Xiaohua Fan

Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: a systematic review and meta-analysis

IntroductionEarly diagnosis of sepsis is vital to the clinical course and outcome of septic patients. Recently, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) appears to be a potential marker of infection. The objective of this systematic review and meta-analysis was to evaluate the accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients.MethodsA systematic literature search of PubMed, Embase and Cochrane Central Register of Controlled Trials was performed using specific search terms (up to 15 October 2012). Studies were included if they assessed the accuracy of plasma sTREM-1 for sepsis diagnosis in adult patients with systemic inflammatory response syndrome (SIRS) and provided sufficient information to construct a 2 X 2 contingency table.ResultsEleven studies with a total of 1,795 patients were included. The pooled sensitivity and specificity was 79% (95% confidence interval (CI), 65 to 89) and 80% (95% CI, 69 to 88), respectively. The positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 4.0 (95% CI, 2.4 to 6.9), 0.26 (95% CI, 0.14 to 0.48), and 16 (95% CI, 5 to 46), respectively. The area under the curve of the summary receiver operator characteristic was 0.87 (95% CI, 0.84 to 0.89). Meta-regression analysis suggested that patient sample size and assay method were the main sources of heterogeneity. Publication bias was suggested by an asymmetrical funnel plot (P = 0.02).ConclusionsThe present meta-analysis showed that plasma sTREM-1 had a moderate diagnostic performance in differentiating sepsis from SIRS. Accordingly, plasma sTREM-1 as a single marker was not sufficient for sepsis diagnosis in systemic inflammatory patients.

Baicalin Improves Survival in a Murine Model of Polymicrobial Sepsis via Suppressing Inflammatory Response and Lymphocyte Apoptosis

Background An imbalance between overwhelming inflammation and lymphocyte apoptosis is the main cause of high mortality in patients with sepsis. Baicalin, the main active ingredient of the Scutellaria root, exerts anti-inflammatory, anti-apoptotic, and even antibacterial properties in inflammatory and infectious diseases. However, the therapeutic effect of baicalin on polymicrobial sepsis remains unknown. Methodology/Principal Findings Polymicrobial sepsis was induced by cecal ligation and puncture (CLP) in C57BL/6 mice. Mice were infused with baicalin intraperitoneally at 1 h, 6 h and 12 h after CLP. Survival rates were assessed over the subsequent 8 days. Bacterial burdens in blood and peritoneal cavity were calculated to assess the bacterial clearance. Neutrophil count in peritoneal lavage fluid was also calculated. Injuries to the lung and liver were detected by hematoxylin and eosin staining. Levels of cytokines, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10 and IL-17, in blood and peritoneum were measured by enzyme-linked immunosorbent assay. Adaptive immune function was assessed by apoptosis of lymphocytes in the thymus and counts of different cell types in the spleen. Baicalin significantly enhanced bacterial clearance and improved survival of septic mice. The number of neutrophils in peritoneal lavage fluid was reduced by baicalin. Less neutrophil infiltration of the lung and liver in baicalin-treated mice was associated with attenuated injuries to these organs. Baicalin significantly reduced the levels of proinflammatory cytokines but increased the level of anti-inflammatory cytokine in blood and peritoneum. Apoptosis of CD3+ T cell was inhibited in the thymus. The numbers of CD4+, CD8+ T lymphocytes and dendritic cells (DCs) were higher, while the number of CD4+CD25+ regulatory T cells was lower in the baicalin group compared with the CLP group. Conclusions/Significance Baicalin improves survival of mice with polymicrobial sepsis, and this may be attributed to its antibacterial property as well as its anti-inflammatory and anti-apoptotic effects.

PD-L1 Blockade Attenuated Sepsis-Induced Liver Injury in a Mouse Cecal Ligation and Puncture Model

Liver plays a major role in hypermetabolism and produces acute phase proteins during systemic inflammatory response syndrome and it is of vital importance in host defense and bacteria clearance. Our previous studies indicated that programmed death-1 (PD-1) and its ligand programmed death ligand-1 (PD-L1) are crucial modulators of host immune responses during sepsis. Our current study was designed to investigate the role of PD-L1 in sepsis-induced liver injury by a mouse cecal ligation and puncture (CLP) model. Our results indicated that there was a significant increase of PD-L1 expression in liver after CLP challenge compared to sham-operated controls, in terms of levels of mRNA transcription and immunohistochemistry. Anti-PD-L1 antibody significantly alleviated the morphology of liver injury in CLP mice. Anti-PD-L1 antibody administration decreased ALT and AST release in CLP mice, decreased the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 mRNA in liver after sepsis challenge. Thus, anti-PD-L1 antibody might have a therapeutic potential in attenuating liver injury in sepsis.

MicroRNA-572 Improves Early Post-Operative Cognitive Dysfunction by Down-Regulating Neural Cell Adhesion Molecule 1

Post-operative cognitive dysfunction (POCD) is a commonly-seen postoperative complication in elderly patients. However, the underlying mechanisms of POCD remain unclear. miRNAs, which are reported to be involved in the pathogenesis of the nervous system diseases, may also affect POCD. In this study, miRNA microarray technology was used to analyze the circulating miRNA expression profile of POCD patients. Among the altered miRNAs, miR-572 had the greatest decrease, which was also verified in vivo in rat POCD model. Further analysis found that miR-572 could regulate the expression of NCAM1 in the hippocampal neurons and interfering miR-572 expression could facilitate the restoration of cognitive function in vivo. Moreover, clinical correlation analysis found that the miR-572 expression was associated with the incidence of POCD. Collectively, miR-572 is involved in the development and restoration of POCD and it may serve as a biological marker for early diagnosis of POCD.

Effects of Three Target‐Controlled Concentrations of Sufentanil on MACBAR of Sevoflurane

An acute increase in heart rate (HR) and blood pressure (BP) in response to surgical stimuli may increase the incidence of cardiovascular events such as acute pulmonary edema, cardiac ischemia, and stroke. Adequate depth of anesthesia is essential to inhibit such cardiovascular responses. A large dose is often required for single use of anesthetic agent, which may result in more severe adverse effects such as respiratory depression, postoperative nausea and vomiting, and cell death in the developing brain [1]. To reduce cardiovascular responses, inhalational anesthetics and opioids are often used in combination for balanced anesthesia, knowing that the synergetic effect between them is useful in reducing the adverse effects of a single agent. The tenet of minimum alveolar concentration (MAC) is developed to evaluate the potency of inhalational anesthetics to prevent movement during skin incision. The potency of inhalational anesthetics in preventing cardiovascular responses is evaluated by MAC for blunting sympathetic responses (MACBAR). It was reported [2] that opioids decreased the MACBAR of volatile anesthetics after surgical incision. For example, 0.1 ng/mL and 0.5 ng/mL sufentanil reduced MAC of isoflurane by 44.2% and 77.8%, respectively. Sevoflurane is a safe and versatile inhalational anesthetic compared with the anesthetic agents currently available. Sevoflurane is useful in adults and children for both induction and maintenance of anesthesia in inpatient and outpatient surgery. In addition, sevoflurane is well known to exert a neuroprotective effect through anesthetic preconditioning or postconditioning [3]. Sufentanil is an opioid about 5–10 times as potent as fentanyl, and yet has a shorter duration of action. A recent study [4] reported that several opioid agents act on α2-adrenoceptors in the brain, including meperidine, remifentanil, and tramadol, but not sufentanil. The effect of sufentanil on MACBAR of sevoflurane remains undetermined. The aim of this study was to compare MACBAR of sevoflurane in the presence of three different target-controlled concentrations of sufentanil in an attempt to identify a relatively ideal dose of these anesthetics in balanced anesthesia. This study was approved by the ethical committee of the Second Military Medical University, and written informed consent was obtained from every patient. Included in this study were 84 patients (American Society of Anesthesiologists physical status I) aged 20–55 years and weighing 45–75 kg who underwent abdominal surgery with an incision longer than 10 cm. The exclusive criteria included: (1) patients with systemic diseases in the cardiovascular system, lung, liver, or kidney; (2) patients with a BMI higher than 30 kg/m2; (3) patients who were alcohol or drug abusers; and (4) patients who were using medications that might affect cardiovascular responses to skin incision. The patients fasted for 8–10 h and received no medication before surgery. Noninvasive BP, HR, electrocardiogram (ECG, lead II) and pulse oximetry were monitored with a HewlettPackard monitor after the patients were brought into the operating room. Bispectral index (BIS) was also monitored using a BIS lead (A2000 XPTM, Aspect, USA) in S/5TM anesthesia monitor (Datex Ohmeda, Madison, Wisconsin, USA). BIS is usually proposed as a measure of the effect of anesthetics on the brain, and BIS value between 40 and 60 is considered a sufficient anesthetic depth. General anesthesia was induced by target-controlled infusion (TCI) of sufentanil (0.3 ng/mL) and propofol (3 μg/mL). After loss of consciousness, BIS dropped to below 60, rocuronium

Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial.

Background Propofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents. Material/Methods Eighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes. Results The demographic data were similarly distributed among the TCI and MCI patients. Endoscopist’s satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients’ satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group. Conclusions TCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.