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Gong M, Qi S, Wu Z, Huang Y, Wu L, Wang X, He L, Lin L, Lin D. A novel therapeutic approach to modulate the inflammatory cascade: A timely exogenous local inflammatory response attenuates the sepsis-induced cytokine storm. Cytokine 2024; 176:156533. [PMID: 38340550 DOI: 10.1016/j.cyto.2024.156533] [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] [Received: 10/19/2023] [Revised: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The emergence of severe sepsis is contingent upon the occurrence of a cytokine storm (CS), a multifaceted process intricately entwined with the temporal dimension, thereby rendering the infection response remarkably intricate. Consequently, it becomes imperative to discern and accurately identify the optimal timing for interventions, predicated upon the dynamic timeline of inflammatory changes. Moreover, the administration of exogenous low-dose pro-inflammatory agents has exhibited the potential to impede the relentless progression of the inflammatory cascade. Hence, the present study aims to scrutinize the impact of exogenous Local Inflammatory Response (eLIR) on the body surface in the context of the inflammatory cascade during sepsis, within a temporal framework, with a particular emphasis on the point of exacerbation of inflammation. METHODS Rats were induced sterile sepsis by intraperitoneal injection of zymosan (ZY) at an appropriate dosage. The temporal progression of inflammatory changes and eLIR effects were described based on the trend of serum crucial inflammatory cytokines, tring to quest time-point of inflammatory aggravation in sepsis. Then, the varying degrees of surface inflammation caused by eLIR on this time point leading to the final effects on the inflammatory cascade response were explored. In addition, given the authentic pathological progression of sepsis, further observation was conducted on the impact of another intervention timing of eLIR on the inflammatory cascade. The survival rate was measured. Serum and organ related inflammatory cytokines were detected, and organ histopathology was investigated. RESULTS In present study, a dosage of 600 mg/kg ZY was found to be optimal for the sterile sepsis model. Initiating eLIR 6 h prior to ZY injection, the maximum effect point of eLIR could be precisely align with the inflammatory aggravation point of sterile sepsis. Initiating eLIR at this time, 3 sessions of eLIR were found to be more effective than 1 or 2 sessions in mitigating inflammatory responses during the initial stage of inflammation and the peak of inflammation. Notably, the findings also suggested that this intervention improve survival rate. In addition, the anti-inflammatory efficacy has been substantially diminished by the prompt initiation of 3 sessions of eLIR immediately after ZY injection at the onset of sepsis. Similarly, the current findings did not demonstrate a statistically significant enhancement in survival rates with eLIR at this time point. CONCLUSIONS Compared with the initial stage of inflammation, low-scale inflammation caused by a certain intensity of eLIR (3 sessions) on the body surface can more effectively pry the inflammation aggravation time-point, thereby shifting the pro-inflammatory to anti-inflammatory milieu, impeding the disproportionate cytokines release in inflammatory diseases, slowing down the inflammatory cascade, and improving the survival rate of sepsis.
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Affiliation(s)
- Meng Gong
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Shiyi Qi
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Zhiting Wu
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Ying Huang
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Lihua Wu
- Department of Otolaryngology, Fujian provincial hospital, Fuzhou, Fujian Province, China
| | - Xiangbin Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Lingling He
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Lili Lin
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China; Institute of Acupuncture and Meridian, Fujian Academy of Chinese Medical Sciences, Fuzhou, Fujian Province, China
| | - Dong Lin
- College of Acupuncture, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China; Institute of Acupuncture and Meridian, Fujian Academy of Chinese Medical Sciences, Fuzhou, Fujian Province, China.
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Zhang X, Feng Y, Wang K, Qiu T, Zhou J, Che G, Chen S, Ji Y. The association between procalcitonin and acute kidney injury in patients stung by wasps. Front Physiol 2023; 14:1199063. [PMID: 37700759 PMCID: PMC10493320 DOI: 10.3389/fphys.2023.1199063] [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: 04/02/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction: The aim of this study was to investigate the status of serum procalcitonin (PCT) in patients stung by wasps and evaluate the association between PCT levels and acute kidney injury (AKI). Methods: Patients stung by wasps admitted to two tertiary hospitals between January 2017 and December 2020 were screened for enrollment. We evaluated serum PCT levels on admission in patients stung by wasps. The patients were divided into an AKI group and a non-AKI group. A logistic regression model was used to analyze the association between PCT status and AKI. The performance of PCT concentrations in predicting the occurrence of AKI was evaluated by the area under the receiver operating characteristic curve (AUROC). Results: A total of 138 patients were enrolled, and 66 patients suffered AKI. PCT levels were elevated in 78.99% of patients stung by wasps. Nearly half of the patients (47.83%) developed AKI. PCT levels were correlated with creatinine levels on admission (r = 0.787, 95% CI: 0.713-0.844). PCT levels in patients with AKI were higher than those in patients without AKI (p < 0.001). After adjustment for covariates, PCT levels on admission were independently associated with AKI (OR: 1.575, 95% CI: 1.071-2.317, p = 0.021). The AUROC of PCT levels on admission was 0.837 (95% CI, 0.771-0.902, p < 0.001). A PCT level of 0.57 μg/L was the cutoff for maximizing the Youden index; the specificity was 79.45%, and the sensitivity was 73.43%. Conclusion: Serum PCT levels may be a potential biomarker of AKI in patients stung by wasps.
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Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yunxia Feng
- Department of Nephrology, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Kai Wang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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Quan Z, Liu M, Zhao J, Yang X. Correlation between early changes of serum lipids and clinical severity in patients with wasp stings. J Clin Lipidol 2022; 16:878-886. [PMID: 36154999 DOI: 10.1016/j.jacl.2022.09.003] [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: 03/30/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Wasp stings are a serious problem worldwide, and patients in severe cases may experience multi-organ failure. However, the mechanism of hypolipidemia in patients with wasp stings is unknown. OBJECTIVE To investigate the relationship between early changes in lipid levels and clinical severity and the possible underlying mechanisms. METHODS A retrospective analysis of 212 patients (mild: 77; moderate: 50; severe: 85) with wasp stings was conducted. Clinical data, including lipid test results within 24 h of admission, were analysed. A total of 1060 healthy age- and gender-matched controls were used. RESULTS Patients with wasp stings had lower lipid levels than healthy controls (P<0.01). Lipid levels decreased with disease severity, except for triglycerides (P<0.05). The number of stings, degree of organ failure, need for mechanical ventilation and extracorporeal blood purification, and mortality were higher in the severe group than in the mild and moderate groups (P<0.01). A decrease in lipid levels was accompanied by an increase in inflammatory indicators. In the severe group, a reduction in lipid levels was associated with ventilator application and blood purification, independent of survival status. CONCLUSIONS Patients with wasp stings experience a reduction in lipid levels, which is related to the severity of clinical manifestations. Early lipid levels may serve as a simple indicator for the severity of wasp stings, and targeting lipid metabolism may be a novel treatment.
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Affiliation(s)
- Zhenglin Quan
- Jinzhou Medical University, Postgraduate Training Base, Taihe Hospital of Hubei University of Medicine, Shiyan 442000, China (Dr Quan); Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China (Dr Quan, Dr Zhao, and Dr Yang).
| | - Mei Liu
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China (Dr Liu)
| | - Juan Zhao
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China (Dr Quan, Dr Zhao, and Dr Yang)
| | - Xianyi Yang
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China (Dr Quan, Dr Zhao, and Dr Yang).
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Wang R, He M, Ou XF, Xie XQ, Kang Y. Serum Procalcitonin Level Predicts Acute Kidney Injury After Traumatic Brain Injury. World Neurosurg 2020; 141:e112-e117. [PMID: 32438001 DOI: 10.1016/j.wneu.2020.04.245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND A common non-neurologic complication after traumatic brain injury (TBI), acute kidney injury (AKI) is a risk factor of mortality. Some studies confirmed the predictive value of procalcitonin (PCT) on AKI in several clinical settings. We designed this study to explore the predictive value of PCT on AKI after TBI. METHODS We retrospectively enrolled patients with TBI admitted to our hospital from February 2015 to June 2019. Multivariate logistic regression analysis was performed to find the risk factors of AKI and construct a predictive model for AKI. Receiver operating characteristics curves were drawn to compare the predictive value of PCT and the constructed model. RESULTS A total of 214 patients were included in this study. The incidence of AKI after TBI was 25.70% in this study. Compared with the non-AKI group, the AKI group had higher age (P = 0.031), lower Glasgow Coma Scale (P < 0.001), and higher incidence of coagulopathy (P < 0.001) and shock (P < 0.001). Moreover, patients complicated with AKI had higher in-hospital mortality (P < 0.001) and worse 90-day outcome (P < 0.001). Multivariate logistic regression analysis indicated that age (P = 0.033), PCT (P = 0.002), serum chlorine (P = 0.011), and creatinine (P < 0.001) were independent risk factors of AKI. We constructed a predictive model using these 4 risk factors. The area under receiver operating characteristics curves of the predictive model was 0.928, which was significantly higher than that of a single PCT value (area under receiver operating characteristics curves = 0.833) (Z = 2.395, P < 0.05). CONCLUSIONS PCT is valuable in predicting AKI after TBI. To avoid AKI after TBI, physicians can adjust treatment strategies according to the level of PCT.
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Affiliation(s)
- Ruoran Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiao Feng Ou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiao Qi Xie
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Yao W, Sun Y, Sun Y, Chen P, Meng Z, Xiao M, Yang X. A Preliminary Report of the Relationship Between Gene Polymorphism of IL-8 and Its Receptors and Systemic Inflammatory Response Syndrome Caused by Wasp Stings. DNA Cell Biol 2019; 38:1512-1518. [PMID: 31613654 DOI: 10.1089/dna.2019.4855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The plasma levels of interleukin-8 (IL-8) and its receptors (CXCR1 and CXCR2) play a significant role in the development of systemic inflammatory response syndrome (SIRS), but it is not clear how these proteins are involved in wasp sting patients developing SIRS. To study potential genetic factors predisposing to the risk of SIRS caused by wasp sting injury, we determined the plasma levels of IL-8 and its receptors among SIRS patients with wasp sting injury and investigated the association of single-nucleotide polymorphisms of these genes with SIRS. A total of 225 patients were divided into the SIRS group (n = 62) and non-SIRS group (control, n = 163), and we associated polymorphisms in IL-8 [rs4073 (-251T>A), rs2227532 (-845C>T), rs2227307 (+396G>T), rs2227306 (+781T>C), CXCR1 rs2234671 (+860C>G), CXCR2 [rs2230054 (+811T>C), rs57929613 (+1235C>T), and rs60626131 (+1440A>G)] with SIRS with a linear additive model. In terms of protein expression, the IL-8, CXCR1, and CXCR2 plasma levels were significantly higher in the SIRS group than in the control group (p < 0.001). Significantly higher frequencies were observed for the IL-8 - 251T allele (AT+TT), CXCR2 + 811T allele (CT+TT), and +1235C allele (TC+CC) in the SIRS group, when compared with the control group, with odds ratio (OR) = 3.971 (95% confidence interval [CI], 1.618-9.734), p = 0.003; OR = 4.223 (95% CI, 1.863-9.571), p = 0.001; and OR = 4.012 (95% CI, 1.773-9.079), p = 0.001; respectively. In addition, SIRS is more likely to occur in males, patients with number of wasp stings ≥10 stings, and stings in the limbs. The current study suggests that the IL-8 - 251T allele (AT+TT) and IL-8 receptor CXCR2 + 811C allele (CT+TT) and +1235T allele (TC+CC) could be risk factors among SIRS patients with wasp sting injury.
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Affiliation(s)
- Wei Yao
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yuwen Sun
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yuhui Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ping Chen
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zhongji Meng
- Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Min Xiao
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xianyi Yang
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Zhu L, Yin H, Sun H, Qian T, Zhu J, Qi G, Wang Y, Qi B. The clinical value of aquaporin-4 in children with hand, foot, and mouth disease and the effect of magnesium sulfate on its expression: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis 2019; 38:1343-1349. [PMID: 31028503 DOI: 10.1007/s10096-019-03559-2] [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: 01/16/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
To evaluate the clinical value of aquaporin-4 (AQP-4) in hand, foot, and mouth disease (HFMD) and to evaluate therapeutic efficacy of magnesium sulfate (MgSO4) and its effect on AQP-4 expression. Children with HFMD were divided into a common group, a severe group and a critical group according to Chinese guidelines; children in the critical group were further divided into two subgroups: routine treatment group and MgSO4 group. Outcome measures included systolic blood pressure (SBP), Heart rate (HR), the levels of AQP-4, interleukin-6 (IL-6), norepinephrine (NE), and neuron-specific enolase (NSE). Serum AQP-4, IL-6, NE, and NSE levels varied significantly among the critical, severe, and common groups before and after treatment. There were no significant differences in AQP-4 levels in cerebrospinal fluid (CSF) between the critical and severe groups before and after treatment; however, CSF AQP-4 levels in these two groups were higher than those in the common group before treatment. Serum and CSF AQP-4 levels in convalescence decreased significantly in the critical and severe groups. SBP, HR and serum AQP-4, IL-6, NE, NSE levels, but not CSF AQP-4 levels, were significantly lower in MgSO4 group than in the routine treatment group. AQP-4 in serum, but not in CSF, is a candidate biomarker for evaluating the severity and prognosis of HFMD; MgSO4 can provide protection on children with critical HFMD.
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Affiliation(s)
- Lei Zhu
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hong Yin
- Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Haomiao Sun
- Department of Infectious Disease, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tong Qian
- Department of Clinical Laboratory, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junling Zhu
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Gongjian Qi
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yin Wang
- Department of Infectious Disease, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Boxiang Qi
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China.
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Zhu L, Yin H, Qian T, Qi GJ, Ren JS, Wang Y, Qi BX. Distinct expression and clinical value of aquaporin 4 in children with hand, foot and mouth disease caused by enterovirus 71. J Med Virol 2019; 94:587-593. [PMID: 30942492 DOI: 10.1002/jmv.25475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/10/2022]
Abstract
Brain dysfunction is a prerequisite for critical complications in children with hand, foot, and mouth disease (HFMD). Aquaporin 4 (AQP-4) may be involved in the pathological process of cerebral oedema and injury in children with severe and critical HFMD. This study aimed to assess the association of AQP-4 with the severity of enterovirus 71 (EV71)-associated HFMD. Children with EV71-infected HFMD were divided into a common group (clinical stage 1), a severe group (clinical stage 2), and a critical group (clinical stage 3) according to Chinese guidelines. The levels of AQP-4, interleukin-6 (IL-6), norepinephrine (NE), and neuron-specific enolase (NSE) before and after treatment were tested. Serum AQP-4, IL-6, NE, and NSE levels showed significant differences among the critical, severe, and common groups before and after treatment (P<0.01). No significant differences in AQP-4 levels in cerebrospinal fluid (CSF) were observed between the critical and severe groups before and after treatment, but the CSF AQP-4 levels in these two groups were higher than those in the common group before treatment (P<0.01). Serum AQP-4 levels, but not CSF AQP-4 levels, closely correlated with serum IL-6, NE, and NSE levels. These results suggest that the level of AQP-4 in serum, but not in CSF, is a candidate biomarker for evaluating the severity and prognosis of EV71-associated HFMD.
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Affiliation(s)
- Lei Zhu
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hong Yin
- Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tong Qian
- Department of Clinical Laboratory, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Gong-Jian Qi
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jin-Song Ren
- Department of Infectious Disease, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yin Wang
- Department of Infectious Disease, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Bo-Xiang Qi
- Department of Intensive Care Unit, Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
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