Impact on hospitalization and infection patterns of advanced lung cancer with lower respiratory tract infections: Targeted therapy vs. chemoradiotherapy

Lung cancer is a prevalent and highly lethal disease often complicated by lower respiratory tract infections. Microbial patterns in these infections vary based on treatment modalities. The present study explored the impact of lung cancer treatments on pathogens and clinical characteristics in the presence of lower respiratory tract infections to inform antimicrobial drug selection. A retrospective analysis was performed that included data from 93 patients diagnosed with advanced lung cancer and lower respiratory tract infections between January 2019 and December 2021. Patients were divided into the targeted therapy and chemoradiotherapy groups. Clinical, nutritional, biochemical, infection and pathogenetic indicators were compared. Of the 93 cases, 24 were in the targeted therapy group and 69 were in the chemoradiotherapy group. Pathological type and hospitalization duration differed significantly (P<0.05), but age, sex, smoking history, alcohol consumption and underlying diseases did not (P>0.05). Lymphocyte counts differed (P<0.05), while body mass index, albumin, hemoglobin, alanine aminotransferase and creatinine levels, erythrocyte sedimentation rate, hypersensitive C-reactive protein and procalcitonin levels, and the percentage of neutrophils did not (P>0.05). Pathogenetic testing was negative in 15 patients and positive in 78 patients, with Gram-negative bacteria (61.77%), fungi (17.65%) and viruses (11.76%) predominant in the targeted therapy group. In the chemoradiotherapy group, Gram-negative bacteria (47.46%), fungi (28.81%) and viruses (16.95%) were also more prevalent. Candida albicans was the most frequent fungal infection in both groups, and mixed infections were common (50% in targeted therapy and 73.92% in chemoradiotherapy). The chemoradiotherapy group had significantly more mixed infections (P<0.05). Overall, common pathogens in both groups included Gram-negative bacteria, fungi and viruses. Chemoradiotherapy patients experienced longer hospital stays and a higher incidence of mixed infections, predominantly involving Gram-negative bacteria and fungi. The results provide valuable insights into the rational selection of empirical antibiotics and antifungals for critically ill patients with lung cancer and lower respiratory tract infections in targeted therapy or chemoradiotherapy.

The influence of metoprolol in patients with sepsis-induced cardiomyopathy: A retrospective study

OBJECTIVES

To focus on evaluating the clinical influence of metoprolol on sepsis-induced cardiomyopathy (SICM).

METHODS

A total of 90 patients with SICM was enrolled from December 2018 to February 2021 and divided into 2 groups according to the use of metoprolol during hospitalization in Suzhou Municipal Hospital in Suzhou, China. We compared them with the cardiac function, sequential organ failure assessment score, and clinical outcomes.

RESULTS

Between the 2 groups, the oxygenation indices and Glasgow coma scale in the metoprolol group were higher on the first day of treatment, with Glasgow coma scale higher on the third day of treatment. However, the doses of norepinephrine in patients with metoprolol showed no significant differences with the control group. The all-causemortality at 28 days in the metoprolol group was lower, and the time of removing from ventilator support as well as the number of failured organs also significantly differed between the 2 groups.

CONCLUSION

Metoprolol can reduce the 28-day mortality and shorten the duration of mechanical ventilation in SICM. It can also reduce the number of organ failures and improve the oxygenation index and Glasgow coma scale of these patients. Meanwhile, metoprolol did not affect the norepinephrine dose in patients with SICM.

Splenic SUMO1 controls systemic inflammation in experimental sepsis

Introduction

The recent discovery of TAK981(Subasumstat), the first-in-class selective inhibitor of SUMOylation, enables new immune treatments. TAK981 is already in clinical trials to potentiate immunotherapy in metastatic tumors and hematologic malignancies. Cancer patients have more than ten times higher risk of infections, but the effects of TAK981 in sepsis are unknown and previous studies on SUMO in infections are conflicting.

Methods

We used TAK981 in two sepsis models; polymicrobial peritonitis (CLP) and LPS endotoxemia. Splenectomy was done in both models to study the role of spleen. Western blotting of SUMO-conjugated proteins in spleen lysates was done. Global SUMO1 and SUMO3 knockout mice were used to study the specific SUMO regulation of inflammation in LPS endotoxemia. Splenocytes adoptive transfer was done from SUMO knockouts to wild type mice to study the role of spleen SUMOylation in experimental sepsis.

Results and discussion

Here, we report that inhibition of SUMOylation with TAK981 improved survival in mild polymicrobial peritonitis by enhancing innate immune responses and peritoneal bacterial clearance. Thus, we focused on the effects of TAK981 on the immune responses to bacterial endotoxin, showing that TAK981 enhanced early TNFα production but did not affect the resolution of inflammation. Splenectomy decreased serum TNFα levels by nearly 60% and TAK981-induced TNFα responses. In the spleen, endotoxemia induced a distinct temporal and substrate specificity for SUMO1 and SUMO2/3, and both were inhibited by TAK981. Global genetic depletion of SUMO1, but not SUMO3, enhanced TNFα production and metabolic acidosis. The transfer of SUMO1-null, but not wild-type, splenocytes into splenectomized wild-type mice exacerbated TNFα production and metabolic acidosis in endotoxemia.

Conclusion

These results suggest that specific regulation of splenic SUMO1 can modulate immune and metabolic responses to bacterial infection.

Outcomes and long-term effects of hematopoietic stem cell transplant in sickle cell disease

INTRODUCTION

Hematopoietic stem cell transplant (HSCT) is the only readily available curative option for sickle cell disease (SCD). Cure rates following human leukocyte antigen (HLA)-matched related donor HSCT with myeloablative or non-myeloablative conditioning are >90%. Alternative donor sources, including haploidentical donor and autologous with gene therapy, expand donor options but are limited by inferior outcomes, limited data, and/or shorter follow-up and therefore remain experimental.

AREAS COVERED

Outcomes are improving with time, with donor type and conditioning regimens having the greatest impact on long-term complications. Patients with stable donor engraftment do not experience SCD-related symptoms and have stabilization or improvement of end-organ pathology; however, the long-term effects of curative strategies remain to be fully established and have significant implications in a patient's decision to seek therapy. This review covers currently published literature on HSCT outcomes, including organ-specific outcomes implicated in SCD, as well as long-term effects.

EXPERT OPINION

HSCT, both allogeneic and autologous gene therapy, in the SCD population reverses the sickle phenotype, prevents further organ damage, can resolve prior organ dysfunction in both pediatric and adult patients. Data support greater success with HSCT at a younger age, thus, curative therapies should be discussed early in the patient's life.

Evolutionary assembly of cooperating cell types in an animal chemical defense system

How the functions of multicellular organs emerge from the underlying evolution of cell types is poorly understood. We deconstructed evolution of an organ novelty: a rove beetle gland that secretes a defensive cocktail. We show how gland function arose via assembly of two cell types that manufacture distinct compounds. One cell type, comprising a chemical reservoir within the abdomen, produces alkane and ester compounds. We demonstrate that this cell type is a hybrid of cuticle cells and ancient pheromone and adipocyte-like cells, executing its function via a mosaic of enzymes from each parental cell type. The second cell type synthesizes benzoquinones using a chimera of conserved cellular energy and cuticle formation pathways. We show that evolution of each cell type was shaped by coevolution between the two cell types, yielding a potent secretion that confers adaptive value. Our findings illustrate how cooperation between cell types arises, generating new, organ-level behaviors.

Predictive value of blood pressure variability for organ dysfunction in patients with sepsis

BACKGROUND

Sepsis is a common disease in the intensive care unit, accompanied by many complications and high mortality. Organ dysfunction is a major risk factor for death in patients with sepsis. Analyzing the related factors of organ dysfunction caused by sepsis can provide more clinical prevention and treatment targets, and better predict patients' prognoses. This study aimed to investigate the relationship between blood pressure variability (BPV) and organ dysfunction in patients with sepsis.

METHODS

One hundred and two patients with sepsis treated in our hospital from January 2019 to January 2021 were retrospectively collected as an observation group, and 102 healthy people were collected as a control group. The 24-hour systolic blood pressure variability (24h SBPV) and 24-hour diastolic blood pressure variability (24h DBPV) of the two groups were compared, and the correlation between 24h SBPV, 24h DBPV, and organ function damage to sepsis patients were analyzed.

RESULTS

Compared with the control group, the 24h DBPV in the observation group was significantly higher (0.56±0.16 vs. 0.37±0.16, P=0.000). 24h SBPV increased significantly (0.56±0.16 vs. 0.36±0.17, P=0.000). Pearson linear correlation analysis showed 24h SBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.301, 0.216 and 0.218, P<0.05). 24h DBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.302, 0.212 and 0.210, P<0.05). 24h SBPV and 24h DBPV are of certain value in the diagnosis of multiple organ failure in patients with sepsis, and the area under the curve was [0.649 (95% CI: 0.539-0.759), P=0.010] and [0.650 (0.540-0.760), P=0.009], respectively. 24h SBPV and 24h DBPV are of certain value in the diagnosis of persistent organ failure in patients with sepsis, and the area under the curve was [0.647 (95% CI: 0.538-0.757), P=0.010] and [0.647 (95% CI: 0.538-0.757), P=0.010], respectively.

CONCLUSIONS

The increase of BPV in patients with sepsis has a certain value in predicting the prognosis and organ function damage to patients with sepsis.

Protective Effects of Inhibition of Mitochondrial Fission on Organ Function After Sepsis

Sepsis-associated organ dysfunction plays a critical role in its high mortality, mainly in connection with mitochondrial dysfunction. Whether the inhibition of mitochondrial fission is beneficial to sepsis-related organ dysfunction and underlying mechanisms are unknown. Cecal ligation and puncture induced sepsis in rats and dynamic related protein 1 knockout mice, lipopolysaccharide-treated vascular smooth muscle cells and cardiomyocytes, were used to explore the effects of inhibition of mitochondrial fission and specific mechanisms. Our study showed that mitochondrial fission inhibitor Mdivi-1 could antagonize sepsis-induced organ dysfunction including heart, vascular smooth muscle, liver, kidney, and intestinal functions, and prolonged animal survival. The further study showed that mitochondrial functions such as mitochondrial membrane potential, adenosine-triphosphate contents, reactive oxygen species, superoxide dismutase and malonaldehyde were recovered after Mdivi-1 administration via improving mitochondrial morphology. And sepsis-induced inflammation and apoptosis in heart and vascular smooth muscle were alleviated through inhibition of mitochondrial fission and mitochondrial function improvement. The parameter trends in lipopolysaccharide-stimulated cardiomyocytes and vascular smooth muscle cells were similar in vivo. Dynamic related protein 1 knockout preserved sepsis-induced organ dysfunction, and the animal survival was prolonged. Taken together, this finding provides a novel effective candidate therapy for severe sepsis/septic shock and other critical clinical diseases.

Role of caveolin-1 in human organ function and disease: friend or foe?

Caveolin-1 (Cav-1) is a structural protein component of caveolae, which are invaginations of the plasma membrane involved in various cellular processes, including endocytosis, extracellular matrix organization, cholesterol distribution, cell migration, and signaling. Mounting evidence over the last 10-15 years has demonstrated a central role of Cav-1 in many diseases, such as cancer, diabetes, and fibrosis. Cav-1 plays positive and negative roles in various diseases through its different regulation pathways. Here, we review the current knowledge on Cav-1 in different diseases and discuss the role of this protein in human organs and diseases.

Intraabdominal pressure and its relation with organ dysfunction in patients scheduled for elective cesarean section: Effect of supine vs left lateral tilt position

INTRODUCTION

Intraabdominal pressure (IAP) is related to clinical outcome of patients. It is measured as intravesical pressure through a Foley catheter in the supine position. During pregnancy, there are data showing elevated IAP and also a suggestion that it may be a false increase due to pressure on the urinary bladder by the gravid uterus in the supine position. Additionally, it is not known whether the elevated IAP during pregnancy is merely a physiological change or is associated with impairment of organ functions. We thus aimed to establish a normal value of IAP in supine (IAP_supine ) as well as 10° left lateral (IAP_lateral-tilt ) positions, and their association with organ functions as well as certain maternal risk characteristics.

MATERIAL AND METHODS

This prospective cross-sectional cohort study included 100 consenting parturients with term gestation posted for elective cesarean section under single-shot subarachnoid block. IAP was measured via an indwelling Foley catheter with a transducer connected to it, as per the recommended technique. Organ dysfunction was defined as Sequential Organ Failure Assessment (SOFA) subscore ≥1 for the particular system.

TRIAL REGISTRATION

ctri.gov.in (CTRI/2017/11/010527).

RESULTS

The IAP_supine was significantly higher than IAP_lateral-tilt (13.8 ± 2.4 vs 12 ± 2.3 mm Hg) (P < .001). The incidence of intraabdominal hypertension as per conventional definition, that is, IAP ≥12 mm Hg, was also higher in the supine position (77% vs 55%) (P < .001). None of the patients had dysfunction of the cardiovascular, renal or central nervous system. The incidence of respiratory, hepatic and hematologic dysfunction was 2%, 15% and 32%, respectively. Receiver operating characteristic analysis showed insignificant association of IAP_supine and IAP_lateral-tilt with various organ dysfunctions (P > .05). There was a significant correlation of intraabdominal hypertension when considering IAP_supine or IAP_lateral-tilt , with obesity (P = .004 and .000, respectively), as well as preeclampsia (P = .006 and .000, respectively).

CONCLUSIONS

In nonlaboring patients undergoing elective cesarean section, IAP is significantly higher in the supine vs 10° left lateral position. In neither position is IAP significantly associated with organ dysfunction. Thus, the usual recommendation of a supine position for measuring IAP to diagnose intraabdominal hypertension, formulated consequent to its pathological effects on organ functions, may not be applicable to pregnant patients and needs urgent validation studies.

Investigation of raphe function in the bicuspid aortic valve and its influence on clinical criteria-A patient-specific finite element study

The aortic valve is normally composed of 3 cusps. In one common lesion, 2 cusps are fused together. The conjoined area of the fused cusps is termed raphe. Occurring in 1% to 2% of the population, the bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. The majority of BAV patients eventually require surgery. There is a lack in the literature regarding modeling of the raphe (geometry and material properties), its role and its influence on BAV function. The present study aims to propose improvements on these aspects. Three patient-specific finite element models of BAVs were created based on 3D trans-esophageal echocardiography measurements, and assuming age-dependent material properties. The raphe was initially given the same material properties as its underlying cusps. Two levels of validation were performed; one based on the anatomical validation of the pressurized geometry in diastole (involving 7 anatomical measures), as simulated starting from the unpressurized geometry, and the other based on a functional assessment using clinical measurements in both systole and diastole (involving 16 functional measures). The pathology was successfully reproduced in the FE models of all 3 patients. To further investigate the role of the raphe, 2 additional scenarios were considered; (1) the raphe was considered as almost rigid, (2) the raphe was totally removed. The results confirmed the interpretation of the raphe as added stiffness in the fused cusp's rotation with respect to the aortic wall, as well as added support for stress distribution from the fused cusps to the aortic wall.

Immune Effects of Corticosteroids in Sepsis

Sepsis, a life-threatening organ dysfunction, results from a dysregulated host response to invading pathogens that may be characterized by overwhelming systemic inflammation or some sort of immune paralysis. Sepsis remains a major cause of morbidity and mortality. Treatment is nonspecific and relies on source control and organ support. Septic shock, the most severe form of sepsis is associated with the highest rate of mortality. Two large multicentre trials, undertaken 15 years apart, found that the combination of hydrocortisone and fludrocortisone significantly reduces mortality in septic shock. The corticosteroids family is composed of several molecules that are usually characterized according to their glucocorticoid and mineralocorticoid power, relative to hydrocortisone. While the immune effects of glucocorticoids whether mediated or not by the intracellular glucocorticoid receptor have been investigated for several decades, it is only very recently that potential immune effects of mineralocorticoids via non-renal mineralocorticoid receptors have gained popularity. We reviewed the respective role of glucocorticoids and mineralocorticoids in counteracting sepsis-associated dysregulated immune systems.

Brain micro-inflammation at specific vessels dysregulates organ-homeostasis via the activation of a new neural circuit

Impact of stress on diseases including gastrointestinal failure is well-known, but molecular mechanism is not understood. Here we show underlying molecular mechanism using EAE mice. Under stress conditions, EAE caused severe gastrointestinal failure with high-mortality. Mechanistically, autoreactive-pathogenic CD4+ T cells accumulated at specific vessels of boundary area of third-ventricle, thalamus, and dentate-gyrus to establish brain micro-inflammation via stress-gateway reflex. Importantly, induction of brain micro-inflammation at specific vessels by cytokine injection was sufficient to establish fatal gastrointestinal failure. Resulting micro-inflammation activated new neural pathway including neurons in paraventricular-nucleus, dorsomedial-nucleus-of-hypothalamus, and also vagal neurons to cause fatal gastrointestinal failure. Suppression of the brain micro-inflammation or blockage of these neural pathways inhibited the gastrointestinal failure. These results demonstrate direct link between brain micro-inflammation and fatal gastrointestinal disease via establishment of a new neural pathway under stress. They further suggest that brain micro-inflammation around specific vessels could be switch to activate new neural pathway(s) to regulate organ homeostasis.

DOI:http://dx.doi.org/10.7554/eLife.25517.001

Pharmacokinetic variability due to environmental differences

This tutorial describes sources of pharmacokinetic variability that are not obviously linked to genetic differences. The sources of variability are therefore described as environmental. The major quantitative sources of environmental variability are body size (including body composition), maturation and organ function. Size should be considered in all patients. Maturation is mainly relevant to neonates and infants less than 2 years of age. Renal function is the most important predictable source of variability due to differences in organ function.

Effect of small-dose levosimendan on mortality rates and organ functions in Chinese elderly patients with sepsis

AIM

As a primary cause of death not only in Western countries but also in the People's Republic of China, sepsis is diagnosed as abnormal organ functions as a result of a disordered response to a severe infection. This study was designed to assess the effect of small-dose levosimendan without a loading dose on mortality rates and organ functions in Chinese elderly patients with sepsis.

METHODS

Following a prospective, randomized, and double-blinded design, 240 Chinese elderly patients with sepsis shock were admitted to the intensive care unit (ICU). All patients were randomly and evenly assigned into a levosimendan group (number of patients =120) and a control group (number of patients =120). The control group underwent standard care, and the levosimendan group was administered levosimendan in addition to standard care.

RESULTS

All participants, comprising 134 males (55.8%) and 106 females (44.2%), were 70 (67-73) years old. Baseline characteristics, preexisting illnesses, initial infections, organ failures, and additional agents and therapies showed no significant difference between the two groups (P>0.05 for all). There were no significant differences in mortality rates at 28 days, at ICU discharge, and at hospital discharge between the two groups (P>0.05 for all). The number of days of ICU and hospital stay in the levosimendan group was significantly less than for those in the control group (P<0.05 for all). Mean daily total sequential organ failure assessment score and all organ scores except the cardiovascular scores showed no significant difference between the two groups (P>0.05 for all). Cardiovascular scores in the levosimendan group were significantly higher than those in the control group (P<0.05 for all).

CONCLUSION

Small-dose levosimendan could not reduce the mortality rates or enhance the respiratory, liver, renal, and coagulation functions, but could shorten the days of ICU and hospital stay, and improve the cardiovascular function, which suggests that small-dose levosimendan is valuable for Chinese elderly patients with sepsis.

Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study

OBJECTIVE

To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis.

DESIGN

Prospectively collected data regarding the function of the pelvic organs.

SETTING

Tertiary endometriosis referral unit, Aarhus University Hospital.

SAMPLE

A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis.

METHODS

The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed.

MAIN OUTCOME MEASURES

Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified.

RESULTS

A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery.

CONCLUSION

A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients.

TWEETABLE ABSTRACT

Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.

Clinical and Laboratory Responses of Cross-Country Skiing for a 24-H World Record: Case Report

The physiological consequences of ultra-endurance cross-country skiing in cold conditions are poorly known. We report here clinical, echocardiographic and laboratory findings from a 41-y old male elite skier in a world record trial for 24-h skiing. The athlete completed a total of 406.8 km outdoors with the temperature ranging between -24°C and -5°C during the 24-h period. Post exercise, notable increases from baseline values were observed in myoglobin (50-fold), creatinine kinase (30-fold) and proBNP (6-fold), whereas troponin T or troponin I levels remained unchanged. At baseline, echocardiographic findings showed cardiac hypertrophy and after skiing, a 5% reduction of left-ventricular end-diastolic dimension. Increases in markers of kidney (creatinine) and liver function (alanine aminotransferase), serum uric acid, C-reactive protein and white blood cell counts were also noted. In addition, electrolyte disturbances including hyponatremia, hypophosphatemia and hypocalcaemia were noted during the follow-up. The data indicates that a prolonged period of high-intensity skiing leads to muscle, heart and kidney affection and activation of inflammation even in an experienced elite skier. The observed health effects underscore the need for strict medical surveillance of participants in extreme sports with long duration. Key pointsAn elite athlete was able to ski over 400 km during 24 hours with an outdoor temperature ranging between -5 °C and -24 °C.Several postrace abnormalities occurred in biomarkers of muscle, heart, kidney, liver and inflammation status.Serum troponins, specific markers of myocardial cell damage, remained stable.The report supports careful medical surveillance of participants in extreme sports with long duration.

Effects of inhaled carbon monoxide and glucocorticoids in porcine endotoxin sepsis

BACKGROUND

Recent animal studies have demonstrated that pre-treatment with inhaled carbon monoxide (iCO) exert anti-inflammatory effects in various septic models. In all these models, there is no information whether iCO might act therapeutically after the onset of septic damage. The objective of this study was to investigate the potential anti-inflammatory effects of iCO to treat established injury in a model of porcine endotoxin sepsis.

METHODS

Five groups of pigs (n=6 in each group), were studied under anesthesia and mechanical ventilation: healthy control group (HC); lipopolysaccharide (LPS) groups, animals received continuous IV infusion of LPS for 6 hours; 2.5 hours after of LPS infusion treated groups received either: 250 ppm of iCO for 3.5 h, (LPS+CO group); 3 mg/Kg hydrocorti-sone bolus [Steroid (ST)], (LPS+ST group); or both steroid and iCO, (LPS+CO+ST group). Measurements of haemodynamics, blood gases, respiratory mechanics and biochemistry of organ function, were made. At the end of the experiment lung tissue was taken for analysis of histology and inflammatory markers: tumor necrosis factor-alpha (TNF-α), nuclear factor kappa B (NF-κB), activator protein-1 (AP-1) and glucocorticoid receptor (GR).

RESULTS

LPS administration induced a dramatic inflammatory injury in lungs, increased expression of TNF-α, NF-κB, AP-1, down regulation of GR, pulmonary hypertension and severe deterioration of respiratory mechanics, oxygenation and organ function. Treatment with steroids and to greater extent with iCO significantly improved the microscopic appearance of the lung but had no effect on inflammatory markers. iCO significantly decreased pulmonary hypertension induced by LPS, without an obvious protective effect on organ function.

CONCLUSION

Using this porcine sepsis model we find that treatment with iCO after the septic damage decreases pulmonary hypertension and partially protects the lung tissue from the inflammatory destruction induced by LPS but has no beneficial effects on organ function.

Trauma and immune response--effect of gender differences

A major consequence of traumatic injury is immunosuppression. Findings from previous studies suggest that the depression of immune functions is severe in young males, ovariectomised and aged females. In contrast, the immune functions in proestrus females following trauma-haemorrhage are maintained. Studies have also shown that the survival rate in proestrus females following trauma-haemorrhage and the induction of subsequent sepsis is significantly higher than in age-matched males and ovariectomised females. Furthermore, administration of female sex hormone 17beta-oestradiol in males and ovariectomised females after trauma-haemorrhage prevents the suppression of immune response. Thus, these findings suggest that sex hormones play a significant role in shaping the host response following trauma. This article reviews studies delineating the mechanism by which sex hormones regulate immune cell functions in the experimental model of trauma-haemorrhage. The findings from the studies reviewed in this article suggest that sex steroids can be synthesised by the immune cell. The findings further indicate that T cell and macrophages express receptors for androgen and oestrogen. Since these cells are also the cells that produce cytokines, local synthesis of active steroids in these cells may become the significant factor in modulating their cytokine production.

Clinical review: hemodynamic monitoring in the intensive care unit

Since the beginning of modern anesthesia, in 1846, the anesthetist has relied on his natural senses to monitor the patient, aided more recently by simple technical devices such as the stethoscope. There has been a tremendous increase in the availability of monitoring devices in the past 30 years. Modern technology has provided a large number of sophisticated monitors and therapeutic instruments, particularly in the past decade. Most of these techniques have enhanced our understanding of the mechanism of the patients' decompensation and have helped to guide appropriate therapeutic interventions. As surgery and critical care medicine have developed rapidly, patient monitoring capability has become increasingly complex. The most important aspect in monitoring the critically ill patient is the detection of life-threatening derangements of vital functions. Aggressive marketing strategies have been promoted to monitor almost every aspect of the patient's status. However, these strategies are only telling us what is possible; they do not tell us whether they enhance patient safety, improve our therapy, or even improve patient outcome.