Objective To evaluate the effect of different fluid resuscitation strategies on the cardiac function in patients with septic shock.Methods Forty-eight patients met diagnostic criteria of septic shock were enrolled prospectively between January 2014 and April 2015.Patients were divided into conservative late fluid management (CLFM) group (n =20) and liberal late fluid management (LLFM) group (n=28) after achieving early goal-directed therapy within 24 h.Haemodynamic parameters,mRNA levels in Toll-like receptor 4 (TLR4) signal pathway and serum levels of myocardial damage markers were compared.Student t-test was used to compare means between two groups.Quantitative data that were not normally distributed were compared by Mann-Whitney U test.Qualitative data were compared using x2 test.Multivariable Logistic regression analysis was used to identify the independent predictors for prognosis.Results The cardiac function index (CFI) in CLFM group were (5.01± 1.41)/min and (5.39±1.48)/min on day 3 and day 7,respectively,and the cardiac index (CI) were (3.43±0.50) and (3.73±0.76) mL · min-1 · m-2 on day 3 and day 7,respectively.The CFI and CI in LLFM group were (4.28±1.22)/min,(4.22±1.63)/min and (3.31±1.24),(3.09±1.14) mL · min-1 · m-2 respectively on day 3 and day 7.The differences between two groups were statistically significant on day 7 (t=2.546,2.185,both P＜0.05).TheTLR4 mRNAlevelswere3.0±1.1 inCLFM group compared to 4.8±1.4in LLFM group on day 3 (t=4.786,P＜0.01) and 1.6±0.5 compared to 4.0±1.1 on day 7 (t=9.089,P＜0.01).Nuclear factor (NF)-κB mRNA levels were 3.5±1.1 inCLFM group compared to 6.8±1.5 in LLFM group on day 3 (t=8.354,P＜0.01) and 2.4±0.5 compared to 5.7±0.9 (t=14.820,P＜0.01) on day 7.The levels of serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β in CLFM group were lower than those in LLFM group on day 3 and day 7 (all P＜0.01).Multivariable Logistic regression analysis showed that fluid balance (OR =1.236,95 ％ CI:0.78-1.692,P =0.033),CFI (OR=3.263,95％CI:1.136-7.936,P=0.027) and acute physiology and chronic health evaluation Ⅱ (OR=2.064,95％CI:1.248-2.898,P=0.003) were the independent predictors for 28-day mortality.Conclusions CLFM may inhibit the product of myocardial depressant factors TNF-α and IL-1β through attenuating TLR4/NF-κB signal pathway activation and thus to improve myocardial function and decrease mortality.

This study aims to investigate the effects of the skin tissue derived peptides on proliferation, apoptosis, migration and collagen expressions in keloid fibroblasts. From January 2015 to January 2017, patients with hypertrophic scar who underwent surgical excision in department of plastic surgery of Nanjing maternal and child health hospital were included in this retrospective study. Four peptides were selected from the differential peptides between human hypertrophic scar and normal skin tissue. They were named as peptide deregulated in hypertrophic scar 2-5 (PDHPS2-5). Bioinformatics and functional analysis were performed. A low dose of 10 μmol/L of four peptides were respectively added to the culture medium of human primary keloid fibroblasts for 24 h. Cell counting kit-8 (CCK-8) were used to detect the changes in cell viability. Cell apoptosis was detected by flow cytometry. Cell migration ability was checked by Transwell chamber. The protein expressions of collagen COL1A2 (Collagen type I alpha 2) and the myofibroblast marker gene ACTA2 (Actin alpha 2) were analyzed by Western blot. The results showed that bioinformatics prediction analysis revealed that peptide PDHPS4 has the longest half-life and the highest thermal stability. Compared with the control group, low dose of four peptides had no significant effect on the survival rate and apoptosis of keloid fibroblasts tested by CCK-8 assay and flowcytometry. Transwell analysis showed that one peptides (PDHPS5) can significantly inhibit the cell migration ability (The optical density value in Control is 0.81±0.11, in PDHPS5 is 0.27±0.03, t=8.61, P=0.001). Western blot analysis showed that four peptides (PDHPS2, PDHPS3, PDHPS4, PDHPS5) can significantly inhibit the protein expressions of COL1A2 (The relative protein band intensity in Control is 1.02±0.02, in PDHPS2 is 0.21±0.04, in PDHPS3 is 0.26±0.03, in PDHPS4 is 0.53±0.04, in PDHPS5 is 0.73±0.04, t=31.38, 38.54, 18.88, 11.07 respectively, all P value are less than 0.01). Three peptides (PDHPS2, PDHPS3, PDHPS5) can significantly inhibit the protein expressions of ACTA2 (The relative protein band intensity in Control is 1.02±0.02, in PDHPS2 is 0.64±0.05, in PDHPS3 is 0.77±0.06, in PDHPS5 is 0.47±0.07, t=12.08, 6.38, 14.06 respectively, all P value are less than 0.01). In conclusion, the differentially expressed peptides in human hypertrophic scar tissue can affect the function of keloid fibroblasts and collagen expressions to varying degrees. Among them, two peptides (PDHPS2,PDHPS3) significantly inhibit the protein expressions of COL1A2 and ACTA2. The peptide PDHPS5 has high stability, significantly suppresses cell migration, and reduces the protein expressions of COL1A2 and ACTA2, which may provide a new strategy for scar prevention and treatment.

Objective To explore the early diagnosis and treatment for transplant renal artery stenosis (TRAS) through single-center retrospective study.Methods Clinical manifestation,laboratory tests and imaging data in 287 patients underwent renal transplantation in our center were analyzed retrospectively.Ultrasound parameters in TRAS patients and non-TRAS patients was compared to discover the thresholds of some CDUS parameters.Changes of ultrasound parameter and serum creatinine in TRAS patients and non-TRAS patients were compared.The changes of blood pressure and serum creatinine before and after percutaneous transluminal angioplasty (PTA) were observed.Results Totally 13 cases had TRAS in the 287 patients.Renal artery PSV ＞ 250 cm/s,interlobar artery resistance index (RI) ＜0.51,PSV ratio of the renal artery to the interlobar artery ＞ 10 were considered as the color doppler ultrasound (CDUS) diagnostic threshold.Symptomatic TRAS patients and asymptomatic TRAS patients were treated by PTA,and the serum creatinine and mean arterial pressure significantly decreased (P ＜ 0.05).Conclusion Monitoring renal allograft blood flow and clinical manifestation after renal transplantation is helpful for early diagnosis of TRAS in the postoperatively follow-up.Transplant renal artery PSV ＞ 250 cm/s,interlobar artery RI ＜ 0.51 and PSV ratio of the renal artery to the interlobar artery ＞ 10 can be considered as the CDUS diagnostic threshold.

Objective To explore the early diagnosis and treatment for transplant renal artery stenosis (TRAS) through single-center retrospective study.Methods Clinical manifestation,laboratory tests and imaging data in 287 patients underwent renal transplantation in our center were analyzed retrospectively.Ultrasound parameters in TRAS patients and non-TRAS patients was compared to discover the thresholds of some CDUS parameters.Changes of ultrasound parameter and serum creatinine in TRAS patients and non-TRAS patients were compared.The changes of blood pressure and serum creatinine before and after percutaneous transluminal angioplasty (PTA) were observed.Results Totally 13 cases had TRAS in the 287 patients.Renal artery PSV ＞ 250 cm/s,interlobar artery resistance index (RI) ＜0.51,PSV ratio of the renal artery to the interlobar artery ＞ 10 were considered as the color doppler ultrasound (CDUS) diagnostic threshold.Symptomatic TRAS patients and asymptomatic TRAS patients were treated by PTA,and the serum creatinine and mean arterial pressure significantly decreased (P ＜ 0.05).Conclusion Monitoring renal allograft blood flow and clinical manifestation after renal transplantation is helpful for early diagnosis of TRAS in the postoperatively follow-up.Transplant renal artery PSV ＞ 250 cm/s,interlobar artery RI ＜ 0.51 and PSV ratio of the renal artery to the interlobar artery ＞ 10 can be considered as the CDUS diagnostic threshold.

This study aims to investigate the effects of the skin tissue derived peptides on proliferation, apoptosis, migration and collagen expressions in keloid fibroblasts. From January 2015 to January 2017, patients with hypertrophic scar who underwent surgical excision in department of plastic surgery of Nanjing maternal and child health hospital were included in this retrospective study. Four peptides were selected from the differential peptides between human hypertrophic scar and normal skin tissue. They were named as peptide deregulated in hypertrophic scar 2-5 (PDHPS2-5). Bioinformatics and functional analysis were performed. A low dose of 10 μmol/L of four peptides were respectively added to the culture medium of human primary keloid fibroblasts for 24 h. Cell counting kit-8 (CCK-8) were used to detect the changes in cell viability. Cell apoptosis was detected by flow cytometry. Cell migration ability was checked by Transwell chamber. The protein expressions of collagen COL1A2 (Collagen type I alpha 2) and the myofibroblast marker gene ACTA2 (Actin alpha 2) were analyzed by Western blot. The results showed that bioinformatics prediction analysis revealed that peptide PDHPS4 has the longest half-life and the highest thermal stability. Compared with the control group, low dose of four peptides had no significant effect on the survival rate and apoptosis of keloid fibroblasts tested by CCK-8 assay and flowcytometry. Transwell analysis showed that one peptides (PDHPS5) can significantly inhibit the cell migration ability (The optical density value in Control is 0.81±0.11, in PDHPS5 is 0.27±0.03, t=8.61, P=0.001). Western blot analysis showed that four peptides (PDHPS2, PDHPS3, PDHPS4, PDHPS5) can significantly inhibit the protein expressions of COL1A2 (The relative protein band intensity in Control is 1.02±0.02, in PDHPS2 is 0.21±0.04, in PDHPS3 is 0.26±0.03, in PDHPS4 is 0.53±0.04, in PDHPS5 is 0.73±0.04, t=31.38, 38.54, 18.88, 11.07 respectively, all P value are less than 0.01). Three peptides (PDHPS2, PDHPS3, PDHPS5) can significantly inhibit the protein expressions of ACTA2 (The relative protein band intensity in Control is 1.02±0.02, in PDHPS2 is 0.64±0.05, in PDHPS3 is 0.77±0.06, in PDHPS5 is 0.47±0.07, t=12.08, 6.38, 14.06 respectively, all P value are less than 0.01). In conclusion, the differentially expressed peptides in human hypertrophic scar tissue can affect the function of keloid fibroblasts and collagen expressions to varying degrees. Among them, two peptides (PDHPS2,PDHPS3) significantly inhibit the protein expressions of COL1A2 and ACTA2. The peptide PDHPS5 has high stability, significantly suppresses cell migration, and reduces the protein expressions of COL1A2 and ACTA2, which may provide a new strategy for scar prevention and treatment.

Animals ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Insulin ; metabolism ; Signal Transduction ; drug effects