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Taylor R, Zhang C, George D, Kotecha S, Abdelghaffar M, Forster T, Santos Rodrigues PD, Reisinger AC, White D, Hamilton F, Watkins WJ, Griffith DM, Ghazal P. Low circulatory levels of total cholesterol, HDL-C and LDL-C are associated with death of patients with sepsis and critical illness: systematic review, meta-analysis, and perspective of observational studies. EBioMedicine 2024; 100:104981. [PMID: 38290288 PMCID: PMC10844818 DOI: 10.1016/j.ebiom.2024.104981] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Mechanistic studies have established a biological role of sterol metabolism in infection and immunity with clinical data linking deranged cholesterol metabolism during sepsis with poorer outcomes. In this systematic review we assess the relationship between biomarkers of cholesterol homeostasis and mortality in critical illness. METHODS We identified articles by searching a total of seven electronic databases from inception to October 2023. Prospective observational cohort studies included those subjects who had systemic cholesterol (Total Cholesterol (TC), HDL-C or LDL-C) levels assessed on the first day of ICU admission and short-term mortality recorded. Meta-analysis and meta-regression were used to evaluate overall mean differences in serum cholesterol levels between survivors and non-survivors. Study quality was assessed using the Newcastle-Ottawa Scale. FINDINGS From 6469 studies identified by searches, 24 studies with 2542 participants were included in meta-analysis. Non-survivors had distinctly lower HDL-C at ICU admission -7.06 mg/dL (95% CI -9.21 to -4.91, p < 0.0001) in comparison with survivors. Corresponding differences were also seen less robustly for TC -21.86 mg/dL (95% CI -31.23 to -12.49, p < 0.0001) and LDL-C -8.79 mg/dL (95% CI, -13.74 to -3.83, p = 0.0005). INTERPRETATION Systemic cholesterol levels (TC, HDL-C and LDL-C) on admission to critical care are inversely related to mortality. This finding is consistent with the notion that inflammatory and metabolic setpoints are coupled, such that the maladaptive-setpoint changes of cholesterol in critical illness are related to underlying inflammatory processes. We highlight the potential of HDL-biomarkers as early predictors of severity of illness and emphasise that future research should consider the metabolic and functional heterogeneity of HDLs. FUNDING EU-ERDF-Welsh Government Ser Cymru programme, BBSRC, and EU-FP7 ClouDx-i project (PG).
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Affiliation(s)
- Rory Taylor
- Deanery of Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, UK.
| | - Chengyuan Zhang
- Department of Anaesthesia, Critical Care and Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Deslit George
- School of Medicine, University of Cardiff, Cardiff, UK
| | - Sarah Kotecha
- Department of Child Health, School of Medicine, University of Cardiff, Cardiff, UK
| | | | | | | | - Alexander C Reisinger
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Daniel White
- Project Sepsis, Systems Immunity Research Institute, School of Medicine, University of Cardiff, Cardiff, UK
| | - Fergus Hamilton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - W John Watkins
- Dept of Immunity and Infection, School of Medicine, Cardiff University, Cardiff, UK
| | - David M Griffith
- Anaesthesia, Critical Care and Pain, Molecular, Genetics, and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Peter Ghazal
- Project Sepsis, Systems Immunity Research Institute, School of Medicine, University of Cardiff, Cardiff, UK.
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Sanaie S, Dolati S, Montazer M, Ranjbari S, Fathalizadeh A, Shadvar K, Faramarzi E, Mahmoodpoor A. Lipid Profile as a Predictive Marker for Organ Dysfunction after Thoracoabdominal Surgery: A Cross-sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:465-473. [PMID: 37786464 PMCID: PMC10541545 DOI: 10.30476/ijms.2022.95364.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 09/24/2022] [Indexed: 10/04/2023]
Abstract
Background Plasma total cholesterol is considered a negative acute phase reactant. In various pathological conditions, such as trauma, sepsis, burns, and liver dysfunction, as well as post-surgery, serum cholesterol level decreases. This study aimed to investigate the role of lipid profiles in determining the probability of organ dysfunction after surgery. Methods This cross-sectional study included patients who underwent thoracoabdominal surgery and were admitted to the intensive care unit of Imam Reza Hospital in Tabriz, Iran, between October 2016 and September 2018. During the first two days of admission, blood samples were taken, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and albumin were measured. The relation between the changes in these laboratory markers and six organ functions including cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use were investigated. The independent t test was used to compare continuous variables. The association between different variables and organ dysfunction and mortality was evaluated by using logistic regression. Results The serum TC increased the risk of mortality (OR=1.09, 95%CI=1.06-1.11, P<0.001), renal dysfunction (OR=1.09, 95%CI=1.06-1.12; P<0.001), liver dysfunction (OR=1.07, 95%CI=1.03-1.10; P<0.001), respiratory dysfunction (OR=1.08, 95%CI=1.05-1.13; P<0.001). Moreover, LDL, HDL, and TG were found to be inversely related to mortality, organ dysfunction, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use. Conclusion TC could be considered a risk factor for mortality, organ dysfunction, and clinical outcomes. On the other hand, LDL, HDL, and TG played a protective role in the patients' mortality, organ dysfunction, and clinical outcomes.
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Affiliation(s)
- Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Montazer
- Department of Cardiothoracic Surgeries, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarina Ranjbari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezoo Fathalizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Gill PK, Hegele RA. Low cholesterol states: clinical implications and management. Expert Rev Endocrinol Metab 2023; 18:241-253. [PMID: 37089071 DOI: 10.1080/17446651.2023.2204932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Hypocholesterolemia results from genetic - both monogenic and polygenic - and non-genetic causes and can sometimes be a source of clinical concern. We review etiologies and sequelae of hypocholesterolemia and therapeutics inspired from genetic hypocholesterolemia. AREAS COVERED Monogenic hypocholesterolemia disorders caused by the complete absence of apolipoprotein (apo) B-containing lipoproteins (abetalipoproteinemia and homozygous hypobetalipoproteinemia) or an isolated absence of apo B-48 lipoproteinemia (chylomicron retention disease) lead to clinical sequelae. These include gastrointestinal disturbances and severe vitamin deficiencies that affect multiple body systems, i.e. neurological, musculoskeletal, ophthalmological, and hematological. Monogenic hypocholesterolemia disorders with reduced but not absent levels of apo B lipoproteins have a milder clinical presentation and patients are protected against atherosclerotic cardiovascular disease. Patients with heterozygous hypobetalipoproteinemia have somewhat increased risk of hepatic disease, while patients with PCSK9 deficiency, ANGPTL3 deficiency, and polygenic hypocholesterolemia typically have anunremarkable clinical presentation. EXPERT OPINION In patients with severe monogenic hypocholesterolemia, early initiation of high-dose vitamin therapy and a low-fat diet are essential for optimal prognosis. The molecular basis of monogenic hypocholesterolemia has inspired novel therapeutics to help patients with the opposite phenotype - i.e. elevated apo B-containing lipoproteins. In particular, inhibitors of PCSK9 and ANGPTL3 show important clinical impact.
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Affiliation(s)
- Praneet K Gill
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 2023; 408:113. [PMID: 36859650 DOI: 10.1007/s00423-023-02851-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE The Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC. METHODS We retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling. RESULTS Severe POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257 min), blood loss (≥ 30 mL), albumin (< 4.0 g/dL), CRP (≥ 1.0 mg/dL), total cholesterol (≤ 180 mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257 min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers. CONCLUSION The NPS is a valuable predictor of severe POCs in RC.
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Association Between Hypocholesterolemia and Mortality in Critically Ill Patients With Sepsis: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0860. [PMID: 36751516 PMCID: PMC9894355 DOI: 10.1097/cce.0000000000000860] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To ascertain the association between cholesterol and triglyceride levels on ICU admission and mortality in patients with sepsis. DATA SOURCES Systematic review and meta-analysis of published studies on PubMed and Embase. STUDY SELECTION All observational studies reporting ICU admission cholesterol and triglyceride levels in critically ill patients with sepsis were included. Authors were contacted for further data. DATA EXTRACTION Eighteen observational studies were identified, including 1,283 patients with a crude overall mortality of 33.3%. Data were assessed using Revman (Version 5.1, Cochrane Collaboration, Oxford, United Kingdom) and presented as mean difference (MD) with 95% CIs, p values, and I 2 values. DATA SYNTHESIS Admission levels of total cholesterol (17 studies, 1,204 patients; MD = 0.52 mmol/L [0.27-0.77 mmol/L]; p < 0.001; I 2 = 91%), high-density lipoprotein (HDL)-cholesterol (14 studies, 991 patients; MD = 0.08 mmol/L [0.01-0.15 mmol/L]; p = 0.02; I 2 = 61%), and low-density lipoprotein (LDL)-cholesterol (15 studies, 1,017 patients; MD = 0.18 mmol/L [0.04-0.32 mmol/L]; p = 0.01; I 2 = 71%) were significantly lower in eventual nonsurvivors compared with survivors. No association was seen between admission triglyceride levels and mortality (15 studies, 1,070 patients; MD = 0.00 mmol/L [-0.16 to 0.15 mmol/L]; p = -0.95; I 2 = 79%). CONCLUSIONS Mortality was associated with lower levels of total cholesterol, HDL-cholesterol, and LDL-cholesterol, but not triglyceride levels, in patients admitted to ICU with sepsis. The impact of cholesterol replacement on patient outcomes in sepsis, particularly in at-risk groups, merits investigation.
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Montague B, Summers A, Bhawal R, Anderson ET, Kraus-Malett S, Zhang S, Goggs R. Identifying potential biomarkers and therapeutic targets for dogs with sepsis using metabolomics and lipidomics analyses. PLoS One 2022; 17:e0271137. [PMID: 35802586 PMCID: PMC9269464 DOI: 10.1371/journal.pone.0271137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Sepsis is a diagnostic and therapeutic challenge and is associated with morbidity and a high risk of death. Metabolomic and lipidomic profiling in sepsis can identify alterations in metabolism and might provide useful insights into the dysregulated host response to infection, but investigations in dogs are limited. We aimed to use untargeted metabolomics and lipidomics to characterize metabolic pathways in dogs with sepsis to identify therapeutic targets and potential diagnostic and prognostic biomarkers. In this prospective observational cohort study, we examined the plasma metabolomes and lipidomes of 20 healthy control dogs and compared them with those of 21 client-owned dogs with sepsis. Patient data including signalment, physical exam findings, clinicopathologic data and clinical outcome were recorded. Metabolites were identified using an untargeted mass spectrometry approach and pathway analysis identified multiple enriched metabolic pathways including pyruvaldehyde degradation; ketone body metabolism; the glucose-alanine cycle; vitamin-K metabolism; arginine and betaine metabolism; the biosynthesis of various amino acid classes including the aromatic amino acids; branched chain amino acids; and metabolism of glutamine/glutamate and the glycerophospholipid phosphatidylethanolamine. Metabolites were identified with high discriminant abilities between groups which could serve as potential biomarkers of sepsis including 13,14-Dihydro-15-keto Prostaglandin A2; 12(13)-DiHOME (12,13-dihydroxy-9Z-octadecenoic acid); and 9-HpODE (9-Hydroxyoctadecadienoic acid). Metabolites with higher abundance in samples from nonsurvivors than survivors included 3-(2-hydroxyethyl) indole, indoxyl sulfate and xanthurenic acid. Untargeted lipidomic profiling revealed multiple sphingomyelin species (SM(d34:0)+H; SM(d36:0)+H; SM(d34:0)+HCOO; and SM(d34:1D3)+HCOO); lysophosphatidylcholine molecules (LPC(18:2)+H) and lipophosphoserine molecules (LPS(20:4)+H) that were discriminating for dogs with sepsis. These biomarkers could aid in the diagnosis of dogs with sepsis, provide prognostic information, or act as potential therapeutic targets.
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Affiliation(s)
- Brett Montague
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - April Summers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Ruchika Bhawal
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Elizabeth T. Anderson
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Sydney Kraus-Malett
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Sheng Zhang
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
- * E-mail:
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Behling-Kelly E, Haak CE, Carney P, Waffle J, Eaton K, Goggs R. Acute phase protein response and changes in lipoprotein particle size in dogs with systemic inflammatory response syndrome. J Vet Intern Med 2022; 36:993-1004. [PMID: 35420224 PMCID: PMC9151453 DOI: 10.1111/jvim.16420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background Improved methodology to measure acute phase proteins and determination of lipoprotein particle‐size distribution (PSD) could be clinically useful in dogs with systemic inflammatory processes. Objectives Evaluate an immunoturbidometric assay for serum amyloid A (SAA) and lipoprotein PSD in dogs with sepsis, nonseptic systemic inflammation, and in healthy controls. Correlate dyslipidemic changes with SAA and C‐reactive protein (CRP) concentrations. Animals Twenty‐five dogs with sepsis, 15 dogs with nonseptic systemic inflammation, and 22 healthy controls. Methods Prospective, case‐control study. Variables included SAA, CRP, and electrophoretic subfractionation of high‐ and low‐density lipoproteins (HDL, LDL). Continuous variables were compared using ANOVA or Kruskal‐Wallis tests with linear regression or Spearman's rank correlation used to assess relationships between variables. Results Median SAA and CRP concentrations were greater in dogs with sepsis (SAA 460 mg/L, interquartile range [IQR] 886 mg/L; CRP 133.2 mg/L, IQR 91.6 mg/L) and nonseptic inflammation (SAA 201 mg/L, IQR 436 mg/L; CRP 91.1 mg/L, IQR 88.6 mg/L) compared to healthy dogs (SAA 0.0 mg/L, IQR 0.0 mg/L; CRP 4.9 mg/L, IQR 0.0 mg/L) P < .0001. A cutoff of >677.5 mg/L SAA was 43.2% sensitive and 92.3% specific for sepsis. Low‐density lipoprotein was higher in dogs with sepsis 29.6%, (mean, SD 14.6) compared to 14.4% (mean, SD 5.6) of all lipoproteins in healthy controls (P = .005). High‐density lipoprotein was not associated with CRP but was negatively correlated with SAA (rs −0.47, P < .0001). Subfractions of LDL and HDL differed between groups (all P < .05). Conclusions and Clinical Importance Measurement of SAA using the immunoturbidometric assay evaluated in this study and lipoprotein PSD in dogs with inflammation might help distinguish septic from nonseptic causes of inflammation.
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Affiliation(s)
- Erica Behling-Kelly
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Carol E Haak
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Patrick Carney
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Jessica Waffle
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Kelly Eaton
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
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Zhu S, Li Y, Gao H, Hou G, Cui X, Chen S, Ding C. Identification and assessment of pulmonary Cryptococcus neoformans infection by blood serum surface-enhanced Raman spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 260:119978. [PMID: 34077861 DOI: 10.1016/j.saa.2021.119978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/06/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
Cryptococcus neoformans (C. neoformans) is a causative agent for acute pulmonary infection, which can further develop to lethal meningoencephalitis if untreated. The meningoencephalitis infection can be prevented, if timely treatment on pulmonary cryptococcal infection can be implemented based on its early diagnosis and accurate assessment. In this study, blood serum surface-enhanced Raman spectroscopy (SERS) method was investigated on identification and assessment of pulmonary C. neoformans infection. The serum SERS measurements were collected from the mice infected with C. neoformans and the healthy mice, in which the infected mice were further divided into four subgroups according to the duration of infection. Based on those SRES measurements, biochemical differences were analyzed among those different groups to investigate the potential biomarkers for identifying and assessing the pulmonary C. neoformans infection. Furthermore, partial least square (PLS) analysis followed by linear discriminant analysis (LDA) model was employed to identify pulmonary cryptococcal infection and to assess the degrees of infection with the accuracies of 96.7% and 85.3%, respectively. Therefore, our study has demonstrated the great clinical potential of using serum SERS technique for an accurate identification and assessment of pulmonary cryptococcal infection.
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Affiliation(s)
- Shanshan Zhu
- Research Institute for Medical and Biological Engineering, Ningbo University, Ningbo 315211, China; College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
| | - Yanjian Li
- College of Life and Health Sciences, Northeastern University, Shenyang 110169, China
| | - Han Gao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China; National Center of Respiratory Medicine, China
| | - Xiaoyu Cui
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, China
| | - Shuo Chen
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, China.
| | - Chen Ding
- College of Life and Health Sciences, Northeastern University, Shenyang 110169, China.
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Lee JH, Liu A, Park JH, Kato H, Hao Q, Zhang X, Zhou L, Lee JW. Therapeutic Effects of Hyaluronic Acid in Peritonitis-Induced Sepsis in Mice. Shock 2020; 54:488-497. [PMID: 31977961 PMCID: PMC7369239 DOI: 10.1097/shk.0000000000001512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Intra-abdominal infection is the second most common cause of sepsis, and the mortality rate from abdominal sepsis remains high. High molecular weight (HMW) hyaluronic acid (HA) has been studied in sterile injury models as an anti-inflammatory and anti-permeability agent. This study evaluated the therapeutic effects of intraperitoneal HMW HA administration in mice with peritonitis-induced sepsis. Sepsis was induced in C57BL/6 mice by cecal ligation and puncture (CLP), followed 4 h later by an intraperitoneal injection of HMW HA (20 mg/kg) solution or phosphate buffered saline (PBS). Survival, physiological data, organ injury, bacterial burden, and inflammatory cytokine levels were assessed in the CLP mice. To assess the effect of HA on macrophage phagocytosis activity, RAW264.7 cells, primed with lipopolysaccharide, were exposed with either PBS or HMW HA (500 μg/mL) prior to exposure to 10 CFU of E coli bacteria. HMW HA instillation significantly improved blood oxygenation, lung histology, and survival in CLP mice. Inflammatory cytokine levels in the plasma and bacterial burdens in the lung and spleen were significantly decreased by HA administration at 24 h after CLP. At 6 h after CLP, HA significantly decreased bacterial burden in the peritoneal lavage fluid. HMW HA administration significantly increased E coli bacterial phagocytosis by RAW264.7 cells in part through increased phosphorylation of ezrin/radixin/moesin, a known downstream target of CD44 (a HA receptor); ezrin inhibition abolished the enhanced phagocytosis by RAW264.7 cells induced by HA. Intraperitoneal administration of HMW HA had therapeutic effects against CLP-induced sepsis in terms of suppressing inflammation and increasing antimicrobial activity.
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Affiliation(s)
- Jae Hoon Lee
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Airan Liu
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Jeong-Hyun Park
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Hideya Kato
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Qi Hao
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Xiwen Zhang
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Li Zhou
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
| | - Jae-Woo Lee
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California
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Shin HJ, Roh CK, Son SY, Hoon H, Han SU. Prognostic value of hypocholesterolemia in patients with gastric cancer. Asian J Surg 2020; 44:72-79. [PMID: 32912730 DOI: 10.1016/j.asjsur.2020.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/04/2020] [Accepted: 08/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND According to previous studies, low serum total cholesterol (TC) is associated with higher cancer incidence and mortality. However, the prognostic implications of preoperative TC in patients with gastric cancer (GC) remain to be determined. METHODS A total of 1251 patients with GC, who underwent radical gastrectomy between 2005 and 2008, were recruited. Propensity score weighting (PSW) based on a generalized boosted method (GBM) was used to control for selection bias. RESULTS After balancing the preoperative and operative covariates, low TC was associated with high incidence of complications (severe complication rate: 15.2% (Low TC) vs. 4.7% (Normal TC) vs 5.5% (High TC); p = 0.004). In multivariable analysis, lowering TC was associated with poor OS and RFS in weighted population. [OS: hazard ratio (HR) = 0.92; 95% CI = 0.867-0.980; P = 0.009 and RFS: HR = 0.93; 95% CI = 0.873-0.988; P = 0.02]. CONCLUSIONS Preoperative TC is a useful predictor of postoperative survival and postoperative complications in patients with stage I-III GC and may help to identify high-risk patients for rational therapy, including nutritional support, and timely follow-up.
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Affiliation(s)
- Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Acute and Critical Care Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chul-Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Gastric Cancer Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Gastric Cancer Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hur Hoon
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Gastric Cancer Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Gastric Cancer Center, Ajou University School of Medicine, Suwon, Republic of Korea.
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Yang JJ, Wu BB, Han F, Chen JH, Yang Y. Gene expression profiling of sepsis-associated acute kidney injury. Exp Ther Med 2020; 20:34. [PMID: 32952625 PMCID: PMC7485311 DOI: 10.3892/etm.2020.9161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/19/2020] [Indexed: 12/29/2022] Open
Abstract
Sepsis accounts for more than 50% of all acute kidney injury (AKI) cases, and the combination of sepsis and AKI increases the risk of mortality from sepsis alone. However, to the best of our knowledge, the specific mechanism by which sepsis causes AKI has not yet been fully elucidated, and there is no targeted therapy for sepsis-associated AKI (SA-AKI). The present study investigated gene expression profiles using RNA sequencing (RNA-Seq) and bioinformatics analyses to assess the function of differentially expressed genes (DEGs) and the molecular mechanisms relevant to the prognosis of SA-AKI. From the bioinformatics analysis, 2,256 downregulated and 3,146 upregulated genes were identified (false discovery rate <0.1 and fold-change >2). Gene Ontology analysis revealed that the genes were enriched in cellular metabolic processes, cell death and apoptosis. The enriched transcription factors were v-rel reticuloendotheliosis viral oncogene homolog A and signaling transducer and activator of transcription 3. The enriched microRNAs (miRNAs or miRs) among the DEGs were miR-30e, miR-181a, miR-340, miR-466d and miR-466l. Furthermore, the enriched pathways included toll-like receptor signaling, nod-like receptor signaling and the Janus kinase/STAT signaling pathway. In conclusion, the present study identified certain prognosis-related genes, transcription factors, miRNAs and pathways by analyzing gene expression profiles of SA-AKI using RNA-Seq, which provides some basis for future experimental studies.
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Affiliation(s)
- Jing-Juan Yang
- Department of Nephrology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang 322000, P.R. China
| | - Bin-Bin Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jiang-Hua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yi Yang
- Department of Nephrology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang 322000, P.R. China.,Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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12
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Tan AWK, Epstein SE, Hopper K. Period prevalence and mortality rates associated with hypocholesterolaemia in dogs and cats: 1,375 cases. J Small Anim Pract 2020; 61:669-675. [PMID: 32767372 DOI: 10.1111/jsap.13204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/09/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022]
Abstract
To determine the period prevalence of hypocholesterolaemia and the associated mortality rates in dogs and cats at a university teaching hospital. The secondary aim was to identify disease processes associated with hypocholesterolaemia. MATERIALS AND METHODS Medical records over a 5-year period were reviewed to determine the severity of hypocholesterolaemia and its associated mortality rate. Medical records of animals with moderate to severe hypocholesterolaemia (<2.59 mmol/L in dogs, <1.81 mmol/L in cats) were analysed further. Animals with hospital-acquired hypocholesterolaemia were identified. RESULTS Among 16,977 dogs and 3,788 cats that had at least one cholesterol measurement, the period prevalence of hypocholesterolaemia was 7.0% in dogs and 4.7% in cats. The mortality rate of hypocholesteraemic dogs and cats was 12% in both species which was significantly higher than that of animals with normal serum cholesterol. The degree of hypocholesterolaemia was significantly associated with mortality. Dogs, but not cats, with hospital-acquired hypocholesterolaemia had a higher mortality rate than those presenting with hypocholesterolaemia. Disease of hepatic, gastrointestinal and lymphoreticular systems were most commonly associated with hypocholesterolaemia, and infectious and neoplastic disease were the most commonly associated pathophysiologic processes in both species. Lymphoma was over-represented in dogs with neoplasia. CLINICAL SIGNIFICANCE Hypocholesterolaemia is not a frequent abnormality but was associated with mortality in this study and may be a negative prognostic indicator. It is not known if hypocholesterolaemia is simply a marker for disease severity, or if it is has active physiologic effects contributing to poor outcomes.
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Affiliation(s)
- A W K Tan
- William R. Pritchard, Veterinary Medical Teaching Hospital, University of California, Davis, 1 Garrod Dr, Davis, CA, 95616, USA
| | - S E Epstein
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 2112 Tupper Hall, Davis, CA, 95616, USA
| | - K Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 2112 Tupper Hall, Davis, CA, 95616, USA
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13
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Bowman C, Viall A, Rudinsky A, Gilor C, Palerme JS. Hypocholesterolemia in cats: a multicenter retrospective study of 106 cats. J Feline Med Surg 2020; 22:768-773. [PMID: 31710272 PMCID: PMC10814506 DOI: 10.1177/1098612x19886398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to describe the clinicopathologic findings and associated diseases found in a population of hypocholesterolemic cats referred to two tertiary care facilities. METHODS An electronic medical record search was performed at two veterinary university referral centers to identify cats with serum cholesterol values below the reference interval between January 2004 and 2016. Clinicopathologic data were reviewed for each case and cats were classified into specific disease categories based on clinical diagnosis. Median cholesterol values were compared between disease categories, as well as between survivors and non-survivors. RESULTS In total, 106 hypocholesterolemic cats were included. The median age of the cats was 6 years (range 0.24-18 years). The most common disease categories were gastrointestinal (25.9%), hepatobiliary (19.8%), hematologic (14.8%) and urogenital (14.8%). Though median serum cholesterol values did not differ significantly between survivors and non-survivors, cats with concurrent hypoalbuminemia were at higher risk (odds ratio 15.6, 95% confidence interval 5.2-46.6; P <0.0001) of not surviving to discharge than cats with normal serum albumin concentrations. CONCLUSIONS AND RELEVANCE Taken together, our data suggest that while the degree of hypocholesterolemia did not appear to influence survival rates, the concurrent presence of hypocholesterolemia and hypoalbuminemia was associated with a worse prognosis.
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Affiliation(s)
- Claudia Bowman
- VCA Care Specialty and Emergency Animal Hospital, Santa Barbara, CA, USA
| | - Austin Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Adam Rudinsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Jean-Sébastien Palerme
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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14
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Viall AK, McNamee AL, Olsen LE, Deitz KL, Hostetter SJ. Prognostic value of dyslipidemia for sick dogs hospitalized in the intensive care unit of a veterinary teaching hospital. J Am Vet Med Assoc 2020; 254:699-709. [PMID: 30835179 DOI: 10.2460/javma.254.6.699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the lipidemia status and serum concentrations of cholesterol and triglycerides of dogs when initially examined for hospitalization in the intensive care unit (ICU) of a veterinary teaching hospital and to determine whether these variables were predictive of survival to hospital discharge. DESIGN Retrospective cohort study. ANIMALS 549 client-owned sick (n = 398) and healthy (151) dogs. PROCEDURES Medical records of sick dogs hospitalized in the ICU at a veterinary teaching hospital between January 1, 2012, and September 30, 2015, and of healthy dogs evaluated at the teaching hospital during the same time frame were reviewed. Data collection included signalment, results of initial physical and clinicopathologic examinations, treatments, diagnosis, and survival to hospital discharge. Lipidemia status and serum concentrations of cholesterol and triglycerides were compared between healthy and sick dogs and between sick dogs that did and did not survive to hospital discharge. Regression analysis was performed to determine whether these variables were predictive of survival to hospital discharge in dogs. RESULTS Factors associated with increased odds of sick dogs not surviving to hospital discharge were hypocholesterolemia (OR, 1.87; 95% confidence interval [CI], 1.04 to 3.34), hypertriglyceridemia (OR, 3.20; 95% CI, 2.00 to 5.13), and concurrent hypocholesterolemia and hypertriglyceridemia (OR, 55.7; 95% CI, 3.2 to 959.6) at the time of initial evaluation. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that hypocholesterolemia and hypertriglyceridemia, alone or in combination, at initial examination were negative prognostic indicators for survival of dogs hospitalized in the ICU and that these conditions were easily identified with routine serum clinicopathologic analyses. (J Am Vet Med Assoc 2019;254:699-709).
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15
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Hrabovsky V, Blaha V, Hyspler R, Ticha A, Skrobankova M, Svagera Z. Changes in cholesterol metabolism during acute upper gastrointestinal bleeding: liver cirrhosis and non cirrhosis compared. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:253-258. [DOI: 10.5507/bp.2018.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/13/2018] [Indexed: 11/23/2022] Open
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16
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Webber DM, Scott MG. A 69-Year-Old Woman with Markedly Decreased Cholesterol. Clin Chem 2018; 64:982-983. [PMID: 29844063 DOI: 10.1373/clinchem.2017.281279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/19/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel M Webber
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
| | - Mitchell G Scott
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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17
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Golucci APBS, Marson FAL, Ribeiro AF, Nogueira RJN. Lipid profile associated with the systemic inflammatory response syndrome and sepsis in critically ill patients. Nutrition 2018; 55-56:7-14. [PMID: 29960160 DOI: 10.1016/j.nut.2018.04.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/22/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Changes in lipid profiles occur in systemic inflammatory response syndrome (SIRS), whether due to sepsis or another cause. Hypocholesterolemia associated with hypertriacylglycerolemia can lead to disease severity and higher mortality. The aim of this systematic review was to describe the principal alterations in markers that participate in the alteration of the lipid profile. METHODS We reviewed articles focused on alterations in the lipid profile in SIRS, sepsis, or both that were indexed in the Scientific Electronic Library Online from 2000 to 2017. The descriptors used were SIRS; sepsis; lipid profile; and lipoproteins. We focused in particular on the relationships among SIRS, sepsis, and lipid profiles. RESULTS We included 29 studies that discussed decreased high-density lipoprotein (HDL), total cholesterol, and low-density lipoprotein, and elevated triacylglycerols concentrations in patients with SIRS, sepsis, or both. The variation in the lipid profile was proportional to the level of inflammation as evaluated by inflammatory markers, including C-reactive protein, interleukin-6 and interleukin-8, lipopolysaccharide-binding protein, and tumor necrosis factor. Additionally, there was a change in the composition of lipoproteins, especially HDL, triacylglycerols, and very low-density lipoprotein. HDL appears to be an inflammatory marker, as reduction of its levels reflects the intensity of the underlying inflammatory process. CONCLUSION Critically ill patients with SIRS, sepsis, or both presented with alterations in lipid metabolism.
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Affiliation(s)
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; Center for Research in Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Antônio Fernando Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Roberto José Negrão Nogueira
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; Center for Research in Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; São Leopoldo Mandic Faculty, São Paulo, Brazil.
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18
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Motafaker Azad M, Abbasi MA, Basharzad N, Fadaei A. Predictive Implications of Serum Lipid Metabolism over Time in Intensive Care Unit Admitted Patients. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Hardy JP, Streeter EM, DeCook RR. Retrospective evaluation of plasma cholesterol concentration in septic dogs and its association with morbidity and mortality: 51 cases (2005-2015). J Vet Emerg Crit Care (San Antonio) 2018; 28:149-156. [PMID: 29489054 DOI: 10.1111/vec.12705] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether plasma cholesterol concentrations in dogs with sepsis is associated with morbidity or in-hospital mortality. DESIGN Retrospective cohort study from 2005-2015. SETTING Two private referral centers. ANIMALS Fifty-one dogs diagnosed with sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Dogs were classified as septic if they displayed ≥2 criteria of the systemic inflammatory response syndrome in conjunction with a documented underlying infectious cause. Dogs were excluded if they had been diagnosed previously with any concurrent illness reported to alter plasma cholesterol concentrations. Plasma cholesterol concentrations at the time of sepsis diagnosis were statistically analyzed for association with morbidity, as measured by the presence of organ dysfunction, the number of dysfunctional organs, duration of hospitalization, cost of hospitalization, and in-hospital mortality. Twenty-eight (55%) dogs survived to discharge, 15 (29%) were euthanized during hospitalization, and 8 (16%) died despite treatment. While median cholesterol concentrations were significantly different when comparing survivors to discharge versus nonsurvivors who died naturally despite treatment (P = 0.0245), they were not significantly different when comparing survivors to all nonsurvivors (P = 0.1821). Receiver operating characteristic curve analysis showed a cholesterol cutoff of 4.5 mmol/L (174 mg/dL) with a sensitivity of 75% and a specificity of 50% for predicting in-hospital mortality. For surviving dogs, plasma cholesterol concentrations were not associated with increased length of hospital stay. Number of dysfunctional organs and plasma cholesterol concentration were the 2 most significant individual predictors for survival, and when incorporated into a multivariate logistic regression model used for prediction, the model yielded a sensitivity of 94% and specificity of 63%. CONCLUSION Plasma cholesterol concentration can provide prognostic information in dogs with sepsis. Further prospective studies investigating the role of cholesterol in sepsis are needed.
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Affiliation(s)
- Jack P Hardy
- Department of Emergency and Critical Care, Eastern Iowa Veterinary Specialty Center, IA, Cedar Rapids
| | - Elizabeth M Streeter
- Department of Emergency and Critical Care, Eastern Iowa Veterinary Specialty Center, IA, Cedar Rapids
| | - Rhonda R DeCook
- Department of Statistics and Actuarial Science, The University of Iowa, Iowa City, IA
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20
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Bermudes ACG, de Carvalho WB, Zamberlan P, Muramoto G, Maranhão RC, Delgado AF. Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock. Nutrition 2017; 47:104-109. [PMID: 29429528 DOI: 10.1016/j.nut.2017.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/13/2017] [Accepted: 09/17/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Limited knowledge exists regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome. The aim of this study was to evaluate the relationship between the intensity of the inflammatory response and changes in the lipid profiles of critically ill pediatric patients admitted to a pediatric intensive care unit (PICU) with severe sepsis/septic shock. METHODS This was a prospective and observational study at a 15-bed PICU at a public university hospital. We analyzed the lipid profiles of 40 patients with severe sepsis/septic shock admitted to the PICU on the first and seventh days of hospitalization. C-reactive protein was used as a marker for systemic inflammation. Forty-two pediatric patients seen in the emergency department and without systemic inflammatory response syndrome were used to provide control values. RESULTS On day 1 of admission to the PICU, the patients had significantly lower levels of total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) as well as higher concentrations of triacylglycerols compared with the control group. There was a significant increase in the TC, HDL, LDL, and apolipoprotein levels from day 1 to day 7 of the study. CONCLUSIONS During severe sepsis/septic shock, we found lower serum levels of lipoproteins and apolipoproteins, and these were negatively correlated with C-reactive protein. As the inflammatory response improved, the levels of TC, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation.
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Affiliation(s)
- Ana Carolina G Bermudes
- Pediatric Critical Care Unit, Instituto da Criança da Faculdade de Medicina, São Paulo University, São Paulo, Brazil.
| | - Werther B de Carvalho
- Pediatric Critical Care Unit, Instituto da Criança da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Patricia Zamberlan
- Division of Nutrition, Instituto da Criança da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Giovana Muramoto
- Emergency Department, Hospital Universitário, São Paulo University, São Paulo, Brazil
| | - Raul C Maranhão
- Lipid Metabolism Laboratory, Heart Institute (InCor) of the Medical School Hospital, São Paulo University, São Paulo, Brazil
| | - Artur F Delgado
- Pediatric Critical Care Unit, Instituto da Criança da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
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21
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Evans HL, Bulger EM. Infectious Complications Following Surgery and Trauma. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Plasma Phospholipid Fatty Acid Profile is Altered in Both Septic and Non-Septic Critically Ill: A Correlation with Inflammatory Markers and Albumin. Lipids 2016; 52:245-254. [DOI: 10.1007/s11745-016-4226-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
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Affiliation(s)
- R.R. Elmehdawi
- Department of Internal Medicine, Faculty of Medicine, Garyounis University, Libya
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24
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Morimoto M, Nakamura Y, Yasuda Y, Lefor AT, Nagaie T, Sata N, Hosoya Y, Horie H, Koinuma K. Serum Total Cholesterol Levels Would Predict Nosocomial Infections After Gastrointestinal Surgery. Indian J Surg 2015; 77:283-9. [PMID: 26702235 DOI: 10.1007/s12262-015-1296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
It has been suggested that total cholesterol levels and the use of statin medications are associated with the incidence of complications after gastrointestinal surgery. The aim of this study was to determine if preoperative total cholesterol levels are associated with a higher risk of postoperative infections and mortality. A total of 2211 patients undergoing general surgical procedures between December 2006 and November 2008 at Iizuka Hospital and between January 2010 and March 2012 at Jichi Medical University Hospital were reviewed. Multiple logistic regression models were used to evaluate serum total cholesterol and other variables as predictors of postoperative nosocomial infections. Serum total cholesterol concentrations lower than 160 mg/dl were associated with an increased incidence of superficial and deep incisional surgical site infections. Serum total cholesterol levels showed a reverse J-shaped relationship with the development of organ space surgical site infection and pneumonia. There was no discernible effect of serum cholesterol levels on the postoperative mortality observed in this cohort of patients. Decreased serum albumin was one of the strongest risk factors for the development of nosocomial infection after surgery. Postoperative pneumonia was not observed in patients taking statin medications whose cholesterol levels were <200 mg/dl. Serum total cholesterol may be a valid predictor of surgical outcome. Preoperative statin use may affect the development of postoperative pneumonia in patients with total cholesterol levels below 200 mg/dl.
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Affiliation(s)
- Mitsuaki Morimoto
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan ; Department of Public Health, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Yoshikazu Nakamura
- Department of Public Health, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Yoshikazu Yasuda
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Alan T Lefor
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Takashi Nagaie
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka 820-8505 Japan
| | - Naohiro Sata
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Yoshinori Hosoya
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Hisanaga Horie
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Koji Koinuma
- Department of Gastrointestinal Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
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Takaoka A, Sasaki M, Kurihara M, Iwakawa H, Inoue M, Bamba S, Ban H, Andoh A, Miyazaki Y. Comparison of energy metabolism and nutritional status of hospitalized patients with Crohn's disease and those with ulcerative colitis. J Clin Biochem Nutr 2015; 56:208-14. [PMID: 26060351 PMCID: PMC4454083 DOI: 10.3164/jcbn.14-95] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/06/2014] [Indexed: 12/18/2022] Open
Abstract
This study aimed to compare the nutritional status and energy expenditure of hospitalized patients with Crohn’s disease (CD) and those with ulcerative colitis (UC). Twenty-two hospitalized patients with CD and 18 patients with UC were enrolled in this study. We analyzed nutritional status upon admission by using nutritional screening tools including subjective global assessment, malnutrition universal screening tool, and laboratory tests. We measured resting energy expenditure (mREE) of the patients with indirect calorimetry and predicted resting energy expenditure (pREE) was calculated by using the Harris-Benedict equation. Results presented here indicate no significant difference in nutritional parameters and energy metabolism between CD and UC patients. In UC patients, a significant correlation was observed between mREE/body weight and disease activity detected by the Lichtiger and Seo indices. However, there was no correlation between mREE/body weight and Crohn’s disease activity index in CD patients. Inflammatory cytokine interleukin-6 levels correlated with mREE/pREE in CD and UC patients while tumor necrosis factor-α was not. In conclusion, energy expenditure significantly correlated with disease activity in UC patients but not in CD patients. These results indicate that establishing daily energy requirements based on disease activity of UC is imperative for improving the nutritional status of patients.
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Affiliation(s)
- Azusa Takaoka
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan ; Kyoto Women's University, Graduate School of Home Economics, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto 605-8501, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Mika Kurihara
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Hiromi Iwakawa
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Mai Inoue
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Shigeki Bamba
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Hiromitsu Ban
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Yoshiko Miyazaki
- Kyoto Women's University, Graduate School of Home Economics, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto 605-8501, Japan
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Serum lipid profile, cytokine production, and clinical outcome in patients with severe sepsis. J Crit Care 2014; 29:723-7. [DOI: 10.1016/j.jcrc.2014.04.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/28/2014] [Accepted: 04/21/2014] [Indexed: 02/04/2023]
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Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass. Crit Care Med 2014; 42:1065-73. [PMID: 24413578 DOI: 10.1097/ccm.0000000000000165] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Systemic inflammatory response syndrome and sepsis frequently occur after cardiac surgery with cardiopulmonary bypass. The aim of the present study was to investigate whether preoperative cholesterol levels can predict sepsis onset and postoperative complications in patients undergoing cardiac surgery with cardiopulmonary bypass. DESIGN Prospective observational study. SETTING Surgical ICU of a French university hospital. PATIENTS Two hundred and seventeen consecutive patients older than 18 years admitted for planned cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Measurements of plasma blood lipids and inflammation markers before anesthesia induction (baseline), at cardiopulmonary bypass start, at cardiopulmonary bypass end, and 3 and 24 hours after cardiac surgery. Outcomes were compared in systemic inflammatory response syndrome patients with sepsis (n = 15), systemic inflammatory response syndrome patients without sepsis (n = 95), and non-systemic inflammatory response syndrome patients (n = 107). MEASUREMENTS AND MAIN RESULTS A gradual decrease in plasma cholesterol concentration occurred during surgery with cardiopulmonary bypass but was no longer present after correction for hemodilution. Corrected cholesterol levels were significantly lower at baseline in sepsis patients than in other subgroups, and it remained lower in the sepsis group during and after cardiopulmonary bypass. With regard to sepsis, the discriminatory power of baseline cholesterol was fairly good as indicated by receiver operating characteristic curve analysis (area under the curve, 0.78; 95% CI, 0.72-0.84). The frequency of sepsis progressively decreased with increasing baseline cholesterol level quintiles (18.6% and 0% in the bottom and top quintiles, respectively, p = 0.005). In multivariate analysis, baseline cholesterol levels and cardiopulmonary bypass duration were significant and independent determinants of the 3-hour postcardiopulmonary bypass increase in concentrations of procalcitonin and interleukin-8, but not of interleukin-6. CONCLUSIONS Low cholesterol levels before elective cardiac surgery with cardiopulmonary bypass may be a simple biomarker for the early identification of patients with a high risk of sepsis.
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Li Y, Wang Z, Ma X, Shao B, Gao X, Zhang B, Xu G, Wei Y. Low-dose cisplatin administration to septic mice improves bacterial clearance and programs peritoneal macrophage polarization to M1 phenotype. Pathog Dis 2014; 72:111-23. [PMID: 24850793 DOI: 10.1111/2049-632x.12189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 02/05/2023] Open
Abstract
Sepsis is a systemic inflammatory response to infection, and early responses of macrophages are vital in controlling the infected microorganisms. We used a cecal ligation and puncture (CLP) model of sepsis to determine the role of cisplatin (0.1, 0.5 and 1 mg kg(-1)) with respect to peritoneal macrophages, controlling peritoneal/blood bacterial infection, and systemic inflammation. We found that mice which received low-dose (0.1 and 0.5 mg kg(-1)) i.p. cisplatin had lower mortality rate and improved clinical scores compared with mice in normal saline-treated group, and the level of IL-6 and TNF-α was significantly reduced after cisplatin administration in peritoneal fluid of mice underwent CLP. Although cisplatin had no directly bactericidal ability, the numbers of bacteria in peritoneal and blood were significantly reduced at 24 and 72 h after the onset of CLP. Besides, in vivo phagocytosis and killing assay showed that the ability of macrophage derived from peritoneum was significantly increased with cisplatin treatment (5, 10, and 15 μM) for both gram-positive (Enterococcus faecalis) and gram-negative (Escherichia coli) bacteria. This was associated with the macrophage phenotype polarization from CD11b(+) F4/80(high) CD206(-) to CD11b(+) F4/80(low) CD206(-) M1 group. These findings underscore the importance of low-dose cisplatin in the treatment of sepsis.
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Affiliation(s)
- Yanyan Li
- The Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Boehme AK, Kapoor N, Albright KC, Lyerly MJ, Rawal PV, Bavarsad Shahripour R, Alvi M, Houston JT, Sisson A, Beasley TM, Alexandrov AW, Alexandrov AV, Miller DW. Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator. J Stroke Cerebrovasc Dis 2014; 23:e271-6. [PMID: 24424334 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/29/2013] [Accepted: 11/23/2013] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Systemic inflammatory response syndrome (SIRS) is an inflammatory process associated with poor outcomes in acute ischemic stroke (AIS) patients. However, no study to date has investigated predictors of SIRS in AIS patients treated with intravenous (IV) tissue plasminogen activator (tPA). METHODS Consecutive patients were retrospectively reviewed for evidence of SIRS during their acute hospitalization. SIRS was defined as the presence of 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% bands for more than 24 hours. Those diagnosed with an infection were excluded. A scoring system was created to predict SIRS based on patient characteristics available at the time of admission. Logistic regression was used to evaluate potential predictors of SIRS using a sensitivity cutoff of ≥65% or area under the curve of .6 or more. RESULTS Of 212 patients, 44 had evidence of SIRS (21%). Patients with SIRS were more likely to be black (61% versus 54%; P = .011), have lower median total cholesterol at baseline (143 versus 167 mg/dL; P = .0207), and have history of previous stroke (51% versus 35%; P = .0810). Ranging from 0 to 6, the SIRS prediction score consists of African American (2 points), history of hypertension (1 point), history of previous stroke (1 point), and admission total cholesterol less than 200 (2 points). Patients with an SIRS score of 4 or more were 3 times as likely to develop SIRS when compared with patients with a score of ≤3 (odds ratio = 2.815, 95% confidence interval 1.43-5.56, P = .0029). CONCLUSIONS In our sample of IV tPA-treated AIS patients, clinical and laboratory characteristics available on presentation were able to identify patients likely to develop SIRS during their acute hospitalization. Validation is required in other populations. If validated, this score could assist providers in predicting who will develop SIRS after treatment with IV tPA.
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Affiliation(s)
- Amelia K Boehme
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Niren Kapoor
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen C Albright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, Birmingham, Alabama; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities Minority Health and Health Disparities Research Center, Birmingham, Alabama
| | - Michael J Lyerly
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; Stroke Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Pawan V Rawal
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Reza Bavarsad Shahripour
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Muhammad Alvi
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - J Thomas Houston
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - April Sisson
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - T Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anne W Alexandrov
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrei V Alexandrov
- Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David W Miller
- Department of Anesthesiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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Sassaki GL, Rattmann YD, Santana-Filho AP, Riter DS, Iagher F, Trindade ES, da Silva MD, Santos ARS, de Souza LM, Iacomini M, Gorin PAJ. Galactofuranosyl glycosides: immunomodulatory effects on macrophages and in vivo enhancement of lethality on sepsis. Chem Biol Interact 2013; 205:29-37. [PMID: 23756126 DOI: 10.1016/j.cbi.2013.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/09/2013] [Accepted: 05/30/2013] [Indexed: 02/08/2023]
Abstract
Galactofuranoside derivatives were synthesised by the classic Fischer glycosydation method, and their immune modulation properties were studied in vitro and in vivo. NMR spectroscopic and ESI-MS analyses confirmed the purity and authenticity of all derivatives. Their phagocyte capacities were tested in resident macrophages. Methyl β-galactofuranoside (GFB-Me) and n-octyl β-galactofuranoside (GFB-O) had an immune stimulant effect at 25μmolml(-1) with an enhancement of 35.12%±0.06 SD and 17.49%±0.11 SD, respectively, but Methyl α-galactofuranoside (GFA-Me) and n-octyl α-galactofuranoside (GFA-O) gave a low immune response. Methyl α-galactofuranoside 5,6-O-isopropylidene (GFA-IP) and Methyl β-galactofuranoside 5,6-O-isopropylidene (GFB-IP) had negative values relative to the control group of minus 4.96%±0.10 SD and -40.72%±0.07 SD, respectively. Furthermore, GFB-Me and GFB-Me-IP were evaluated in vivo on the lethality induced by cecal ligation and puncture. Cytokine levels and iNOS expression were determined and correlated to mortality data. The results showed that the free HO-5 and HO-6 and the β-configuration are essential for the induction of phagocytic activity by the galactofuranosyl units. The methyl β-galactofuranosides also enhanced lethality during sepsis, increasing the levels of pro-inflammatory cytokines and iNOS expression.
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Affiliation(s)
- Guilherme L Sassaki
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Cholesterol metabolism in acute upper gastrointestinal bleeding, preliminary observations. Wien Klin Wochenschr 2012. [DOI: 10.1007/s00508-012-0292-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Agouridis AP, Liberopoulos EN, Kostapanos MS, Elisaf MS. New-onset extremely low levels of high-density lipoprotein cholesterol. J Clin Lipidol 2012; 6:593-5. [PMID: 23312055 DOI: 10.1016/j.jacl.2012.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 11/19/2022]
Abstract
We report the case of a 55-year-old man who presented to the outpatient lipid clinic for his scheduled follow-up with severely low high-density lipoprotein cholesterol levels of new onset. Diagnostic workup showed that he was infected by visceral leishmaniasis. He was treated with liposomal amphotericin B and serum lipid levels returned to usual values.
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Affiliation(s)
- Aris P Agouridis
- Department of Internal Medicine, Medical School, University of Ioannina, 45 110 Ioannina, Greece
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Liver X receptor α activation with the synthetic ligand T0901317 reduces lung injury and inflammation after hemorrhage and resuscitation via inhibition of the nuclear factor κB pathway. Shock 2011; 35:367-74. [PMID: 20926989 DOI: 10.1097/shk.0b013e3181f7d742] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Liver X receptor α (LXRα) is a nuclear transcription factor that regulates lipid metabolism. Recently, it has been shown that activation of LXRα with synthetic ligands has anti-inflammatory effects in atherosclerosis and chemical-induced dermatitis. We investigated the effect of the LXRα agonist, T0901317, on lung inflammation in a rodent model of hemorrhagic shock. Hemorrhagic shock was induced in male rats by withdrawing blood to a goal mean arterial blood pressure of 50 mmHg. Blood pressure was maintained at this level for 3 h, at which point rats were rapidly resuscitated with shed blood. Animals were then treated with T0901317 (50 mg · kg) or vehicle i.p. and sacrificed at 1, 2, and 3 h after resuscitation. Treatment with T0901317 significantly improved the cardiac and stroke volume indices as well as the heart rate of rats during the resuscitation period as compared with vehicle-treated rats. The T0901317-treated animals showed significant improvement in the plasma level of lactate, whereas base deficit and bicarbonate levels both trended toward improvement. The T0901317-treated animals also showed lower levels of plasma cytokines and chemokines monocyte chemoattractant protein 1, macrophage inflammatory protein 1α, TNF-α, KC, and IL-6. Lung injury and neutrophil infiltration were reduced by treatment with T0901317, as evaluated by histology and myeloperoxidase assay. At molecular analysis, treatment with T0901317 increased nuclear LXRα expression and DNA binding while also inhibiting activation of nuclear factor κB, a proinflammatory transcription factor, in the lung. Thus, our data suggest that LXRα is an important modulator of the inflammatory response and lung injury after severe hemorrhagic shock, likely through the inhibition of the nuclear factor κB pathway.
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Morimoto M, Nakamura Y, Atsuko S, Nagaie T, Shirabe K. Serum Total Cholesterol in Nosocomial Infections After Gastrointestinal Surgery. World J Surg 2010; 34:2051-6. [DOI: 10.1007/s00268-010-0652-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chiarla C, Giovannini I, Giuliante F, Zadak Z, Vellone M, Ardito F, Clemente G, Murazio M, Nuzzo G. Severe hypocholesterolemia in surgical patients, sepsis, and critical illness. J Crit Care 2010; 25:361.e7-361.e12. [DOI: 10.1016/j.jcrc.2009.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 07/29/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
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Sasaki M, Johtatsu T, Kurihara M, Iwakawa H, Tanaka T, Bamba S, Tsujikawa T, Fujiyama Y, Andoh A. Energy expenditure in Japanese patients with severe or moderate ulcerative colitis. J Clin Biochem Nutr 2010; 47:32-6. [PMID: 20664728 PMCID: PMC2901761 DOI: 10.3164/jcbn.10-07] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 02/02/2010] [Indexed: 12/15/2022] Open
Abstract
We investigated the energy expenditure in hospitalized patients with severe or moderate ulcerative colitis (UC), and compared them to healthy controls. Thirteen patients (5 women and 8 men; mean age 31.8 years; mean BMI 19.0 kg/m2) and 10 healthy volunteers were enrolled in this study. The resting energy expenditure (mREE) levels were determined by indirect calorimetry. The mREEs of the UC patients were significantly higher than those of healthy controls (26.4 ± 3.6 vs 21.8 ± 1.7 kcal/kg/day), although the mREEs of the UC patients were almost the same as the predicted REEs (pREEs) calculated by the Harris-Benedict equation (26.4 ± 2.4 kcal/kg/day vs 26.5 ± 2.6 kcal/kg/day). The mREE/pREE ratio, which reflects stress, was 1.0 ± 0.15. In the UC patients, a significant correlation was observed between the mREEs and the clinical activity index. In conclusion, UC patients showed a hyper-metabolic status as evaluated by their mREE/body weight. Energy expenditure was significantly correlated with disease activity. From our observations, we recommend that nutritional management with more than 30–35 kcal/ideal body weight/day (calculated by the mREE × activity factor) may be optimal for active severe or moderate ulcerative colitis.
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Affiliation(s)
- Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
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Eachempati SR, Hydo LJ, Shou J, Barie PS. Implementation of tight glucose control for critically ill surgical patients: a process improvement analysis. Surg Infect (Larchmt) 2010; 10:523-31. [PMID: 20001333 DOI: 10.1089/sur.2009.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tight glucose control has been advocated as a method to improve outcomes of surgical critical care. However, continuous infusion of insulin has potential morbidity (e.g., neurologic consequences of hypoglycemia), and it remains unclear to what degree the glucose concentration must be controlled. We examined our performance in instituting a protocol for tight glucose control in our surgical intensive care unit (ICU). METHODS Prospective study of 220 consecutive patients (February, 2003-March, 2006) who received an infusion of insulin for glucose control for >24 h by protocol. Data collected included age, acuity (Acute Physiology and Chronic Health Evaluation [APACHE] III) score, sex, history of diabetes mellitus, organ dysfunction (Marshall), and death or survival. Infusion-related data included initial glucose concentration, time to glucose <120 mg/dL, h/day of glucose <110 mg/dL and <140 mg/dL, duration of infusion (days), insulin units/day, year of therapy, and complications. Analysis was performed by chi(2), analysis of variance, and logistic regression, with p < 0.05 considered significant. RESULTS Insulin drips were required by 10.2% of patients (287/2,804); 29 of these (10.1%) had diabetes mellitus. The mean APACHE III score for the treated patients was 77 +/- 2 (standard deviation), and the mortality rate was 24%. Hypoglycemia (<60 mg/dL) occurred in 4.2% of patients. The trigger insulin concentration decreased over time (2003 vs. 2005) from 249 +/- 14 to 160 +/- 5 mg/dL, and the h/day of glucose <140 increased from 11 +/- 1 to 16 +/- 1. However, age, acuity, APACHE III, days of insulin, time to achieve glucose <120, h/day of glucose <110, and mortality rate were unchanged. By logistic regression, only the year of treatment (odds ratio [OR] 1.871; 95% confidence interval [CI] 1.177, 2.972; p = 0.008] predicted success in controlling the blood glucose concentration to <140 mg/dL; age, illness severity, diabetes history, and trigger glucose concentration [OR 0.996; 95% CI 0.992, 1.001; p = 0.11] did not. CONCLUSIONS Success in implementing tight glucose control was modest, albeit improving, despite a specific protocol for administration. No medical reason could be identified for inability to achieve tight glucose control; therefore, successful implementation must be volitional. Education, particularly regarding hypoglycemia, and possible refinement of our protocol may improve our ability to control blood glucose in our ICU.
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Efficacy and safety of a phospholipid emulsion (GR270773) in Gram-negative severe sepsis: Results of a phase II multicenter, randomized, placebo-controlled, dose-finding clinical trial. Crit Care Med 2009; 37:2929-38. [DOI: 10.1097/ccm.0b013e3181b0266c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hrabovský V, Zadák Z, Bláha V, Hyspler R, Karlík T, Martínek A, Mendlová A. Cholesterol metabolism in active Crohn's disease. Wien Klin Wochenschr 2009; 121:270-5. [PMID: 19562284 DOI: 10.1007/s00508-009-1150-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 01/26/2009] [Indexed: 01/15/2023]
Abstract
Hypocholesterolemia has been investigated as a typical feature of critical illness and is connected with poor prognosis. Crohn's disease is an inflammatory process and is associated with several metabolic disturbances. In recent decades clinical studies have established a link between lipid metabolism and systemic inflammation. In our study we examined the serum profile of cholesterol (total cholesterol, LDL- and HDL-cholesterol) and changes in the cholesterol absorption/synthesis process by determination of plasma non-cholesterol sterol (squalene, lathosterol, campesterol, sitosterol) concentrations. Serum concentrations of total cholesterol, LDL- and HDL-cholesterol and non-cholesterol sterols were evaluated in 24 patients with active Crohn's disease during a period of 28 days. We detected lower serum levels of total cholesterol (P < 0.001), LDL- and HDL-cholesterol (P < 0.05) in the patients with active Crohn's disease than in the control group. In addition, the patients had significantly lower plasma levels of lathosterol (P < 0.001) and higher concentrations of squalene, although without significant differences. A significant decrease of campesterol plasma levels (P < 0.001) was detected, but lower plasma concentrations of sitosterol were without statistical significance. The active phase of Crohn's disease is characterized by altered metabolism of lipids, mainly of cholesterol. Our results show abnormalities in plasma concentrations of non-cholesterol sterols and provide evidence that the process of cholesterol synthesis and absorption is altered in active Crohn's disease.
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Affiliation(s)
- Vladimír Hrabovský
- Intensive Care Unit, Department of Internal Medicine, Faculty Hospital Ostrava, Czech Republic.
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Nutritional status and mortality of critically ill patients with acute kidney injury. Crit Care Med 2008; 36:3259-60. [PMID: 19020434 DOI: 10.1097/ccm.0b013e318187b753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Low insulin-like growth factor-1 and hypocholesterolemia as mortality predictors in acute kidney injury in the intensive care unit*. Crit Care Med 2008; 36:3165-70. [DOI: 10.1097/ccm.0b013e318186ab70] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Vyroubal P, Chiarla C, Giovannini I, Hyspler R, Ticha A, Hrnciarikova D, Zadak Z. HYPOCHOLESTEROLEMIA IN CLINICALLY SERIOUS CONDITIONS - REVIEW. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152:181-9. [DOI: 10.5507/bp.2008.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Reply. J Am Coll Cardiol 2008; 52:1500-1. [DOI: 10.1016/j.jacc.2008.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/28/2008] [Indexed: 11/23/2022]
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Affiliation(s)
- Rr Elmehdawi
- Department of Internal Medicine, Faculty of Medicine, Garyounis University, Libya
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Abstract
PURPOSE OF REVIEW The intention of this article is to review endotoxin, host response to endotoxin, clinical significance of endotoxemia, past failed therapies targeting endotoxin, current therapeutic efforts in this area and the authors' opinion on the future of such therapy. RECENT FINDINGS Endotoxin or lipopolysaccharide is implicated in the activation of cytokine release with the potential to lead to severe sepsis. Therapies targeting endotoxin are very appealing and remain a matter of study and debate. Antiendotoxin antibody studies did not show consistent benefit to warrant its approval for use. Lipid A analog, phospholipid emulsion, and ethyl pyruvate are currently being evaluated for potential clinical use. Polymyxin B as an antiendotoxin strategy has an unacceptable toxicity profile for routine use as an intravenous agent and its use in plasmapheris is too cumbersome. Curcumin and lipopolysaccharide binding peptides, although having a potentially desirable effect on ameliorating endotoxin toxicity, remain to be shown effective in clinical trials. The development of a vaccine against endotoxin carries promise. SUMMARY The benefits of therapies targeting endotoxin remain to be elucidated. Clinical trials targeting populations with documented endotoxemia are more likely to provide an adequate test of this therapeutic approach. Prophylaxis of high-risk populations should also be considered.
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Dimopoulou I, Orfanos S, Kotanidou A, Livaditi O, Giamarellos-Bourboulis E, Athanasiou C, Korovesi I, Sotiropoulou C, Kopterides P, Ilias I, Kanellakopoulou K, Armaganidis A. Plasma pro- and anti-inflammatory cytokine levels and outcome prediction in unselected critically ill patients. Cytokine 2008; 41:263-7. [PMID: 18191577 DOI: 10.1016/j.cyto.2007.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Revised: 10/23/2007] [Accepted: 11/30/2007] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the inter-relationships between cytokine levels and physiological scores in predicting outcome in unselected, critically ill patients. METHODS To this end, 127 patients (96 men), having a mean+/-SD age of 45+/-20 years, with a wide range in admission diagnoses (medical, surgical, and multiple trauma patients) were prospectively investigated. Severity of critical illness and organ dysfunction were graded by acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores, respectively. Blood samples were drawn on admission in the ICU to determine pro- and anti-inflammatory cytokines, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, and IL-10. The main outcome measure was 28-day mortality. RESULTS Overall, 88 patients survived and 39 patients died. Univariate logistic regression analysis showed that SOFA, APACHE II, IL-8, IL-6, and IL-10 on admission in the ICU were related to mortality. Multiple logistic regression analysis in the entire cohort of critically ill patients revealed that SOFA (OR=1.341, p<0.001) and IL-6 (OR=1.075, p=0.01) constituted independent outcome predictors. receiver operator characteristics curve analysis showed that SOFA, APACHE II, and IL-6 had the highest area under the curve values. IL-6 correlated with APACHE II (r(s)=0.44, p<0.0001) and SOFA (r(s)=0.40, p<0.0001) scores. CONCLUSIONS In mixed ICU patients cytokine concentrations on admission in the ICU represent independent outcome predictors in the presence of disease severity scores.
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Affiliation(s)
- Ioanna Dimopoulou
- Second Department of Critical Care Medicine, Attikon Hospital, Medical School, University of Athens, 2 Pesmazoglou Street, 14 561 Kifissia, Athens, Greece.
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Levels JHM, Pajkrt D, Schultz M, Hoek FJ, van Tol A, Meijers JCM, van Deventer SJH. Alterations in lipoprotein homeostasis during human experimental endotoxemia and clinical sepsis. Biochim Biophys Acta Mol Cell Biol Lipids 2007; 1771:1429-38. [PMID: 17980169 DOI: 10.1016/j.bbalip.2007.10.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 09/17/2007] [Accepted: 10/02/2007] [Indexed: 11/26/2022]
Abstract
Cell wall constituents of bacteria are potent endotoxins initiating inflammatory responses which may cause dramatic changes in lipid metabolism during the acute phase response. In this study, the sequential changes in lipoprotein composition and lipid transfer and binding proteins during clinical sepsis and during low-dose experimental endotoxemia were followed. In addition, the effect on (phospho)lipid homeostasis by administration of reconstituted HDL (rHDL) prior to low-dose LPS administration was investigated. Changes in (apo)lipoprotein concentrations typical of the acute phase response were observed during clinical sepsis and experimental endotoxemia with and without the rHDL intervention. During clinical sepsis negative correlations between the acute phase marker C-reactive protein (CRP) and lecithin:cholesterol acyltransferase (LCAT) and cholesterylester transfer protein (CETP) activities were seen, whereas positive correlations between plasma phospholipid transfer protein (PLTP) activity and acute phase markers such as CRP and LPS binding protein were observed. Plasma lipid changes upon rHDL/LPS infusion were comparable with the control group (low-dose LPS only). PLTP activity decreased upon LPS infusion and transiently increased during rHDL infusion, whereas LCAT activity slightly decreased upon both LPS infusion and LPS/rHDL infusion. However, long-lasting increases of circulating HDL cholesterol, apo A-I and a high initial processing of both phosphatidylcholine (PC) and lyso-PC, were indicative for extensive rHDL and LDL remodelling. Both sepsis and experimental endotoxemia lead to a disbalance of lipid homeostasis. Depending on the magnitude of the inflammatory stimulus, LCAT and PLTP activities reacted in divergent ways. rHDL infusion did not prevent the lipid alterations seen during the acute phase response. However profound changes in both HDL and LDL phospholipid composition occurred upon rHDL infusion. This may be explained, at least in part, by the fact that PLTP as a positive acute phase protein, can accelerate the alterations in (phospho)lipid homeostasis thereby playing a role in the attenuation of the acute phase response.
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Affiliation(s)
- Johannes H M Levels
- Department of Experimental Vascular Medicine, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE To characterise the lipid profiles in dogs with parvoviral enteritis. METHODS Blood was collected before treatment from 30 dogs that fulfilled the criteria for severe sepsis including hypo- or hyperthermia, hypotension, leucopenia, thrombocytopenia and evidences of organ dysfunction. Canine parvovirus was detected by haemagglutination and indirect fluorescence antibody tests in the faeces. Twenty control dogs were also enrolled on the basis of normal physical examination results, complete blood count and serum biochemistry profiles. RESULTS Tachycardia, tachypnoea, hypotension, leucopenia, thrombocytopenia and increased serum markers of tissue injury (alanine aminotransferase, creatinine kinase myocardial isoenzyme [CK-MB], blood urea nitrogen and creatinine) were observed in dogs with parvoviral enteritis. Serum total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels were lower, but serum triglyceride level was higher in dogs with parvoviral enteritis than those in control dogs (P<0.001). Circulating tumour necrosis factor alpha correlated negatively with total cholesterol (r=-0.979; P<0.001) but positively with triglyceride (r=0.953; P<0.001) in dogs with parvoviral enteritis. Serum total cholesterol and high-density lipoprotein cholesterol levels were lower in non-survival (n=9) dogs than in survival dogs (n=21, P<0.001). CLINICAL SIGNIFICANCE Serum total cholesterol and high-density lipoprotein cholesterol levels decreased, but serum triglyceride level increased in dogs with parvoviral enteritis. Low serum total cholesterol and high-density lipoprotein cholesterol levels may be used as an index of the severity of parvoviral enteritis.
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Affiliation(s)
- Z Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Uludag University, 16190 Bursa, Turkey
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49
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Berger MM, Tappy L, Revelly JP, Koletzko BV, Gepert J, Corpataux JM, Cayeux MC, Chiolero RL. Fish oil after abdominal aorta aneurysm surgery. Eur J Clin Nutr 2007; 62:1116-22. [PMID: 17538537 DOI: 10.1038/sj.ejcn.1602817] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Fish oil (FO) may attenuate the inflammatory response after major surgery such as abdominal aortic aneurysm (AAA) surgery. We aimed at evaluating the clinical impact and safety aspects of a FO containing parenteral nutrition (PN) after AAA surgery. METHODS Intervention consisted in 4 days of either standard (STD: Lipofundin medium-chain triglyceride (MCT): long-chain triglyceride (LCT)50%-MCT50%) or FO containing PN (FO: Lipoplus: LCT40%-MCT50%-FO10%). Energy target were set at 1.3 times the preoperative resting energy expenditure by indirect calorimetry. Blood sampling on days 0, 2, 3 and 4. Glucose turnover by the (2)H(2)-glucose method. Muscle microdialysis. CLINICAL DATA maximal daily T degrees, intensive care unit (ICU) and hospital stay. RESULTS Both solutions were clinically well tolerated, without any differences in laboratory safety parameters, inflammatory, metabolic data, or in organ failures. Plasma tocopherol increased similarly; with FO, docosahexaenoic and eicosapentaenoic acid increased significantly by day 4 versus baseline or STD. To increased postoperatively, with a trend to lower values in FO group (P=0.09). After FO, a trend toward shorter ICU stay (1.6+/-0.4 versus 2.3+/-0.4), and hospital stay (9.9+/-2.4 versus 11.3+/-2.7 days: P=0.19) was observed. CONCLUSIONS Both lipid emulsions were well tolerated. FO-PN enhanced the plasma n-3 polyunsaturated fatty acid content, and was associated with trends to lower body temperature and shorter length of stay.
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Affiliation(s)
- M M Berger
- Department of Intensive Care Medicine, CHUV, Lausanne, Switzerland.
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50
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Kannan KB, Barlos D, Hauser CJ. Free cholesterol alters lipid raft structure and function regulating neutrophil Ca2+ entry and respiratory burst: correlations with calcium channel raft trafficking. THE JOURNAL OF IMMUNOLOGY 2007; 178:5253-61. [PMID: 17404309 DOI: 10.4049/jimmunol.178.8.5253] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recent studies associate cholesterol excess and atherosclerosis with inflammation. The link between these processes is not understood, but cholesterol is an important component of lipid rafts. Rafts are thought to concentrate membrane signaling molecules and thus regulate cell signaling through G protein-coupled pathways. We used methyl beta-cyclodextrin to deplete cholesterol from polymorphonuclear neutrophil (PMN) rafts and thus study the effects of raft disruption on G protein-coupled Ca(2+) mobilization. Methyl beta-cyclodextrin had no effect on Ca(2+) store depletion by the G protein-coupled agonists platelet-activating factor or fMLP, but abolished agonist-stimulated Ca(2+) entry. Free cholesterol at very low concentrations regulated Ca(2+) entry into PMN via nonspecific Ca(2+) channels in a biphasic fashion. The specificity of cholesterol regulation for Ca(2+) entry was confirmed using thapsigargin studies. Responses to cholesterol appear physiologic because they regulate respiratory burst in a proportional biphasic fashion. Investigating further, we found that free cholesterol accumulated in PMN lipid raft fractions, promoting formation and polarization of membrane rafts. Finally, the transient receptor potential calcium channel protein TRPC1 redistributed to raft fractions in response to cholesterol. The uniformly biphasic relationships between cholesterol availability, Ca(2+) signaling and respiratory burst suggest that Ca(2+) influx and PMN activation are regulated by the quantitative relationships between cholesterol and other environmental lipid raft components. The association between symptomatic cholesterol excess and inflammation may therefore in part reflect free cholesterol- dependent changes in lipid raft structure that regulate immune cell Ca(2+) entry. Ca(2+) entry-dependent responses in other cell types may also reflect cholesterol bioavailability and lipid incorporation into rafts.
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Affiliation(s)
- Kolenkode B Kannan
- Department of Surgery, Beth Israel-Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
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