnosed as NF. We found no significant difference for sex, age, location of infection, coexisting condition, predisposition, duration of symptoms before admission and micro-organisms, WBC, procalcitonin and c-reactive protein in NF and class III SSTIs group. NF had higher levels of IL-6 in serum (50.46 [24.89, 108.89] vs. 11.87 [5.20, 25.32] pg/ml; p＜0.01), IL-10 in serum (3.45 [2.03, 5.12] vs. 2.51 [1.79, 3.29] pg/ml; p＜0.01), IL-2 in wound drainage fluid (0.89 [0.49, 1.33] vs. 0.63 [0.14, 1.14] pg/ml; p = 0.02), IL-6 in wound drainage fluid (5000.84 [1392.30, 13287.19] vs. 1927.82 (336.65, 6759.27) pg/ml; p＜0.01), TNF-a in wound drainage fluid (5.20 [1.49, 22.97] vs. 0.96 [0.12, 3.21] pg/ml; p＜0.01) and IFN-r in wound drainage fluid (1.32 [0.47, 4.62] vs. 0.68 [0.10, 1.88] pg/ml; p = 0.02) as compared to the class III SSTIs. Multivariate logistic regression analyses showed that IL-6 in serum, IL-10 in serum and TNF-a in wound drainage fluid exhibited independently significant associations with diagnosis of NF(p＜0.05). In ROC curve analysis of IL-2, IL-6, IL-10, TNF-a and IFN-r for diagnosis of NF, the area under the curve (AUC) of IL-6 in serum could reach to 0.80 (p＜0.001). Using 27.62 pg/ml as the cut off value, the sensitivity was 74% and the specificity was 79% in IL-6 in serum.ConclusionsTh1/Th2 cytokines, IL-6 in serum in particular, are potential biomarkers for the diagnosis of NF in the early stage. However, larger patient populations with multiple centers and prospective studies are necessary to ensure the prognostic role of Th1/Th2 cytokines.     

甲状腺结节微波消融术后体温及炎性指标变化规律及其意义

目的观察微波消融(MWA)治疗甲状腺结节后患者体温及炎性指标变化,并探讨其意义。方法选取93例接受MWA治疗的甲状腺结节患者(160枚结节)。测量消融前及消融后30 min、12 h、24 h及48 h时腋下体温;于消融前及消融后24 h检测白细胞(WBC)、中性粒细胞百分比(NEU%)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-1(IL-1)、IL-2、IL-6、IL-8及肿瘤坏死因子(TNF)水平。结果93例均一次性完全消融,消融时间60~862 s,平均(259.11±209.85)s。消融前后各时间点腋下体温总体比较差异无统计学意义(F=0.384,P=0.820)。消融后24 h,患者WBC、IL-6、IL-8、TNF均高于消融前(P均<0.05),消融前后NEU%、ESR、CRP、IL-1、IL-2差异无统计学意义(P均>0.05)。结论MWA治疗甲状腺结节可引起部分炎性因子改变,但程度较轻,术后患者体温轻微波动。     

Evaluation of inflammatory-response-induced thoracoscopic surgical stress

OBJECTIVE: Due to the paucity of reports evaluating stress induced by thoracoscopic surgery with minithoracotomy, we assessed this stress based on the inflammatory response to surgery. METHODS: Differences in pre- and postoperative peripheral white blood cell (WBC) count, serum C-reactive protein (CRP), and serum interleukin-6 (IL-6) were evaluated, defined as dW, dCRP, and dIL-6. Thoracoscopic partial lung resection cases were divided into 2 groups by access route: Group A patients in which surgery was concluded via several small access ports. and Group B patients going surgery via small access ports plus minithoracotomy. We also compared dW in standard lobectomy with exploratory thoracotomy (thoracotomy without lobectomy) cases. RESULTS: No significant difference was seen in dW, dCRP, or dIL-6 between groups. dW in response to exploratory thoracotomy was lower than that in standard lobectomy (p = 0.06). CONCLUSIONS: Surgical stress induced by thoracoscopic partial lung resection does not increase significantly when minithoracotomy is added. Postoperative inflammatory response may, however, be influenced by the extent of surgical trauma.     

超声刀在开放小切口甲状腺切除术中的应用及对术后创伤应激反应、血钙水平与喉返神经损伤的影响

目的探讨超声刀在开放小切口甲状腺切除术中应用疗效,并观察术后患者创伤应激反应、血清钙离子水平及喉返神经(RLN)损伤情况。方法以我院进行甲状腺切除术患者80例为研究对象,根据患者则术式不同分为观察组与对照组,对照组(40例)予以传统甲状腺切除术,观察组(40例)予以超声刀小切口甲状腺切除术。比较两组手术时间、术中出血量、术后引流量等手术情况,并检测两组术前、术后3 d白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(procalcition,PCT)等术后创伤应激水平,监测喉返神经损伤程度及血钙变化情况。结果观察组手术时间、术中出血量及术后引流量等手术情况均明显优于对照组,差异均显著(P0.05);两组WBC、CRP、PCT等创伤应激指标较术前均显著升高,且对照组上升幅度均明显高于观察组,差异显著(P0.05);对照组低血钙发生率42.5%,明显高于观察组20.0%,组间差异显著(P0.05);对照组暂时性RLNI 17.5%,明显高于观察组5.0%。结论超声刀在开放性小切口甲状腺切除术中可有效降低术后创伤应激反应,减少钙代谢紊乱及喉返神经损伤,且手术时间短、出血量少,手术效果显著。