连续肾替代治疗对严重烧伤脓毒症患者血浆内毒素和细胞因子水平的影响

目的　分析连续肾替代治疗 (continuousrenalreplacementtherapy,CRRT)对严重烧伤脓毒症患者血浆内毒素和细胞因子水平的影响。　方法　对 10例应用CRRT及 10例应用常规疗法治疗的严重烧伤脓毒症患者血浆内毒素和细胞因子 (TNFα、IL 1β、IL 6、IL 8)浓度变化进行比较分析。　结果　严重烧伤脓毒症患者应用CRRT后血浆内毒素、细胞因子浓度较治疗前明显下降 ,其下降速度与常规治疗组比较差异有非常显著性意义 (P <0 .0 1)。　结论　严重烧伤脓毒症患者应用CRRT能有效降低血浆内毒素和细胞因子浓度     

生物标志物联合检测在脓毒症相关急性肝损伤患者中的应用价值

目的:探讨生物标志物联合检测对脓毒症相关急性肝损伤患者的早期诊断和预后评估的价值。方法:收集内蒙古科技大学包头医学院第一附属医院重症医学科(ICU)2019年11月-2022年1月收治的104例脓毒症患者临床资料,按照入ICU时是否发生急性肝损伤分为脓毒症相关急性肝损伤组(n=42)和非肝损伤组(n=62),将脓毒症相关急性肝损伤患者按28 d是否存活分为存活组(n=16)和死亡组(n=26),记录104例患者入ICU 6 h内血清正五聚蛋白3(PTX-3)、C-反应蛋白(CRP)、降钙素原(PCT)、总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、凝血酶原时间国际标准化比值(INR值)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、血小板(PLT)、入ICU 24 h内急性生理与慢性健康状况评估量表II(APACHEII)评分最差值及序贯器官衰竭评估(SOFA)评分;同时记录脓毒症相关急性肝损伤患者28 d预后。PTX-3的相关性采用Spearman相关分析;绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),分析各指标单独检测以及联合检测对脓毒...     

Measure of association between selenium status and sepsis in cattle

Odds ratio was used to evaluate relationship between sepsis in cattle less than 1 year old and mastitis in cows and erythrocyte glutathione peroxides (GSH-PX) activity as an indicator of selenium status. Data were from 178 blood samples collected from referred cases to Urmia University, Veterinary Teaching Hospital. Low activity of GSH-PX was significantly associated with higher odds of developing sepsis (P=0.005) in young cattle and mastitis (P=0.044) in adult cows. The odds ratios for the low activity of GSH-PX on incidence of sepsis and mastitis were 4.74 and 3.95, respectively. Selenium deficiency was associated with sepsis in young cattle and mastitis in cows, i.e., cattle with low activity of erythrocyte GSH-PX were at increased risk of sepsis and mastitis.     

Inhibition of interleukin-6 synthesis in an animal model of septic shock by anti-C5a monoclonal antibodies

The complement activation fragment C5a was recently shown to induce interleukin (IL)-6 synthesis by peripheral blood mononuclear cells. To understand better the role of C5a in cytokine regulation in vivo, we investigated the effects of complement depletion by cobra venom factor (CVF) or of anti-C5a monoclonal antibodies (mAb) on IL-6 generation in an animal model of septic shock. Complement-depleted pigs which were subsequently challenged with Escherichia coli generated significantly (p < 0.05) less IL-6 during the 6-h observation period than complement-sufficient controls. To address specifically the role of C5a in IL-6 regulation, we produced a C5a(57–74) peptide-specific mAb (T13/9) which neutralizes the bioactivity of porcine C5a. The mAb T13/9 does not crossreact with the precursor protein C5. The pretreatment of pigs with anti-C5a mAb T13/9 prior to the induction of sepsis resulted in a decrease of over 75 % in serum IL-6 bioactivity compared to control animals (p < 0.0001). These results indicate a role for C5a in the modulation of IL-6 synthesis in Gram-negative bacteremia.     

闽东地区新生儿败血症54例分析

目的 为了解闽东地区新生儿败血症临床表现、主要病原菌及其药敏情况。方法 本篇回顾性分析了54例2000年2月～2003年4月闽东医院儿科住院的血培养阳性的新生儿败血症患儿的临床表现、主要病原菌、药敏实验结果。结果主要临床表现:黄疸占48.1％,少哭、少动、少吃、反应差占46.3％,外周血象WBC<10 × 109/L占37.1％。金黄色葡萄球菌败血症26例(占48.1％)和表皮葡萄球菌16例(占29.6％)为主要致病菌。几乎全部对青霉素及红霉素耐药,对菌必治与先锋V敏感率>73.1％,尚未发现耐万古霉素的菌株。结论 新生儿出现黄疸、反应差等临床表现即使血白细胞不高也需考虑败血症的可能,治疗首选抗菌素为先锋V。     

Organ specific apoptosis following polymicrobial intraperitoneal infection

Background Leukocyte apoptosis allows safe removal of potentially harmful cells and facilitates resolution of inflammation. We hypothesized that the number of apoptotic cells changes in a disproportionate fashion in parenchymal organs in response to intra-abdominal infection. Materials and methods The percentage of apoptotic cells in the liver, spleen, lung, and peripheral blood was evaluated following cecal ligation and puncture (CLP) in mice. Tissue myeloperoxidase (MPO) levels were measured as an index of neutrophil extravasation. Results Liver & spleen MPO continually increased, while lung MPO remained low after CLP. In parallel to the increase in MPO, liver & spleen apoptosis continually increased throughout the 9-day follow-up period, whereas lung apoptosis remained unchanged. Conclusions The distribution of apoptotic cells during intraperitoneal infection occurs in an organ specific manner, with significant increases in the spleen and liver. This distribution likely reflected the clearance of apoptotic cells as the inflammatory focus became contained. Supported by the American Association for the Surgery of Trauma, John H. Davis Research Scholarship, and by the Veterans Administration Merit Review Project 0005. Received 7 October 2005; returned for revision 22 November 2005; accepted by G. Wallace 23 December 2005     

Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis in adults – A systematic review and meta-analysis

Objectives

The pleiotropic effect of hydroxymethylglutaryl-CoA reductase inhibitors (statins) might have a beneficial effect in sepsis through several mechanisms. The aim was to assess the efficacy and safety of statins, compared with placebo, for the treatment of sepsis in adults.

Anastomotic insufficiency in small bowel surgery —incidence and treatment

Summary In the period 1977–1981 234 small bowel anastomoses were constructed in 143 patients. Eight anastomoses showed leakage (3.4%) and from nine anastomoses a fistula developed (3.8%): a total rate of disturbed healing of small bowel anastomoses (7.3%). In the presence of intra-abdominal infection this rate was 14.8%, in the absence of infection 0.8%. The results of treatment with oversewing and with resection and immediate anastomosis were disappointing. Better results were obtained by dismantling of the anastomosis, establishment of a split-enterostomy and reestablishment of continuity in a second stage. Mortality was 3/17 (18%). The literature is reviewed.

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Insuffizienz von Dünndarmanastomosen — Ineidenz und Therapie

Zusammenfassung In dem Zeitraum 1977–1981 wurden bei 143 Patienten 234 Dünndarmanastomosen angelegt. Acht Anastomosen zeigten eine Nahtleckage (3,4%), bei neun entwickelte sich eine Fistel (3,8%): die Gesamthäufigkeit von Wundheilungsstörungen bei Dünndarmanastomosen war 7,3%. Bei gleichzeitigem Vorliegen intraabdominaler Infektionen betrug die Häufigkeit 14,8%, ohne diese 0,8%. Die Resultate einer Therapie durch Übernähung oder Resektion mit sofort anschließender Reanastomosierung waren enttäuschend. Befriedigendere Ergebnisse wurden durch Aufheben der Anastomosen, Anlage einer split enterostomy unter Wiederherstellung der Kontinuität in einer zweiten Sitzung erzielt. Die Mortalität betrug 3/17 (18%). Ein Literaturüberblick wird gegeben.

     

新生儿败血症休克预测模型的构建——1 695例患儿回顾性研究

目的 筛选新生儿发生败血症休克的危险因素,建立新生儿败血症休克临床预测模型。方法 选取2016年1月1日—2019年12月31日重庆医科大学7家附属医疗机构中患有败血症的新生儿,根据是否发生败血症休克分为研究组和对照组。采用单因素分析、LASSO和logistic回归分析筛选危险因素。采用logistic、极端梯度提升（XGBoost）、随机森林（RF）、分类回归树（CART）和人工神经网络（ANN）建立新生儿败血症休克预测模型,根据灵敏度、特异度、曲线下面积等指标评估模型性能。结果 本研究中,共有339名败血症新生儿发生败血症休克,1 356名败血症新生儿未发生败血症休克。单因素分析筛选出31项差异指标,多因素分析筛选出12项独立危险因素。测试集中,logistic、XGBoost、RF、CART、ANN模型的曲线下面积分别为0.856 (0.809～0.903),0.861 (0.819～0.904),0.880 (0.838～0.922),0.835 (0.790～0.881),0.808 (0.756～0.860)。结论 本文构建的五种预测模型相对稳定,其中,RF模型的预测性能最佳,能为新生儿败血症休克提供较好的预测。     

脓毒血症大鼠肝脏血红素加氧酶的变化及作用

目的 :探讨脓毒血症时肝脏血红素加氧酶 (HO)的变化及作用。方法 :盲肠结扎穿孔法复制大鼠腹膜炎脓毒血症模型 ,术后 9h和 18h测心功能指标及血压 ,取肝脏测 HO活性和 MDA含量 ,NorthernBlot测 HO- 1m RNA表达。腹腔注射锌原卟啉 IX(Zn PPIX)抑制 HO活性。结果 :9h组心功能指标及血压无明显变化 ,MDA含量增加 4 9.2 % (P<0 .0 5 ) ;18h组血压下降、心功能降低 ,MDA含量升高14 1.6% (P<0 .0 1)。 9h组与 18h组 HO- 1m RNA表达分别比对照组增加 78.2 %与 83.1% ,HO活性分别比对照组升高 112 .5 % (P<0 .0 1)与 12 0 .6% (P<0 .0 1) ;应用 Zn PPIX后 ,9h组与 18h组 HO活性比未用抑制剂时分别降低 5 2 .4 % (P<0 .0 1)与 5 1.0 (P<0 .0 1) ,MDA含量分别比未用抑制剂组增高4 8.5 %与 5 6.7% ;结论 :脓毒血症时肝脏 HO- 1m RNA表达增加、HO活性增强 ,在此病理过程中 HO具有抗氧化损伤作用