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Saito Z, Uchiyama S, Nishioka S, Tamura K, Tamura N, Kuwano K. Predictors of in-hospital mortality in elderly unvaccinated patients during SARS-CoV-2 Alpha variants epidemic. Infect Prev Pract 2024; 6:100341. [PMID: 38357519 PMCID: PMC10864849 DOI: 10.1016/j.infpip.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/21/2023] [Indexed: 02/16/2024] Open
Abstract
Background COVID-19, caused by SARS-CoV-2, has caused a global pandemic. This study aimed to identify predictors of in-hospital mortality in unvaccinated elderly patients with COVID-19 by comparing various predictive factors between the survivors and non-survivors. Methods We retrospectively selected 132 unvaccinated patients aged over 65 years with COVID-19 at a hospital in Kanagawa, Japan, during SARS-CoV-2 Alpha variants epidemic. We compared the clinical characteristics, laboratory and radiological findings, treatment, and complications of the survivors and non-survivors. In logistic regression analysis, variables that were significant in the univariate analysis were subjected to multivariate analysis using the variable increase method. Results There were 119 and 13 patients in the survivor and non-survivor groups, respectively. Multivariate regression revealed increasing odds with the presence of ARDS and DIC (odd ratio (OR) = 16.35, 34.36; P=0.002, 0.001, respectively) and prolonged hospital stay (OR = 1.17; P=0.004). Conclusions We found the complications of ARDS and DIC and hospital length of stay to be independent predictors of in-hospital mortality in elderly unvaccinated patients with COVID-19. Establishing treatments and prevention methods for ARDS and DIC could result in lower mortality rates.
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Affiliation(s)
- Zenya Saito
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Shota Uchiyama
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Saiko Nishioka
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Kentaro Tamura
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Nobumasa Tamura
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Ionescu (Miron) AI, Atasiei DI, Ionescu RT, Ultimescu F, Barnonschi AA, Anghel AV, Anghel CA, Antone-Iordache IL, Mitre R, Bobolocu AM, Zamfir A, Lișcu HD, Coniac S, Șandru F. Prediction of Subclinical and Clinical Multiple Organ Failure Dysfunction in Breast Cancer Patients-A Review Using AI Tools. Cancers (Basel) 2024; 16:381. [PMID: 38254870 PMCID: PMC11154446 DOI: 10.3390/cancers16020381] [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: 12/20/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
This review explores the interconnection between precursor lesions of breast cancer (typical ductal hyperplasia, atypical ductal/lobular hyperplasia) and the subclinical of multiple organ failure syndrome, both representing early stages marked by alterations preceding clinical symptoms, undetectable through conventional diagnostic methods. Addressing the question "Why patients with breast cancer exhibit a tendency to deteriorate", this study investigates the biological progression from a subclinical multiple organ failure syndrome, characterized by insidious but indisputable lesions, to an acute (clinical) state resembling a cascade akin to a waterfall or domino effect, often culminating in the patient's demise. A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus databases in October 2023, employing keywords such as "MODS", "SIRS", "sepsis", "pathophysiology of MODS", "MODS in cancer patients", "multiple organ failure", "risk factors", "cancer", "ICU", "quality of life", and "breast cancer". Supplementary references were extracted from the retrieved articles. This study emphasizes the importance of early identification and prevention of the multiple organ failure cascade at the inception of the malignant state, aiming to enhance the quality of life and extend survival. This pursuit contributes to a deeper understanding of risk factors and viable therapeutic options. Despite the existence of the subclinical multiple organ failure syndrome, current diagnostic methodologies remain inadequate, prompting consideration of AI as an increasingly crucial tool for early identification in the diagnostic process.
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Affiliation(s)
- Andreea-Iuliana Ionescu (Miron)
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania;
| | - Dimitrie-Ionut Atasiei
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Radu-Tudor Ionescu
- Department of Computer Science, University of Bucharest, 010041 Bucharest, Romania;
| | - Flavia Ultimescu
- Department of Pathology, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania;
- Department of Pathological Anatomy, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andrei-Alexandru Barnonschi
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Alexandra-Valentina Anghel
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Cătălin-Alexandru Anghel
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Ionuț-Lucian Antone-Iordache
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Ruxandra Mitre
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania;
| | - Alexandra Maria Bobolocu
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Andreea Zamfir
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
| | - Horia-Dan Lișcu
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.I.); (A.-A.B.); (A.-V.A.); (C.-A.A.); (I.-L.A.-I.); (R.M.); (A.M.B.); (A.Z.); (H.-D.L.)
- Department of Radiotherapy, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Simona Coniac
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania;
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Dermatology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Leisewitz AL, Mrljak V, Dear JD, Birkenheuer A. The Diverse Pathogenicity of Various Babesia Parasite Species That Infect Dogs. Pathogens 2023; 12:1437. [PMID: 38133320 PMCID: PMC10746086 DOI: 10.3390/pathogens12121437] [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: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Babesia species infect a very wide range of mammal hosts across the globe, and zoonotic infections are of growing concern. Several species of the Babesia genus infect dogs, and some of these cause significant morbidity and mortality. The Apicomplexan parasite resides within the red cell and infections result in direct damage to the host through intra- and extravascular hemolysis. An exuberant inflammatory response by the host to some species of Babesia parasites also results in significant collateral damage to the host. Canine infections have been the subject of many studies as the well-being of these companion animals is increasingly threatened by the spread of tick vectors and an increasingly mobile dog population. There are currently no widely available and effective vaccines, and effective treatment can be challenging. Understanding disease pathogenesis underlies the development of new treatments. The varying pathogenicity of the various Babesia parasite species that infect dogs offers an opportunity to explore the molecular basis for the wide range of diseases caused by infection with this parasite genus. In this review, we focus on what has been reported about the clinical presentation of Babesia-infected dogs in an attempt to compare the severity of disease caused by different Babesia species.
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Affiliation(s)
- Andrew L. Leisewitz
- Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
| | - Vladimir Mrljak
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jonathan D. Dear
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Adam Birkenheuer
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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Gasser B, Uscategui RAR, Aires LPN, Yamada DI, Del'Aguila-Silva P, Lima BB, Silva P, da Cruz ICK, Carneiro RK, Feliciano MAR. Abdominal perfusion in canine patients with pyometra and sepsis evaluated by Doppler and contrast-enhanced ultrasound. BMC Vet Res 2023; 19:180. [PMID: 37777757 PMCID: PMC10542259 DOI: 10.1186/s12917-023-03747-5] [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: 10/24/2022] [Accepted: 09/22/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Sepsis is a condition characterized by organic dysfunction, leading to hemodynamic instability and high morbidity and mortality rates in humans and animals. Early identification of perfusion changes and appropriate management of sepsis are crucial for improving patient prognosis. Currently, the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely studied for sepsis identification and evaluation of organ dysfunction. However, these scores do not assess gastrointestinal involvement, which is common in this condition. Contrast-enhanced ultrasound (CEUS) and Doppler have been considered promising diagnostic techniques for detecting changes in vascularization and microcirculation in a non-invasive and safe manner, particularly in the gastrointestinal system. This study aimed to evaluate duodenal perfusion using CEUS, as well as abdominal aortic and cranial mesenteric artery blood flow using Doppler ultrasound, and systolic arterial pressure (SAP) in 17 bitches with pyometra and in 10 healthy animals. RESULTS The variables were compared between the pyometra and control groups, as well between patients with and without sepsis determined by the SOFA or SIRS scores. Pyometra was found to cause a reduction in abdominal aortic blood flow volume, aortic peak systolic velocity, and resistivity index as evaluated by Doppler ultrasound. Patients with sepsis according to the SOFA criteria only presented lower SAP. In contrast, sepsis animals identified by the SIRS score exhibited lower SAP, aortic peak systolic velocity, aortic blood flow volume, and aortic resistivity index and additionally, higher peak intensity of contrast in the duodenal wall. CONCLUSIONS Pyometra causes a reduction in abdominal aortic blood flow, which is more pronounced in animals with sepsis identified by the SIRS criteria. These animals also exhibited a decrease in systolic blood pressure and an increase in duodenal perfusion, as evident by CEUS. However, these changes were not observed in patients with sepsis identified by the SOFA criteria. The alterations in intestinal perfusion observed in animals with sepsis indicate the presence of inflammation or dysfunction. In this regard, CEUS proves to be a valuable technique for detecting subtle changes in tissue hemodynamics that may not be apparent in conventional exams.
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Affiliation(s)
- Beatriz Gasser
- Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brasil.
- Instituto de Ciências Agrárias, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Unaí, Minas Gerais, Brasil.
| | | | - Luiz Paulo Nogueira Aires
- Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brasil
| | | | - Priscila Del'Aguila-Silva
- Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brasil
| | - Bruna Bressianini Lima
- Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brasil
| | - Priscila Silva
- Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brasil
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He Y, Liu X, Zhong S, Fu Q. Neutrophil-to-lymphocyte ratio in relation to trauma severity as prognosis factors in patients with multiple injuries complicated by multiple organ dysfunction syndrome: A retrospective analysis. Immun Inflamm Dis 2023; 11:e1031. [PMID: 37773708 PMCID: PMC10521378 DOI: 10.1002/iid3.1031] [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: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore potential risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with multiple injuries by evaluating neutrophil-to-lymphocyte ratio (NLR)-associated trauma severity. METHODS This retrospective case-control study included 95 patients with multiple injuries, who were admitted to our hospital (between January 2018 and December 2020). Clinical data including gender, age, underlying disease, number of injury sites (NIS), injury severity score (ISS), hemoglobin level within 24 h of admission (HL-24h), neutrophil count (NC), white blood cell count, platelet count (PC), NLR, d-dimer level, activated partial thromboplastin time (APTT), complicated shock within 24 h of admission (CS-24h), length of stay, as well as prognostic outcome was systematically analyzed. According to MODS occurrence, patients were divided into a MODS group (n = 27) and a non-MODS group (n = 68). The risk factors affecting patients with multiple injuries complicated by MODS were identified using univariate and multivariate logistic regression analyses. Candidate risk factors were further analyzed using receiver operating characteristic (ROC) curves. RESULTS Univariate analysis revealed a significant difference between the MODS and non-MODA groups in terms of NIS, ISS, HL-24h, PC, APTT, d-dimer level, CS-24h, NLR, NC, prognostic outcome, and other indicators (p < .05). Multivariate logistic regression analysis showed that d-dimer levels within 24 h of admission and ISS, NLR, and CS-24h were significantly associated with multiple injuries complicated by MODS. Compared with the non-MODS controls, the NLR in the MODS group showed a much higher level and tended to rise with the increase in ISS score, indicating a significant intergroup difference (p < .05). The ROC curve analysis results suggested that the NLR had good sensitivity and specificity for predicting the prognosis of patients with MODS with multiple injuries. CONCLUSION d-dimer level, ISS, NLR, and CS-24h are important risk factors for MODS in patients with multiple injuries. Notably, NLR expression may be a good indicator of injury severity and predictor of the occurrence of MODS in patients with multiple injuries. Therefore, assessment of injury severity and coagulation function, active resuscitation, as well as prevention of infection should be emphasized during treatment of multiple injuries, to reduce and prevent the risk of MODS in patients with multiple injuries.
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Affiliation(s)
- Yong‐Ming He
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
| | - Xing Liu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
| | - Si‐Yi Zhong
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
- Department of Public HealthGuangdong Medical UniversityDongguanChina
| | - Qiu‐Hong Fu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
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Blangy-Letheule A, Vergnaud A, Dupas T, Rozec B, Lauzier B, Leroux AA. Spontaneous Sepsis in Adult Horses: From Veterinary to Human Medicine Perspectives. Cells 2023; 12:cells12071052. [PMID: 37048125 PMCID: PMC10093263 DOI: 10.3390/cells12071052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Sepsis is a life-threatening disease defined as an organ dysfunction caused by a dysregulated host response to an infection. Early diagnosis and prognosis of sepsis are necessary for specific and timely treatment. However, no predictive biomarkers or therapeutic targets are available yet, mainly due to the lack of a pertinent model. A better understanding of the pathophysiological mechanisms associated with sepsis will allow for earlier and more appropriate management. For this purpose, experimental models of sepsis have been set up to decipher the progression and pathophysiology of human sepsis but also to identify new biomarkers or therapeutic targets. These experimental models, although imperfect, have mostly been performed on a murine model. However, due to the different pathophysiology of the species, the results obtained in these studies are difficult to transpose to humans. This underlines the importance of identifying pertinent situations to improve patient care. As humans, horses have the predisposition to develop sepsis spontaneously and may be a promising model for spontaneous sepsis. This review proposes to give first an overview of the different animal species used to model human sepsis, and, secondly, to focus on adult equine sepsis as a spontaneous model of sepsis and its potential implications for human and veterinary medicine.
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Affiliation(s)
| | - Amandine Vergnaud
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
| | - Thomas Dupas
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
| | - Benjamin Lauzier
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
- CHU Sainte-Justine Research Center, Montreal, QC H3T 1C5, Canada
| | - Aurélia A. Leroux
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, F-44300 Nantes, France
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Martí‐Chillón G, Muntión S, Preciado S, Osugui L, Navarro‐Bailón A, González‐Robledo J, Sagredo V, Blanco JF, Sánchez‐Guijo F. Therapeutic potential of mesenchymal stromal/stem cells in critical-care patients with systemic inflammatory response syndrome. Clin Transl Med 2023; 13:e1163. [PMID: 36588089 PMCID: PMC9806020 DOI: 10.1002/ctm2.1163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite notable advances in the support and treatment of patients admitted to the intensive care unit (ICU), the management of those who develop a systemic inflammatory response syndrome (SIRS) still constitutes an unmet medical need. MAIN BODY Both the initial injury (trauma, pancreatitis, infections) and the derived uncontrolled response promote a hyperinflammatory status that leads to systemic hypotension, tissue hypoperfusion and multiple organ failure. Mesenchymal stromal/stem cells (MSCs) are emerging as a potential therapy for severe ICU patients due to their potent immunomodulatory, anti-inflammatory, regenerative and systemic homeostasis-regulating properties. MSCs have demonstrated clinical benefits in several inflammatory-based diseases, but their role in SIRS needs to be further explored. CONCLUSION In the current review, after briefly overviewing SIRS physiopathology, we explore the potential mechanisms why MSC therapy could aid in the recovery of this condition and the pre-clinical and early clinical evidence generated to date.
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Affiliation(s)
| | - Sandra Muntión
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Silvia Preciado
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Lika Osugui
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Almudena Navarro‐Bailón
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Javier González‐Robledo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
| | | | - Juan F. Blanco
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
- Department of SurgeryUniversity of SalamancaSalamancaSpain
| | - Fermín Sánchez‐Guijo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
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The Importance of Pore-Forming Toxins in Multiple Organ Injury and Dysfunction. Biomedicines 2022; 10:biomedicines10123256. [PMID: 36552012 PMCID: PMC9776026 DOI: 10.3390/biomedicines10123256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple organ injury and dysfunction often occurs in acute critical illness and adversely affects survival. However, in patients who survive, organ function usually recovers without permanent damage. It is, therefore, likely that there are reversible mechanisms, but this is poorly understood in the pathogenesis of multiple organ dysfunction syndrome (MODS). AIMS Based on our knowledge of extracellular histones and pneumolysin, as endogenous and exogenous pore-forming toxins, respectively, here we clarify if the extent of cell membrane disruption and recovery is important in MODS. METHODS This is a combination of retrospective clinical studies of a cohort of 98 patients from an intensive care unit (ICU) in a tertiary hospital, with interventional animal models and laboratory investigation. RESULTS In patients without septic shock and/or disseminate intravascular coagulation (DIC), circulating histones also strongly correlated with sequential organ failure assessment (SOFA) scores, suggesting their pore-forming property might play an important role. In vivo, histones or pneumolysin infusion similarly caused significant elevation of cell damage markers and multiple organ injury. In trauma and sepsis models, circulating histones strongly correlated with these markers, and anti-histone reagents significantly reduced their release. Comparison of pneumolysin deletion and its parental strain-induced sepsis mouse model showed that pneumolysin was not essential for sepsis development, but enhanced multiple organ damage and reduced survival time. In vitro, histones and pneumolysin treatment disrupt cell membrane integrity, resulting in changes in whole-cell currents and elevated intracellular Ca2+ to lead to Ca2+ overload. Cell-specific damage markers, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and cardiac troponin I (cTnI), were released from damaged cells. Once toxins were removed, cell membrane damage could be rapidly repaired and cellular function recovered. CONCLUSION This work has confirmed the importance of pore-forming toxins in the development of MODS and proposed a potential mechanism to explain the reversibility of MODS. This may form the foundation for the development of effective therapies.
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Bagaswoto HP, Ardelia YP, Setianto BY. First 24-h Sardjito Cardiovascular Intensive Care (SCIENCE) admission risk score to predict mortality in cardiovascular intensive care unit (CICU). Indian Heart J 2022; 74:513-518. [PMID: 36370802 PMCID: PMC9773286 DOI: 10.1016/j.ihj.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The application of prognostic scoring systems to identify risk of death within 24 h of CICU admission has significant consequences for clinical decision-making. Previous score of parameters collected after 24 h was considered too late to predict mortality. As a result, we attempted to develop a CICU admission risk score to predict hospital mortality using indicators collected within 24 h. METHODS Data were obtained from SCIENCE registry from January 1, 2021 to December 21, 2021. Outcomes of 657 patients (mean age 58.91 ± 12.8 years) were recorded retrospectively. Demography, risk factors, comorbidities, vital signs, laboratory and echocardiography data at 24-h of patient admitted to CICU were analysed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. RESULTS From a total of 657 patients, the hospital mortality was 15%. The significant predictors of mortality were male, acute heart failure, hemodynamic instability, pneumonia, baseline creatinine ≥1.5 mg/dL, TAPSE <17 mm, and the use of mechanical ventilator within first 24-h of CICU admission. Based on Receiver Operating Characteristic (ROC) curve analysis a cut off of ≥3 is considered to be a high risk of in-hospital mortality (sensitivity 75% and specificity 65%). CONCLUSION The initial 24-h SCIENCE admission risk rating system can be used to predict in-hospital mortality in patients admitted to the CICU with a high degree of sensitivity and specificity.
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Affiliation(s)
- Hendry Purnasidha Bagaswoto
- Cardiologist at Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
| | - Yuwinda Prima Ardelia
- Resident of Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Indonesia.
| | - Budi Yuli Setianto
- Cardiologist at Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
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10
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Cota LO, Júnior OS, Oliveira APL, Paz CFR, Maróstica TP, Duarte PC, Leme FOP, Faleiros RR. Oral supplementation with Lithothamnion extract in horses subjected to oligofructose overload intake: effects on systemic inflammation and multiple organ function. J Equine Vet Sci 2022; 117:104082. [PMID: 35850436 DOI: 10.1016/j.jevs.2022.104082] [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: 04/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Systemic inflammatory response syndrome (SIRS) is a common condition in horses with gastrointestinal disorders. If not prevented or controlled, SIRS promotes multiple organ dysfunctions that may culminate in serious disabilities or even death. The objective of this study was to evaluate the effects of Lithothamnion supplementation on systemic inflammatory response and organ function variables in horses undergoing oligofructose overload (OFO) intake. Twelve healthy horses were randomly divided into control and treated groups. The treated group received Lithothamnion (100 mg/kg bw PO BID) for 7 days before oligofructose intake (10 g/kg PO). Horses underwent clinical and laboratory evaluation immediately before and 6, 12, 18, and 24 h following administration of oligofructose. Parametric data were subjected to ANOVA in randomized blocks, followed by Tukey, and Student's t-tests for mean comparsions. Non-parametric data were analyzed by the Friedman, Dunn's, and Mann-Whitney tests (P < .05). Systemic inflammation and organ dysfunction was evident in both groups; however, these changes were milder and delayed in the treated group. Supplementation attenuated and delayed the tachycardia, tachypnea, leukocytosis, hyperproteinemia, hyperbilirubinemia, hyperalbuminemia and hyperglycemia in treated horses undergoing OFO. Furthermore, increases in packed cell volume, red blood cells, hemoglobin, globulin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, indirect and direct bilirubin and creatinine were observed only in the control group, remaining unchanged in the treated group. These findings demonstrate the potential of oral supplementation with Lithothamnion to ameliorate systemic inflammation and organ dysfunction in horses at risk of acquiring gastrointestinal disorders.
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Affiliation(s)
- Letícia O Cota
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Odael S Júnior
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alvaro P L Oliveira
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cahuê F R Paz
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thairê P Maróstica
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Patrícia C Duarte
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiola O P Leme
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; MULTILAB, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael R Faleiros
- EQUINOVA Research Group, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; MULTILAB, Veterinary School of Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; National Council for Scientific and Technological Development - CNPq, Brasília, Distrito Federal, Brazil.
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11
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Magnin M, Oriel J, Combet-curt J, Salama J, Allaouchiche B, Bonnet-Garin JM, Junot S, Pouzot-Nevoret C. Evaluation of the impact of blood donation on tissue perfusion and sublingual microcirculation in dogs: A pilot study. Res Vet Sci 2022; 152:707-716. [DOI: 10.1016/j.rvsc.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022]
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12
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Inflammation: A New Look at an Old Problem. Int J Mol Sci 2022; 23:ijms23094596. [PMID: 35562986 PMCID: PMC9100490 DOI: 10.3390/ijms23094596] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023] Open
Abstract
Pro-inflammatory stress is inherent in any cells that are subject to damage or threat of damage. It is defined by a number of universal components, including oxidative stress, cellular response to DNA damage, unfolded protein response to mitochondrial and endoplasmic reticulum stress, changes in autophagy, inflammasome formation, non-coding RNA response, formation of an inducible network of signaling pathways, and epigenetic changes. The presence of an inducible receptor and secretory phenotype in many cells is the cause of tissue pro-inflammatory stress. The key phenomenon determining the occurrence of a classical inflammatory focus is the microvascular inflammatory response (exudation, leukocyte migration to the alteration zone). This same reaction at the systemic level leads to the development of life-critical systemic inflammation. From this standpoint, we can characterize the common mechanisms of pathologies that differ in their clinical appearance. The division of inflammation into alternative variants has deep evolutionary roots. Evolutionary aspects of inflammation are also described in the review. The aim of the review is to provide theoretical arguments for the need for an up-to-date theory of the relationship between key human pathological processes based on the integrative role of the molecular mechanisms of cellular and tissue pro-inflammatory stress.
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13
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Burhans W, Rossiter Burhans C, Baumgard L. Invited review: Lethal heat stress: The putative pathophysiology of a deadly disorder in dairy cattle. J Dairy Sci 2022; 105:3716-3735. [DOI: 10.3168/jds.2021-21080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/11/2022] [Indexed: 01/13/2023]
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14
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Restrained expression of canine glucocorticoid receptor splice variants α and P prognosticates fatal disease outcome in SIRS. Sci Rep 2021; 11:24505. [PMID: 34969952 PMCID: PMC8718537 DOI: 10.1038/s41598-021-03451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Glucocorticoids play a central role in the inflammatory response and alleviate the symptoms in critically ill patients. The glucocorticoid action relies on the glucocorticoid receptor (GR) which translocates into the nucleus upon ligand-binding and regulates transcription of a battery of genes. Although the GR is encoded by a single gene, dozens of its splice variants have been described in diverse species. The GRα isoform encodes the full, functionally active protein that is composed of a transactivation, a DNA-binding, and a C-terminal ligand-binding domain. The second most highly expressed receptor variant, the GR-P, is formed by an intron retention that introduces an early stop codon and results in a probably dysfunctional protein with truncated ligand-binding domain. We described the canine ortholog of GR-P and showed that this splice variant is highly abundant in the peripheral blood of dogs. The level of cGRα and cGR-P transcripts are elevated in patients of SIRS and the survival rate is increased with elevated cGRα and cGR-P expression. The ratio of cGRα and cGR-P mRNA did not differ between the survivor and non-survivor patients; thus, the total GR expression is more pertinent than the relative expression of GR isoforms in assessment of the disease outcome.
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15
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Pereshein AV, Kuznetsova SV, Shevantaeva ON. On the Nonspecific Resistance in Burn Injury: Pathophysiological Aspects (Review). Sovrem Tekhnologii Med 2021; 12:84-93. [PMID: 34795984 PMCID: PMC8596251 DOI: 10.17691/stm2020.12.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 11/14/2022] Open
Abstract
An analysis of nonspecific resistance in burn patients is conducted. The role of subpopulations of neutrophils and monocytes/ macrophages in severe burn injury is discussed. The significance of blood cells for the burn-induced immune dysfunction, susceptibility to sepsis and multiple organ failure is underscored. The involvement of secondary complications in the development of morbidity and mortality in patients with burn injury is shown. New approaches to identifying individuals with a risk of adverse outcome are considered.
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Affiliation(s)
- A V Pereshein
- Assistant, Department of Pathological Physiology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S V Kuznetsova
- Associate Professor, Department of Pathological Physiology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - O N Shevantaeva
- Professor, Department of Pathological Physiology Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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16
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Perry KM, Lynch AM, Caudill A, Vigani A, Roberston JB, Vaden S. Clinical features, outcome, and illness severity scoring in 32 dogs with urosepsis (2017-2018). J Vet Emerg Crit Care (San Antonio) 2021; 32:236-242. [PMID: 34730876 DOI: 10.1111/vec.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the clinical features, outcome, and utility of illness severity scoring in dogs diagnosed with urosepsis. DESIGN Retrospective study (2017-2018). SETTING University teaching hospital. ANIMALS Thirty-two dogs diagnosed with urosepsis secondary to pyometra, prostatitis, or pyelonephritis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Urosepsis was identified in 32 dogs, consisting of 9 of 32 (28.1%) with pyometra, 7 of 32 (21.8%) with prostatitis, and 16 of 32 (50%) with pyelonephritis. In total, 28 (87.5%) dogs survived to discharge, with the following group-specific survival rates: pyometra, 9 of 9 (100%); prostatitis, 5 of 7 (71.4%); and pyelonephritis, 14 of 16 (87.5%). Positive bacterial cultures were obtained in 27 of 32 (84.1%) dogs. The most commonly implicated pathogens were Escherichia coli (14/37 [37.8%]), Klebsiella pneumoniae (8/37 [21.6%]), and Staphylococcus pseudintermedius (6/37 [16.2%]). Multiple organ dysfunction syndrome (MODS) was identified in 21 of 32 dogs (65.6%). Although the presence of MODS was not different between survivors and nonsurvivors (P = 0.6), nonsurvivors had more dysfunctional organs (P = 0.04). Nonsurvivors also had higher Acute Patient Physiology and Laboratory Evaluation (APPLEFAST ) scores compared to survivors (P = 0.01). CONCLUSIONS Survival of dogs with urosepsis was good and may be higher than for other sources of sepsis. Compared to survivors, nonsurvivors had more dysfunctional organs and higher illness severity scores, which may be helpful in the assessment and management of dogs with urosepsis.
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Affiliation(s)
- Kayla M Perry
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alex M Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alexander Caudill
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alessio Vigani
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - James B Roberston
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Shelly Vaden
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
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17
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Brunner A, Schuller S, Hettlich B, Marti E, Lehmann A, Peters LM, Adamik KN. Kinetics of Plasma Cytokines, Angiopoietin-2, and C-Reactive Protein in Dogs With Gastric Dilatation Volvulus. Front Vet Sci 2021; 8:652479. [PMID: 34222394 PMCID: PMC8242176 DOI: 10.3389/fvets.2021.652479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The degree of systemic inflammation, reperfusion injury and endothelial activation are potentially important determinants of clinical outcomes in dogs with gastric dilatation volvulus (GDV). Objective: To evaluate plasma concentrations and kinetics of inflammatory markers in dogs with GDV over a time frame of 48 h, and to compare to healthy dogs. Design and Setting: Prospective, observational cohort study in client-owned dogs with GDV. Materials and Methods: Fifteen dogs with GDV and 9 healthy control dogs were enrolled. Plasma concentrations of interleukin (IL)-6, IL-7, IL-8, IL-10, IL-15, IL-18, interferon gamma (IFN-γ), keratinocyte chemotactic-like, monocyte chemotactic protein (MCP)-1, Angiopoietin (Ang)-2, and C-reactive protein (CRP) were measured at admission (prior any therapeutic intervention, (T0), immediately after surgery (T1), 24 ± 4 h (T24), and 48 ± 4 h (T48) post-surgery. Cytokines were measured using multiplex magnetic bead assay. Plasma Ang-2 was measured with a commercial human ELISA test kit validated for dogs. Results: Dogs with GDV had significantly higher plasma concentrations of IFN-γ and IL-10 compared to healthy control dogs at all time points. Concentrations of IL-6 were significantly higher at T1 and T24, concentrations of MCP-1 at T24, and concentrations of CRP at T24 and T48. A significant increase between T0 and T1 was found for IL-6, IL-10, and CRP, between T1 and T24 for IL-8, IFN-γ, MCP-1, and CRP, and between T24 and T48 for IL-15, Ang-2, and CRP. A significant decrease between T0 and T1 was found for IL-7, IL-8, IL-15, IL-18, and Ang-2; between T1 and T24 for IL-6 and KC-like; and between T24 and T48 for IL-6. Conclusion: In GDV dogs, a mild pro-inflammatory reaction was present at admission, which peaked immediately after and up to 24 h post-surgery, mainly represented by IL-6, IFN-γ, MCP-1, and CRP, and which decreased at T48. In addition, the anti-inflammatory IL-10 was increased in GDV dogs at all time points.
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Affiliation(s)
- Anna Brunner
- Division of Small Animal Surgery, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Bianca Hettlich
- Division of Small Animal Surgery, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Eliane Marti
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Anna Lehmann
- Division of Small Animal Internal medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Laureen M Peters
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Katja-Nicole Adamik
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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18
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Schimunek L, Lindberg H, Cohen M, Namas RA, Mi Q, Yin J, Barclay D, El-Dehaibi F, Abboud A, Zamora R, Billiar TR, Vodovotz Y. Computational Derivation of Core, Dynamic Human Blunt Trauma Inflammatory Endotypes. Front Immunol 2021; 11:589304. [PMID: 33537029 PMCID: PMC7848165 DOI: 10.3389/fimmu.2020.589304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023] Open
Abstract
Systemic inflammation ensues following traumatic injury, driving immune dysregulation and multiple organ dysfunction (MOD). While a balanced immune/inflammatory response is ideal for promoting tissue regeneration, most trauma patients exhibit variable and either overly exuberant or overly damped responses that likely drive adverse clinical outcomes. We hypothesized that these inflammatory phenotypes occur in the context of severe injury, and therefore sought to define clinically distinct endotypes of trauma patients based on their systemic inflammatory responses. Using Patient-Specific Principal Component Analysis followed by unsupervised hierarchical clustering of circulating inflammatory mediators obtained in the first 24 h after injury, we segregated a cohort of 227 blunt trauma survivors into three core endotypes exhibiting significant differences in requirement for mechanical ventilation, duration of ventilation, and MOD over 7 days. Nine non-survivors co-segregated with survivors. Dynamic network inference, Fisher Score analysis, and correlations of IL-17A with GM-CSF, IL-10, and IL-22 in the three survivor sub-groups suggested a role for type 3 immunity, in part regulated by Th17 and γδ 17 cells, and related tissue-protective cytokines as a key feature of systemic inflammation following injury. These endotypes may represent archetypal adaptive, over-exuberant, and overly damped inflammatory responses.
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Affiliation(s)
- Lukas Schimunek
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Haley Lindberg
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria Cohen
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rami A Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Jinling Yin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Derek Barclay
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fayten El-Dehaibi
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew Abboud
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Timothy Robert Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
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19
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BEYDİLLİ Y, GÖKÇE Hİ. Investigations of Cardiac Functions and Organ Damages in Neonatal Calves with Suscepted Sepsis. MEHMET AKIF ERSOY ÜNIVERSITESI VETERINER FAKÜLTESI DERGISI 2020. [DOI: 10.24880/maeuvfd.815632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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20
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Jiang Y, Bian Y, Lian N, Wang Y, Xie K, Qin C, Yu Y. iTRAQ-Based Quantitative Proteomic Analysis of Intestines in Murine Polymicrobial Sepsis with Hydrogen Gas Treatment. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:4885-4900. [PMID: 33209018 PMCID: PMC7670176 DOI: 10.2147/dddt.s271191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
Objective Sepsis-associated intestinal injury has a higher morbidity and mortality in patients with sepsis, but there is still no effective treatment. Our research team has proven that inhaling 2% hydrogen gas (H2) can effectively improve sepsis and related organ damage, but the specific molecular mechanism of its role is not clear. In this study, isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomics analysis was used for studying the effect of H2 on intestinal injury in sepsis. Methods Male C57BL/6J mice were used to prepare a sepsis model by cecal ligation and puncture (CLP). The 7-day survival rates of mice were measured. 4-kd fluorescein isothiocyanate-conjugated Dextran (FITC-dextran) blood concentration measurement, combined with hematoxylin-eosinstain (HE) staining and Western blotting, was used to study the effect of H2 on sepsis-related intestinal damage. iTRAQ-based liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis was used for studying the proteomics associated with H2 for the treatment of intestinal injury. Results H2 can significantly improve the 7-day survival rates of sepsis mice. The load of blood and peritoneal lavage bacteria was increased, and H2 treatment can significantly reduce it. CLP mice had significant intestinal damage, and inhalation of 2% hydrogen could significantly reduce this damage. All 4194 proteins were quantified, of which 199 differentially expressed proteins were associated with the positive effect of H2 on sepsis. Functional enrichment analysis indicated that H2 may reduce intestinal injury in septic mice through the effects of thyroid hormone synthesis and nitrogen metabolism signaling pathway. Western blot showed that H2 was reduced by down-regulating the expressions of deleted in malignant brain tumors 1 protein (DMBT1), insulin receptor substrate 2 (IRS2), N-myc downregulated gene 1 (NDRG1) and serum amyloid A-1 protein (SAA1) intestinal damage in sepsis mice. Conclusion A total of 199 differential proteins were related with H2 in the intestinal protection of sepsis. H2-related differential proteins were notably enriched in the following signaling pathways, including thyroid hormone synthesis signaling pathway, nitrogen metabolism signaling pathways, digestion and absorption signaling pathways (vitamins, proteins and fats). H2 reduced intestinal injury in septic mice by down-regulating the expressions of SAA1, NDRG1, DMBT1 and IRS2.
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Affiliation(s)
- Yi Jiang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Yingxue Bian
- Department of Anesthesiology, Tianjin Union Medical Center, Tianjin, People's Republic of China
| | - Naqi Lian
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Yaoqi Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Keliang Xie
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Chao Qin
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Tianjin Institute of Anesthesiology, Tianjin, People's Republic of China
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21
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Sarvazad H, Cahngaripour SH, Eskandari Roozbahani N, Izadi B. Evaluation of electrolyte status of sodium, potassium and magnesium, and fasting blood sugar at the initial admission of individuals with COVID-19 without underlying disease in Golestan Hospital, Kermanshah. New Microbes New Infect 2020; 38:100807. [PMID: 33294198 PMCID: PMC7701326 DOI: 10.1016/j.nmni.2020.100807] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
We examined electrolyte imbalance and blood sugar levels in patients with COVID-19 who had no underlying disease. This cross-sectional study in a clinical center was performed in Kermanshah, west of Iran. All patients who had a record of magnesium (Mg2+), potassium (K+), sodium (Na+), and fasting blood sugar (FBS) tests in their clinical files at the time of admission to the hospital from April 21 to July 12, and didn't have a history of an underlying disease, were included in the study. Patients were divided into outpatient (as less severe COVID-19) and intensive care units (ICU) (as severe COVID-19). For statistical analysis of collected data, the SPSS software (version 16) was used. Among a total of 134 patients, 58 cases (24 ICU and 34 outpatients) were included in the study. The mean and median age was 56 and 62 years, respectively. From all included, 33 men (57%), 25 women (43%), 52 urban (89.7%), 6 rural (10.3%), 41 alive (70.7%), and 17 died (29.3%) were recorded. From all included patients, 49.1% hyperglycemia, 38% hyponatremia, 7.3% hypokalemia, and 32% hypomagnesemia were observed. Unlike the mean of age and the level of K+, there was a statistically significant difference between the outpatient and ICU groups in terms of Mg2+, Na+, and FBS (p < 0.05). Hyperglycemia and electrolyte imbalance in COVID-19 patients is feasible. Therefore, notice to measuring these cases and monitoring the patient can be effective in the treatment process and prevent the serious complications of the disease.
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Affiliation(s)
- H Sarvazad
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S H Cahngaripour
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - N Eskandari Roozbahani
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - B Izadi
- Molecular Pathology Research Centre, Imam Reza Hospital, Kermanshah University of Medical Science, Zakaria Razi Blv, Kermanshah, Iran
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22
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Asim M, Amin F, El-Menyar A. Multiple organ dysfunction syndrome: Contemporary insights on the clinicopathological spectrum. Qatar Med J 2020; 2020:22. [PMID: 33628712 PMCID: PMC7884906 DOI: 10.5339/qmj.2020.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/03/2020] [Indexed: 12/27/2022] Open
Abstract
Multiorgan dysfunction syndrome (MODS) remains a major complication and challenge to treat patients with critical illness in different intensive care unit settings. The exact mechanism and pathophysiology of MODS is complex and remains unexplored. We reviewed the literature from January 2011 to August 2019 to analyze the underlying mechanisms, prognostic factors, MODS scoring systems, organ systems dysfunctions, and the management of MODS. We used the search engines PubMed, MEDLINE, Scopus, and Google Scholar with the keywords "multiple organ dysfunction syndrome," "intensive care units," "multiorgan failure," "MODS scoring system," and "MODS management." The initial search yielded 3550 abstracts, of which 91 articles were relevant to the scope of the present article. A better understanding of a disease course will help differentiate the signs of an intense inflammatory response from the early onset of sepsis and minimize the inappropriate use of medications. This, in turn, will promote organtargeted therapy and prevent occurrence and progression of MODS.
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Affiliation(s)
- Mohammad Asim
- Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Farhana Amin
- Sri Ramaswamy Memorial Medical College Hospital & Research Center, Tamil Nadu, India
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23
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Lakhdhir S, Viall A, Alloway E, Keene B, Baumgartner K, Ward J. Clinical presentation, cardiovascular findings, etiology, and outcome of myocarditis in dogs: 64 cases with presumptive antemortem diagnosis (26 confirmed postmortem) and 137 cases with postmortem diagnosis only (2004-2017). J Vet Cardiol 2020; 30:44-56. [PMID: 32668360 PMCID: PMC7256493 DOI: 10.1016/j.jvc.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study describes presentation, cardiovascular abnormalities, etiology, and outcome of canine myocarditis in geographic areas not endemic for Trypanosoma or Leishmania. ANIMALS Sixty-four (presumed antemortem diagnosis) and 137 (postmortem diagnosis only) client-owned dogs at two tertiary care facilities were included. MATERIALS AND METHODS Medical records of dogs with clinical or histopathological diagnosis of myocarditis were reviewed retrospectively. RESULTS Common examination findings in dogs with a presumed antemortem diagnosis included fever (21%) and heart murmur (19%). Median cardiac troponin I was 12.2 ng/mL (range: 0.2-808.0 ng/mL), and troponin exceeded 1.0 ng/mL in 26 of 29 (90%) dogs. Ventricular ectopy was the most common arrhythmia (54%), whereas decreased left ventricular systolic function was the most common echocardiographic abnormality (56%). An infectious etiology was diagnosed in 35 of 64 (55%) dogs. Confirmed infectious etiologies included bacterial sepsis (n = 9) or extension of endocarditis (3), toxoplasmosis or neosporosis (3), parvovirus (2), and one case each of bartonellosis, trypanosomiasis, leptospirosis, and dirofilariasis. Median survival time was 4 days (range: 0-828 days) for all dogs vs. 82 days for dogs who survived at least 2 weeks after diagnosis. Presence of pericardial effusion or azotemia was a significant predictor of non-survival. The most common inflammatory infiltrate on histopathology was neutrophilic (47%), and 20 of 137 (14.5%) dogs had concurrent bacterial endocarditis on postmortem. CONCLUSIONS Bacterial infection was the most common confirmed etiology of myocarditis in this study. Prognosis for canine myocarditis is guarded and similar to that reported for infective endocarditis. Criteria for the antemortem diagnosis of canine myocarditis are suggested.
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Affiliation(s)
- S Lakhdhir
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA
| | - A Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA
| | - E Alloway
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - B Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - K Baumgartner
- VCA Veterinary Specialists of Northern Colorado, 201 W. 67th Court, Loveland, CO 80538, USA
| | - J Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA.
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Zhao G, Lu S, Li L, Fan X. Local anesthetic articaine ameliorates LPS-induced acute kidney injury via inhibition of NF-ĸB activation and the NLRP3 inflammasome pathway. J Biochem Mol Toxicol 2020; 34:e22554. [PMID: 32687258 DOI: 10.1002/jbt.22554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
The present study was conducted to determine the protective effect of articaine (ART) in an lipopolysaccharide (LPS)-induced acute kidney injury (AKI) animal model. The results suggest ART causes a significant decrease in serum blood urea nitrogen, creatinine, and serum cystatin C level, showing a protective effect against LPS-induced AKI. This has been further supported by histopathological findings of kidney tissues. The level of tumor necrosis factor-α, interleukin (IL)-6, and IL-1β in serum and kidney tissues was remarkably inhibited by ART in a dose-dependent manner. ART causes a significant reduction of malondialdehyde and increases the activities of glutathione and superoxide dismutase with an increase in dose as compared to the LPS-treated group. Moreover, the ART-treated group showed dose-dependent inhibition of LPS-induced nuclear factor-κB activation and TLR4 expression as confirmed by Western blot analysis. The level of Bcl-2 family genes (Bcl-2 and Bax) was restored near to normal by ART. Collectively, all the above results indicated that ART had protective effects against LPS-induced AKI by blocking inflammatory and oxidative responses.
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Affiliation(s)
- Guanjie Zhao
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Shan Lu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Linlin Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaodi Fan
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Alves F, Prata S, Nunes T, Gomes J, Aguiar S, Aires da Silva F, Tavares L, Almeida V, Gil S. Canine parvovirus: a predicting canine model for sepsis. BMC Vet Res 2020; 16:199. [PMID: 32539830 PMCID: PMC7294767 DOI: 10.1186/s12917-020-02417-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system. RESULTS The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome. Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%. CONCLUSION These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.
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Affiliation(s)
- F. Alves
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - S. Prata
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - T. Nunes
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - J. Gomes
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - S. Aguiar
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - F. Aires da Silva
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - L. Tavares
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - V. Almeida
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - S. Gil
- Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, ULisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
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Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical Illnesses. Crit Care Med 2020; 47:e677-e684. [PMID: 31162199 DOI: 10.1097/ccm.0000000000003839] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Multiple organ dysfunction syndrome is characterized by simultaneous multiple organ failure, which is the leading cause of death in acute critically ill patients. However, what mediates multiple organ dysfunction syndrome is not fully understood. The discovery of toxic effects by extracellular histones on different individual organs strongly suggests their involvement in multiple organ dysfunction syndrome. In this study, we investigate whether circulating histones are major mediators of multiple organ dysfunction syndrome in acute critical illnesses. DESIGN Combination of retrospective clinical studies and animal models with intervention. SETTING ICU in a tertiary hospital and research laboratories. PATIENTS Four hundred and twenty ICU patients, including sepsis (140), severe trauma (63), severe pancreatitis (89), and other admission diagnoses (128). LABORATORY INVESTIGATION Cells from major organs are treated with calf thymus histones or histone-containing sera. Animal models for sepsis, trauma, and acute pancreatitis are treated with antihistone reagents. INTERVENTION Antihistone reagents in in vitro, ex vivo, and animal models. MEASUREMENT AND MAIN RESULTS Retrospective analysis of a prospectively recruited ICU cohort demonstrated a strong correlation between circulating histones and organ injury markers and Sequential Organ Failure Assessment scores. Ex vivo experiments showed that patient sera containing high histone levels were toxic to cultured cells from different origins, suggesting their universal toxicity to multiple organs. Animal models of sepsis, trauma, and pancreatitis further demonstrated a temporal correlation between histone levels and disease severity and multiple organ injury. Importantly, antihistone reagents, that is, antihistone single-chain variable fragment and nonanticoagulant heparin, could dramatically reduce multiple organ injury, particularly of the heart and lungs, and improve survival in mouse models. CONCLUSIONS High levels of circulating histones are major mediators of multiple organ dysfunction syndrome. Our results indicate that monitoring upon ICU admission could inform on disease severity and developing antihistone therapy holds great potential of reducing multiple organ dysfunction syndrome and improving survival of critically ill patients.
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Eppensteiner J, Kwun J, Scheuermann U, Barbas A, Limkakeng AT, Kuchibhatla M, Elster EA, Kirk AD, Lee J. Damage- and pathogen-associated molecular patterns play differential roles in late mortality after critical illness. JCI Insight 2019; 4:127925. [PMID: 31434802 DOI: 10.1172/jci.insight.127925] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple organ failure (MOF) is the leading cause of late mortality and morbidity in patients who are admitted to intensive care units (ICUs). However, there is an epidemiologic discrepancy in the mechanism of underlying immunologic derangement dependent on etiology between sepsis and trauma patients in MOF. We hypothesized that damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs), while both involved in the development of MOF, contribute differently to the systemic innate immune derangement and coagulopathic changes. We found that DAMPs not only produce weaker innate immune activation than counterpart PAMPs, but also induce less TLR signal desensitization, contribute to less innate immune cell death, and propagate more robust systemic coagulopathic effects than PAMPs. This differential contribution to MOF provides further insight into the contributing factors to late mortality in critically ill trauma and sepsis patients. These findings will help to better prognosticate patients at risk of MOF and may provide future therapeutic molecular targets in this disease process.
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Affiliation(s)
- John Eppensteiner
- Department of Surgery and.,Division of Emergency Medicine, Duke University, Durham, North Carolina, USA.,Surgical Critical Care Initiative (SC2i), Bethesda, Maryland, USA
| | | | | | | | - Alexander T Limkakeng
- Department of Surgery and.,Division of Emergency Medicine, Duke University, Durham, North Carolina, USA.,Surgical Critical Care Initiative (SC2i), Bethesda, Maryland, USA
| | - Maggie Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Eric A Elster
- Surgical Critical Care Initiative (SC2i), Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Allan D Kirk
- Department of Surgery and.,Surgical Critical Care Initiative (SC2i), Bethesda, Maryland, USA
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Chernigova SV, Chernigov YV, Vatnikov YA, Kulikov EV, Popova IA, Shirmanov VI, Molchanova MA, Likhacheva IF, Voronina YY, Lukina DM. Special aspects of systemic inflammation course in animals. Vet World 2019; 12:932-937. [PMID: 31528014 PMCID: PMC6702551 DOI: 10.14202/vetworld.2019.932-937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022] Open
Abstract
AIM In this study, we identified characteristics of systemic inflammation associated with surgical sepsis in animals. We evaluated the role of purine metabolism, functionally associated lipoperoxidation processes of membrane structures, and the antioxidant system in the development of surgical sepsis in dogs. MATERIALS AND METHODS Dogs with a provisional exclusion of sepsis were included in the study. The control group (Group 1) included clinically healthy dogs (n=5), and medium-breed dogs with systemic inflammation response syndrome (n=30) were categorized in the experimental group (Group 2). Along with hemogram and biochemical analysis, we determined the amount of malondialdehyde, glutathione, superoxide dismutase, catalase, glutathione reductase, and glucose-6-phosphate dehydrogenase on the 1st and 14th day of the study. Treatment included a thorough reorganization of the septic focus, followed by antibacterial therapy. Sick animals were injected with a drug (dexamethasone) that suppresses the synthesis and inhibits the action of inflammatory mediators. Decompensation of the functions of organs and systems was carried out using symptomatic therapy. RESULTS We found that enhanced lipid peroxidation of unsaturated fatty acids of membrane structures stimulates the generalization of inflammatory process, as evidenced by the significant deviation from the physiologically normal values of lipid peroxidation, C-reactive protein, blood cell count, etc. The course of systemic inflammation associated with surgical sepsis in animals can be attributed to several consistently developing processes that function as a result of increased purine mononucleotide catabolism, peroxide compound formation, and their excessive breakdown in reactions associated with the consumption of glutathione due to the insufficient recovery of glutathione disulfide. CONCLUSION The amount of uric acid, glycosaminoglycans, hyaluronic acid in blood plasma, and the content of malondialdehyde, glutathione, and glutathione reductase in erythrocytes should be considered when assessing the severity of the systemic inflammatory process. The increased glutathione requirement in dogs with surgical sepsis requires intervention with pharmacological agents, and further research is needed in this aspect.
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Affiliation(s)
| | | | - Yury Anatolyevich Vatnikov
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Irina Anatolyevna Popova
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | | | | | - Irina Fedorovna Likhacheva
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Yuliya Yuryevna Voronina
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Darya Mikhaylovna Lukina
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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Troìa R, Mascalzoni G, Calipa S, Magagnoli I, Dondi F, Giunti M. Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication. J Feline Med Surg 2019; 21:559-565. [PMID: 30099963 PMCID: PMC10814542 DOI: 10.1177/1098612x18792106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis. METHODS Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05. RESULTS A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. CONCLUSIONS AND RELEVANCE MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.
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Affiliation(s)
- Roberta Troìa
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Giulia Mascalzoni
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Stefano Calipa
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Ilaria Magagnoli
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Francesco Dondi
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Science, Alma Mater Studiorum–University of Bologna, Ozzano dell’Emilia, Bologna, Italy
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Leisewitz A, Goddard A, De Gier J, Van Engelshoven J, Clift S, Thompson P, Schoeman JP. Disease severity and blood cytokine concentrations in dogs with natural Babesia rossi infection. Parasite Immunol 2019; 41:e12630. [PMID: 31063593 DOI: 10.1111/pim.12630] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
Abstract
AIMS Babesia rossi causes severe disease in dogs. Here, we describe the association between serum cytokine concentrations and disease severity. METHODS Seventeen controls and 55 PCR confirmed B rossi-infected dogs were included. Diseased dogs were subdivided into 23 critically ill and 32 relatively well cases. Serum concentrations of 11 cytokines and biochemical markers of disease severity were determined. RESULTS Significant differences were detected for IL-6, IL-8, IL-10, MCP-1 and TNF-α between the groups. Generally, the more complicated the disease, the more pro-inflammatory the cytokine milieu. IL-8 showed a reverse trend and was negatively correlated with disease severity. IL-6, MCP-1 and TNF-α were also significantly higher in the dogs that died (n = 9) compared to the dogs that survived (n = 46). IL-8 showed the opposite. MCP-1 and TNF-α were negatively correlated with biochemical markers of severity. Glucose was negatively correlated with IL-6. Cortisol, peripheral parasite density and band neutrophil count were positively correlated, whilst thyroid hormone was negatively correlated with IL-6, MCP-1 and TNF-α. CONCLUSIONS As in malaria and sepsis, B rossi infection induces a pro-inflammatory cytokine storm that correlates with disease severity and adverse outcome. The multiplicity of cytokines involved argues for redundancy in the system once the disease is established.
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Affiliation(s)
- Andrew Leisewitz
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Amelia Goddard
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Jill De Gier
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Jessica Van Engelshoven
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Sarah Clift
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Peter Thompson
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Johan P Schoeman
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Lee GW, Park HM, Kang MH. Global brain ischemia in a dog with concurrent multiorgan dysfunction syndrome after bite wound trauma. Acta Vet Scand 2019; 61:22. [PMID: 31060620 PMCID: PMC6501374 DOI: 10.1186/s13028-019-0458-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bite wounds are one of the most common traumatic injuries in dogs and depending on their severity, location, etc., urgent care including antibiotic therapy may be necessary. Serious complications can result from these injuries, such as multiple organ dysfunction syndrome (MODS), as well as a generalized reduction in cerebral perfusion, e.g. during cardiac arrest, shock, or severe hypotension that may cause global brain ischemia (GBI). CASE PRESENTATION A 5-year-old spayed female Maltese dog was presented with generalized seizures, ataxia, and obtunded mentation. The dog was injured by severe bite wounds that penetrated its abdomen and had received blood transfusions, antibiotic therapy (including metronidazole and cefazoline) and underwent emergency surgery 4 days before its visit. Based on a clinical examination, intracranial hypoxic damage with elevated intra-cranial pressure and MODS were highly suspected, and GBI was confirmed following magnetic resonance imaging. Increased signal intensity diffusely distributed in the olfactory bulb and frontal, temporal, and parietal grey matter was evident on the T2-weighted and fluid attenuated inversion recovery transverse images, along with corresponding high signal intensity observed on diffusion weighted imaging. During the 10-month follow-up period, the clinical signs gradually improved, but intermittent circling and cognitive dysfunction deficits remained. CONCLUSIONS GBI should be included among the differential diagnoses in case of any peracute non-progressive neurological dysfunction that occurs with episodes of hypotension or hypoxia. The abnormal signal intensity observed on diffusion weighted imaging was a useful indicator for diagnosing this condition. Long-term medical management with antibiotics and anti-convulsant and anti-oxidant therapies were considered to be helpful in managing the GBI concurrent with MODS in this dog.
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Bar-Or D, Rael LT, Madayag RM, Banton KL, Tanner A, Acuna DL, Lieser MJ, Marshall GT, Mains CW, Brody E. Stress Hyperglycemia in Critically Ill Patients: Insight Into Possible Molecular Pathways. Front Med (Lausanne) 2019; 6:54. [PMID: 30972338 PMCID: PMC6445875 DOI: 10.3389/fmed.2019.00054] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023] Open
Abstract
Severe sepsis, systemic inflammatory response syndrome (SIRS), and traumatic brain injury are frequently associated with hyperglycemia in non-diabetic patients. In patients suffering from any of these conditions, hyperglycemia at admission to an intensive care unit (ICU) is directly correlated with increased mortality or morbidity. Although there was initial enthusiasm for insulin treatment to blood glucose levels below 110 mg/dL in these patients, recent understanding suggests that the potential for hypoglycemic complications make this approach potentially dangerous. More moderate glucose control seems to be more beneficial than the aggressive glucose lowering initially suggested. An important publication has shown that hyperlactatemia accompanying hyperglycemia could be the real culprit in bad outcomes. This suggests that coupling moderate glucose lowering with therapeutic agents which might treat the underlying metabolic disturbances in these conditions may be a better strategy. The key metabolic disturbance in these three conditions seems to be persistent glycolysis as an energy source even in the presence of adequate tissue oxygenation (the Warburg Effect). We look at recent advances in understanding aerobic glycolysis and possibly the action of DPP4 on incretins resulting in insulin dysregulation and suggest key metabolic pathways involved in hyperglycemia regulation.
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Affiliation(s)
- David Bar-Or
- Trauma Research Laboratory, Swedish Medical Center, Englewood, CO, United States.,St. Anthony Hospital, Lakewood, CO, United States.,Penrose Hospital, Colorado Springs, CO, United States.,Wesley Medical Center, Wichita, KS, United States.,Research Medical Center, Kansas City, MO, United States.,Medical City Plano Hospital, Plano, TX, United States
| | - Leonard T Rael
- Trauma Research Laboratory, Swedish Medical Center, Englewood, CO, United States
| | | | - Kaysie L Banton
- Trauma Research Laboratory, Swedish Medical Center, Englewood, CO, United States
| | - Allen Tanner
- Penrose Hospital, Colorado Springs, CO, United States
| | | | - Mark J Lieser
- Research Medical Center, Kansas City, MO, United States
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Gong H, Sheng X, Xue J, Zhu D. Expression and role of TNIP2 in multiple organ dysfunction syndrome following severe trauma. Mol Med Rep 2019; 19:2906-2912. [PMID: 30720079 DOI: 10.3892/mmr.2019.9893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/30/2018] [Indexed: 11/05/2022] Open
Abstract
Severe trauma can result in secondary multiple organ dysfunction syndrome (MODS) and death. Inflammation response and oxidative stress promote the occurrence and development of MODS. TNFAIP3‑interacting protein 2 (TNIP2), which can repress the activation of nuclear factor‑κB (NF‑κB) and may be involved in MODS progression, has not been studied in regards to MODS. The present study aimed to investigate the expression, role and mechanism of TNIP2 in MODS following severe trauma. The expression level of TNIP2 was initially detected in the blood of patients with MODS using reverse transcription‑quantitative polymerase chain reaction and western blot assay. Then, to investigate the role of TNIP2 in MODS, a MODS rat model was conducted by trauma and the model rats were treated with TNIP2‑plasmid (intraperitoneal injection). Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatine (Cr) and creatine kinase (CK); and tumor necrosis factor α (TNF‑α), high‑mobility group box 1 (HMGB‑1), malondialdehyde (MDA) and total antioxidant capacity (TAC) in the different groups were assessed. In addition, activation of NF‑κB was assessed by detecting the level of phospho‑p65. The results showed that TNIP2 was significantly decreased in the blood of patients with MODS. TNIP2 was also significantly downregulated in the blood and the pulmonary, renal and hepatic tissues of MODS rats. The levels of ALT, AST, LDH, BUN, Cr and CK were markedly increased in the blood of MODS rats, and these increases were inhibited by TNIP2‑plasmid administration. Moreover, blood levels of TNF‑α, HMGB‑1 and MDA were significantly increased in MODS rats, while TAC was notably decreased, and these changes were prevented by TNIP2‑plasmid administration. Furthermore, it was found that activation of NF‑κB induced by MODS was eliminated by TNIP2‑plasmid. In conclusion, the data indicated that TNIP2 is significantly decreased in MODS following severe trauma, and it plays a protective role in MODS development by inhibiting the inflammation response and oxidative stress by preventing NF‑κB activation.
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Affiliation(s)
- Hui Gong
- Department of Emergency Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiaomin Sheng
- Department of Emergency Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jianhua Xue
- Department of Emergency Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Dongbo Zhu
- Department of Emergency Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
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Sharma D, Hill AE, Christopher MM. Hypercholesterolemia and hypertriglyceridemia as biochemical markers of disease in companion rabbits. Vet Clin Pathol 2018; 47:589-602. [PMID: 30556916 DOI: 10.1111/vcp.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inflammation has important effects on lipid metabolism, but the relationship between hyperlipidemia, inflammation, and disease remains unknown in rabbits. While rabbits are sensitive to dietary hypercholesterolemia, the etiology of hyperlipidemia when fed non-atherogenic diets is uncertain. OBJECTIVES This study aimed to determine the association between hypercholesterolemia and patient characteristics, diseases, and select CBC and biochemistry analytes in rabbits, and to measure plasma lipoprotein lipid fractions in rabbits with inflammatory and other diseases. METHODS Complete blood count and plasma biochemistry data, including total cholesterol concentrations, were evaluated in 531 companion rabbits. Lipoprotein cholesterol fractions (non-high-density lipoprotein cholesterol [non-HDLc] and high-density lipoprotein [HDLc]) and triglycerides were measured using a colorimetric enzymatic assay in archived plasma from a subset of 267 rabbits. Rabbits were categorized by age, sex, spay/neuter status, breed, diet status (fed atherogenic dietary components or not), the organ system affected by disease, and the pathologic process. RESULTS Cholesterol was associated with fibrinogen (P = 0.01), globulins (P < 0.01), and heterophil (P < 0.01) concentrations. Adjusting for diet, rabbits with severe infection or sepsis (odds ratio [OR] = 13.25, 95% CI = 5.83-30.12), renal failure (OR = 14.42, 95% CI = 5.69-36.54), and hepatopathy (OR = 8.55, 95% CI = 3.55-20.62) had increased risks of hypercholesterolemia. Increased non-HDLc and triglyceride concentrations were also associated with these three disease states (P < 0.05). CONCLUSIONS Hyperlipidemia is associated with biochemical and CBC markers of inflammation, and with severe infection or sepsis, renal failure, and hepatopathy. Independent of diet, increased cholesterol, non-HDLc, and triglycerides are indicators of disease in companion rabbits.
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Affiliation(s)
- Diya Sharma
- Department of Pathology, Microbiology and Immunology, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Ashley E Hill
- California Animal Health and Food Safety Laboratory System, University of California-Davis, Davis, California
| | - Mary M Christopher
- Department of Pathology, Microbiology and Immunology, University of California-Davis School of Veterinary Medicine, Davis, California
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Zhao X, Yin L, Fang L, Xu L, Sun P, Xu M, Liu K, Peng J. Protective effects of dioscin against systemic inflammatory response syndromevia adjusting TLR2/MyD88/NF‑κb signal pathway. Int Immunopharmacol 2018; 65:458-469. [PMID: 30390593 DOI: 10.1016/j.intimp.2018.10.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022]
Abstract
Development of active compounds to control inflammation against systemic inflammatory response syndrome (SIRS) is critical important. Dioscin shows anti-inflammatory effects in our previous works. However, the action of the compound on SIRS still remained unknown. In the present paper, zymosan induced generalized inflammation (ZIGI) models in mice and rats, and PMA-differentiated THP‑1 cells stimulated by lipopolysaccharide (LPS) and Pam3-Cys-Ser-Lys4 (Pam3CSK4) were used. The results showed that dioscin significantly inhibited the proliferation of THP‑1 cells stimulated by LPS and Pam3CSK4, obviously reduced the soakage of inflammatory cells and necrosis in liver, kidney and intestine of rats and mice, and reduced peritoneal ascites fluid compared with ZIGI model groups. In addition, dioscin significantly declined the levels of alanine transaminase (ALT), aspartate transaminase (AST), creatinine (Cr), blood urea nitrogen (BUN), malondialdehyde (MDA) and myeloperoxidase (MPO), increased the levels of superoxide dismutase (SOD) in rats and mice. The migration of macrophages in tissues was also suppressed by dioscin. Mechanism investigation showed that dioscin significantly inhibited the expression levels of TLR2, MyD88, NF‑κb, HMGB‑1, increased the expression levels of IKBα, and decreased the mRNA levels of interleukin‑1 beta (IL‑1β), interleukin‑6 (IL‑6) and tumor necrosis factor‑alpha (TNF‑α) in liver, kidney, intestine tissues of rats and mice, and in PMA-differentiated THP‑1 cells, which were further confirmed by TLR2 siRNA silencing in vitro. In conclusion, our data confirmed that dioscin exhibited protective effects against SIRS via adjusting TLR2/MyD88 signal pathway, which should be developed as one potent candidate to treat SIRS in the future.
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Affiliation(s)
- Xuerong Zhao
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Lianhong Yin
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Lingling Fang
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Lina Xu
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Pengyuan Sun
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Ming Xu
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Kexin Liu
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China
| | - Jinyong Peng
- College of Pharmacy, Dalian Medical University, Western 9 Lvshun nan Road, Dalian 116044, China.
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Lux CN, Culp WTN, Mellema MS, Rosselli DD, Schmiedt CW, Singh A, Haynes A, Selmic LE, Phillips H, Milovancev M, Mayhew PD, Brown DC. Factors associated with survival to hospital discharge for cats treated surgically for thoracic trauma. J Am Vet Med Assoc 2018; 253:598-605. [DOI: 10.2460/javma.253.5.598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lux CN, Culp WTN, Mellema MS, Rosselli DD, Schmiedt CW, Singh A, Haynes A, Schoenrock E, Selmic LE, Phillips H, Milovancev M, Mayhew PD, Brown DC. Perioperative mortality rate and risk factors for death in dogs undergoing surgery for treatment of thoracic trauma: 157 cases (1990–2014). J Am Vet Med Assoc 2018; 252:1097-1107. [DOI: 10.2460/javma.252.9.1097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Dkhil MA, Al-Quraishy S, Moneim AEA. Ziziphus spina-christi leaf extract pretreatment inhibits liver and spleen injury in a mouse model of sepsis via anti-oxidant and anti-inflammatory effects. Inflammopharmacology 2018; 26:779-791. [PMID: 29327282 DOI: 10.1007/s10787-017-0439-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/26/2017] [Indexed: 12/20/2022]
Abstract
Sepsis is a systemic response to infection that can result in acute hepatic and splenic damage. Ziziphus spina-christi (L.) is a wild tree used as a medicinal plant by ancient Egyptians. However, little is known about the mechanism underlying its effects on sepsis. The current study investigated the protective effects of a Z. spina-christi leaf extract (ZSCLE) on liver and spleen damage in a male C57BL/6 mouse model of sepsis, induced by cecal ligation and puncture (CLP). Prior to CLP, ZSCLE was administered daily for five consecutive days via oral gavage at doses of 100, 200, or 300 mg/kg. The mice were euthanized 9 h after CLP, and oxidative stress markers were measured (myeloperoxidase, lipid peroxidation, nitric oxide, and reduced glutathione). In addition, we investigated histological changes, anti-oxidant enzyme activities (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase), cytokine levels, protein expression of nuclear factor-κB and inducible nitric oxide synthase (iNOS), and mRNA levels of mitogen-activated protein kinase (8, 9, and 14), iNOS, tumor necrosis factor-α, and interleukin-1β. Our results indicated that ZSCLE significantly and dose-dependently inhibited sepsis-induced liver and spleen injury. These results suggest that ZSCLE could provide a therapeutic agent for sepsis by inducing anti-inflammatory and anti-oxidant effects.
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Affiliation(s)
- Mohamed A Dkhil
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia. .,Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt.
| | - Saleh Al-Quraishy
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed E Abdel Moneim
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt.
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INFLUENCE OF LACTOPROTEINUM SOLUTION WITH SORBITOL ON DNA CONTENT OF CELLS OF ENDOCRINE GLANDS ON THE BACKGROUND OF SKIN BURN IN RATS. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-2-64-33-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rutland BE, Byl KM, Hydeskov HB, Miniter B, Johnson CA. Systemic manifestations of Cuterebra infection in dogs and cats: 42 cases (2000–2014). J Am Vet Med Assoc 2017; 251:1432-1438. [DOI: 10.2460/javma.251.12.1432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Zhao X, Gu T, Xiu Z, Shi E, Yu L. Mild Hypothermia May Offer Some Improvement to Patients with MODS after CPB Surgery. Braz J Cardiovasc Surg 2017; 31:246-251. [PMID: 27737408 PMCID: PMC5062708 DOI: 10.5935/1678-9741.20160048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/08/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: To summarize the effect of mild hypothermia on function of the organs in
patients with multiple organ dysfunction syndrome after cardiopulmonary
bypass surgery. METHODS: The patients were randomly divided into two groups, northermia group (n=71)
and hypothermia group (n=89). We immediately began cooling the hypothermia
group when test results showed multiple organ dysfunction syndrome,
meanwhile all patients of two groups were drawn blood to test blood gas,
liver and kidney function, blood coagulation function, and evaluated the
cardiac function using echocardiography from 12 to 36 hours. We compared the
difference of intra-aortic balloon pump, extracorporeal membrane oxygenation
rate and mortality within one month after intensive care unit admission. RESULTS: Among the 160 patients, 36 died, 10 (11.24%) patients were from the
hypothermia group and 26 (36.6%) from the northermia group
(P <0.05). In northermia group, 45 (63.38%) patients
used intra-aortic balloon pump and 4 (5.63%), extracorporeal membrane
oxygenation; in hypothermia group, 35 (39.32%) patients used intra-aortic
balloon pump and 2 (2.25%), extracorporeal membrane oxygenation(
P <0.05). The patients' heart rate decreased
significantly in the hypothermia group. The heart rate of hypothermia group
is significantly slower than the northermia group at the 36th
hour (P <0.05). But the mean arterial pressure of
hypothermia group is significantly higher than the northermia group at the
36th hour (P <0.05). In hypothermia
group, PO2, SvO2 and lactate were improved
significantly compared to pre-cooling (P <0.05), and
they were significantly better than the northermia group at the
36th hour (P <0.05%). Prothrombin time
and activated partial thromboplastin time have no significantly difference
between the two groups (P >0.05). But the platelet count
has significantly difference between the two groups at the 36th
hour (P <0.05). The aspartate transaminase, alanine
transaminase and creatinine were improved significantly in the hypothermia
group, and they were significantly better than the northermia group
(P <0.05). CONCLUSION: Mild hypothermia is feasible and safe for patients with multiple organ
dysfunction syndrome after cardiopulmonary bypass surgery.
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Affiliation(s)
- Xiaoqi Zhao
- Department of Cardiac Surgery ICU, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Tianxiang Gu
- Department of Cardiac Surgery ICU, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Zongyi Xiu
- Department of Cardiac Surgery ICU, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Enyi Shi
- Department of Cardiac Surgery ICU, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Lei Yu
- Department of Cardiac Surgery ICU, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
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A Systematic Review of Neuroprotective Strategies during Hypovolemia and Hemorrhagic Shock. Int J Mol Sci 2017; 18:ijms18112247. [PMID: 29072635 PMCID: PMC5713217 DOI: 10.3390/ijms18112247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023] Open
Abstract
Severe trauma constitutes a major cause of death and disability, especially in younger patients. The cerebral autoregulatory capacity only protects the brain to a certain extent in states of hypovolemia; thereafter, neurological deficits and apoptosis occurs. We therefore set out to investigate neuroprotective strategies during haemorrhagic shock. This review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Before the start of the search, a review protocol was entered into the PROSPERO database. A systematic literature search of Pubmed, Web of Science and CENTRAL was performed in August 2017. Results were screened and evaluated by two researchers based on a previously prepared inclusion protocol. Risk of bias was determined by use of SYRCLE’s risk of bias tool. The retrieved results were qualitatively analysed. Of 9093 results, 119 were assessed in full-text form, 16 of them ultimately adhered to the inclusion criteria and were qualitatively analyzed. We identified three subsets of results: (1) hypothermia; (2) fluid therapy and/or vasopressors; and (3) other neuroprotective strategies (piracetam, NHE1-inhibition, aprotinin, human mesenchymal stem cells, remote ischemic preconditioning and sevoflurane). Overall, risk of bias according to SYRCLE’s tool was medium; generally, animal experimental models require more rigorous adherence to the reporting of bias-free study design (randomization, etc.). While the individual study results are promising, the retrieved neuroprotective strategies have to be evaluated within the current scientific context—by doing so, it becomes clear that specific promising neuroprotective strategies during states of haemorrhagic shock remain sparse. This important topic therefore requires more in-depth research.
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Llewellyn EA, Todd JM, Sharkey LC, Rendahl A. A pilot study evaluating the prognostic utility of platelet indices in dogs with septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2017; 27:569-578. [PMID: 28749085 DOI: 10.1111/vec.12628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/22/2015] [Accepted: 11/08/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterize platelet indices at time of diagnosis of septic peritonitis in dogs and to assess the relationship between platelet parameter data and survival to discharge in dogs treated surgically. DESIGN Retrospective, observational, descriptive pilot study from 2009 to 2014. SETTING University teaching hospital. ANIMALS Forty-eight dogs diagnosed with septic peritonitis were included in this study. Thirty-six dogs had surgical source control. Blood samples from 46 healthy control dogs were used for reference interval (RI) generation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) with increased proportions of dogs having values above the RI compared to healthy dogs. A significantly increased proportion of dogs with septic peritonitis had platelet counts above (12.5%) and below (8.3%) the RI, with no significant difference in mean platelet count compared to healthy dogs. No significant differences in the mean platelet count, MPV, PCT, or PDW were found between survivors and nonsurvivors in dogs with surgical source control; however, dogs with MPV values above the RI had significantly increased mortality compared to dogs within the RI (P = 0.025). Values outside the RI for other platelet parameters were not associated with significant differences in mortality. CONCLUSIONS Dogs with septic peritonitis have increased frequency of thrombocytosis and thrombocytopenia with increased MPV, PCT, and PDW. An increased MPV may be a useful indicator of increased risk of mortality in dogs treated surgically.
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Affiliation(s)
- Efa A Llewellyn
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108
| | - Jeffrey M Todd
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108
| | - Leslie C Sharkey
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108
| | - Aaron Rendahl
- School of Statistics, University of Minnesota, St Paul, MN, 55108
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Wang T, Liu C, Wei P, Lv L, Yang Z. The inhibiting effect of intravenous anesthesia on adrenal gland functions under the sepsis condition. Int J Immunopathol Pharmacol 2017; 30:188-193. [PMID: 28406323 PMCID: PMC5806798 DOI: 10.1177/0394632017705049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to explore the effect of intravenous anesthesia on the adrenal gland functions of rats with sepsis as well as on their lungs and adrenal gland tissues in order to provide a theoretical reference for the cure of sepsis. Female Sprague Dawley (SD) rats were taken as the research objects in this study. Venous channels of rats were constructed by catheterization through the external jugular vein, and the cecal ligation and puncture technique was adopted to duplicate the sepsis rat models. The level of tumor necrosis factor-α (TNF-α) in serum was detected using enzyme-linked immunosorbent assay (ELISA), and necrocytosis was observed by the fluorescent staining method. The results showed that the survival rates of groups A, B, C, and D were 100%, 60%, 60%, and 50%, respectively, while their concentrations of TNF-α in serum were101.26 ± 43.38, 1398.68 ± 178.56, 451.16 ± 78.68, and 649.83 ± 98.56 pg/mL, respectively. Results of fluorescent staining showed that the number of living cells per unit view in group A was 1428 ± 166 and those of groups B, C and D were 175 ± 56, 618 ± 76, and 468 ± 55, respectively. Besides, it was found that changes of inflammatory pathology of lung tissues of each group were significant. In conclusion, etomidate does not affect the survival of sepsis rats and does not exacerbate lung tissue inflammation in sepsis rats. Instead, it can inhibit TNF-α in serum of sepsis rats, as well as the apoptosis of adrenal cells in sepsis rats.
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Affiliation(s)
- Te Wang
- 1 Department of Anesthesiology, The Wendeng Osteopath Hospital, Weihai, China
| | - Changdong Liu
- 2 Department of Anesthesiology, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, China
| | - Pihong Wei
- 3 Department of Anesthesiology, Taian City Central Hospital, Tai'an, China
| | - Lili Lv
- 1 Department of Anesthesiology, The Wendeng Osteopath Hospital, Weihai, China
| | - Zaiqi Yang
- 3 Department of Anesthesiology, Taian City Central Hospital, Tai'an, China
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General Systemic States. Vet Med (Auckl) 2017. [PMCID: PMC7195945 DOI: 10.1016/b978-0-7020-5246-0.00004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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INFLUENCE OF HAES-LX-5% INFUSION SOLUTION ON THE DNA CONTENT OF ENDOCRINE GLANDS CELLS AGAINST THE BACKGROUND OF THERMAL BURN OF SKIN IN RATS. WORLD OF MEDICINE AND BIOLOGY 2017. [DOI: 10.26724/2079-8334-2017-4-62-168-173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Figueiredo V, Muzzi R, Pereira C, Mantovani M, Muzzi L, Oberlender G, Júnior A, Arruda P. Avaliação da depressão miocárdica por meio do feature tracking bidimensional em cadelas com sepse. ARQ BRAS MED VET ZOO 2016. [DOI: 10.1590/1678-4162-8693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O objetivo deste estudo prospectivo foi analisar a função do ventrículo esquerdo de cadelas que apresentavam sepse ou não e diagnosticar a depressão miocárdica de forma precoce, por meio do feature tracking imaging bidimensional (FTI-2D).Vinte e nove cadelas diagnosticadas com piometra, patologia usada como modelo experimental para sepse, foram avaliadas. Os animais foram submetidos ao exame ecocardiográfico convencional e ao FTI-2D e divididos em três grupos: grupo I (controle), grupo II (piometra sepse) e grupo III (piometra não sepse). Em relação aos parâmetros da ecocardiografia convencional, não houve diferença estatística entre os grupos avaliados. Quanto ao strain radial, os grupos II e III apresentaram função ventricular inferior no momento do diagnóstico (22,805,80 grupo I; 18,455,96 grupo II; 18,719,45 grupo III; P=0,032) e o grupo III manteve essa redução no retorno. Já no strain rate radial, apenas o grupo III obteve função ventricular inferior no momento do diagnóstico (1,900,57 grupo I; 1,910,70 grupo II, 1,570,53 grupo III; P=0,021). Para o strain longitudinal, observou-se função ventricular mais baixa nos grupos II e III no momento do diagnóstico (11,043,38 grupo I; 8,593,97 grupo II; 8,211,99; P=0,048) e após 10 dias de pós-cirúrgico (11,043,38 grupo I; 9,002,16 grupo II; 8,122,27 grupo III; p=0,048). O FTI-2D foi capaz de detectar alterações precoces da função ventricular esquerda, que não foram observadas no exame ecocardiográfico convencional, sugerindo quadro de depressão miocárdica, até mesmo em cadelas com piometra sem quadro clínico evidente de sepse. Assim, essa modalidade pode ser útil no diagnóstico, pois pode detectar alterações cardíacas precoces, possibilitando uma intervenção terapêutica rápida.
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Ma MJ, Han B, Xu SQ. Trefoil factor 3 related to gastrointestinal failure in pediatric critical illness. Arch Pediatr 2016; 23:681-4. [PMID: 27262626 DOI: 10.1016/j.arcped.2016.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 03/04/2016] [Accepted: 04/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND To determine the relationship between the serum concentration of trefoil factor 3 (TFF3) and gastrointestinal failure (GIF) in pediatric critical illness in order to provide knowledge for disease management. MATERIALS AND METHODS We enrolled 137 cases and divided them into three groups, including a control group (group A), critical illness without GIF (group B), and critical illness with GIF (group C). The serum TFF3 concentration was determined by ELISA and compared among the groups. RESULTS Serum TFF3 concentrations measured before the occurrence of GIF in group C were significantly higher than in groups A and B (P<0.01). Under the conditions of GIF in group C, serum TFF3 concentration was significantly related to the gastrointestinal tract function score (r=-0.712). Cox's proportional hazards model analysis showed that the serum TFF3 concentrations at the time of occurrence of GIF, and 48hours later, could be used as prognostic factors in critically ill pediatric patients with GIF (r=1.443 and 1.872, respectively). CONCLUSION TFF3 may play an important role in predicting GIF in pediatric critical illness and has a protective function in the mucosal repair process.
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Affiliation(s)
- M-J Ma
- Department of Thoracic, the First Hospital, Lanzhou University, No. 1 Donggang West Road, 730000, Lanzhou, Gansu Province, China.
| | - B Han
- Department of Thoracic, the First Hospital, Lanzhou University, No. 1 Donggang West Road, 730000, Lanzhou, Gansu Province, China
| | - S-Q Xu
- Department of Thoracic, the First Hospital, Lanzhou University, No. 1 Donggang West Road, 730000, Lanzhou, Gansu Province, China
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Abstract
Veterinarians practicing emergency medicine and/or working with exotic animals must be well versed in the pathophysiology of shock because many exotic pets present with an acute crisis or an acute manifestation of a chronic process causing poor organ perfusion. This article discusses the pathophysiology of shock and the systemic inflammatory response syndrome, which may lead to organ dysfunction, organ failure, sepsis, and death. The physiology of perfusion, perfusion measurements, categories of shock, and altered function of the immune system, gastrointestinal barrier, and coagulation system are discussed. Veterinarians providing emergency care to patients with shock must also be aware of comorbidities.
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Affiliation(s)
- Brian K Roberts
- Department of Clinical Sciences, School of Veterinary Medicine, St Matthew's University, PO Box 32330, Grand Cayman KY1-1209, Cayman Islands; Small Animal Medicine, School of Veterinary Medicine, St Matthew's University, PO Box 32330, Grand Cayman KY1-1209, Cayman Islands.
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