Objective To study the changes of S100βin serum and brain tissue of rats with sepsisassociated encephalopathy (SAE).Methods After placement of pole plates of electroencephalogram (EEG) on the brain cortex,thirty SD rats were randomly (random number) divided into three groups post hoc:sepsis group in which rats were made to be sepsis models by cecal ligation and puncture (n =18),normal group (n =6) and sham operation group (n =6).The sepsis-associated encephalopathy was diagnosed with electroencephalogram taken by RM6240 physiological signal recorder.Meanwhile,heart rate and blood pressure were recorded.Eight hours later,serum and brain tissue of sacrificed rats were taken for measuring S100β.The results ware analyzed with one-way ANOVA.Results Of 18 sepsis rats,3 were dead,8 without SAE and 7 with SAE.The levels of S100βin serum and brain tissue of rats with SAE group were significantly higher than those in normal group and sham operation proup (P ＜ 0.05).The Ratio of brain/serum S100βin rats with SAE group was higher than that in rats without SAE (1.74 vs 1.51,P ＜ 0.05).Conclusions Significantly high level of serum S100βwas a reliable bio-marker for diagnosis of SAE in rats.

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on the peripheral blood levels of high mobility group box chromosomal protein 1 (HMGB-1) in patients with systemic inflammatory response syndrome (SIRS) or sepsis.Methods Thirty patients with SIRS or sepsis in Intensive Care Unit of our hospital were scheduled for treatment of CVVH.The replacement liquid was put in by the pattern of pre-dilution of 40％ and post-dilution of 60％.The flow-rate was 3 L/h.The blood flow-rate was from 200 to 300 ml/min.5 ml blood from right radial artery was got at the time points of preCVVH,CVVH 2 h,6 h,8 h and post-CVVH 12 h and the serum was stored at the temperature of-20 ℃ after high speed centrifugation,and 2 ml filter liquor was reserved at the time point of CVVH 6 h.The concentration of serum and filter liquor HMGB-1 was measured by ELISA,but that of TNF-α and IL-6 were measured by radioimmunity.Results 30 patients adept CVVH therapy within 24 h to the hospital,and their therapy time was 2 ～ 5(2.4 ± 1.5) d.Among them,17 cases survived and 13 cases died with a fatality rate of 43.3％.Serum concentration of HMGB-1 decreased from the baseline in patients,although this decrease was not statistically significant[(11.88 ± 6.06) ng/ml,(11.97 ± 5.66) ng/ml,(11.94 ± 5.94) ng/ml,(11.73 ± 5.19) ng/ml vs (13.87 ± 4.68) ng/ml,P ＞ 0.05],Serum concentration of both TNF-αand IL-6 after therapy significantly decreased compared to the baseline in patients [TNF-α: (0.28 ± 0.15)ng/ml,(0.30 ± 0.14) ng/ml,(0.29 ± 0.19) ng/ml,(0.33 ± 0.19) ng/ml vs (0.41 ± 0.12) ng/ml,IL-6:(408.20 ±92.18)pg/ml,(250.51 ± 107.34)pg/ml,(276.00 ± 126.20) pg/ml,(315.16 ± 130.97) pg/ml vs (513.35 ± 125.95) pg/ml,P ＜ 0.05].Conclusions CVVH could decrease the concentration of HMGB-1 in peripheral blood,which would be one of the mechanisms of action for CVVH on sepsis.

Objective To investigate the application of Critical Care Chest Ultrasonic Examination (CCUE)-plus (CCUE-plus) in the etiological diagnosis in patieuts with dyspnea and/or hemodynamic instability caused by abdominal abnormalities.Methods Patients who suffered from dyspnea and/or hemodynamic instability in the Department of Critical Care Medicine,Xiangya Hospital,Central South University from September 2013 to September 2016 were recruited in this study.A total of 255 consecutive patients completed CCUE within 2hrs of admission.If the diaphragm could not be seen in the routine phrenic points according to Bedside Lung Ultrasound Evaluation (BLUE) protocol,it would be found along midaxillary line and defined m-point.The 59 patients with altered diaphragmatic position (m-point was more than 2 cm higher than phrenic point) received sequential abdominal ultrasonography.The latter ultrasonographic findings were compared with CT results.Results There were 42 (71.19％) cases with positive findings of abdominal ultrasonography,including 18 cases of seroperitoneum,16 cases of intestinal obstruction and 8 cases combined.Compared with 56 patients who applied with CT exam,the abdominal ultrasonography revealed a sensitivity of 76.7％ and a specificity of 100.0％ to diagnose seroperitoneum (AUCRoc 0.917);whereas the sensitivity was 75.0％ and the specificity was 90.9％ (AUCRoc 0.778) to diagnose intestinal obstruction.Moreover,there were 44 (74.58％) patients with normal left ventricular systolic function;more than three quarters (46/59,77.97％) patients had pulmonary consolidation.Conclusion In patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities and altered diaphragmatic position in BLUE protocol,CCUE-plus protocol has a high positive predictive value of more than 90％ in abdominal abnormality.The findings of abdominal ultrasonography may change therapeutic target from cardio-pulmonary optimization to relief of intestinal obstruction or drainage of seroperitoneum.

Objective To establish sepsis-associated encephalopathy (SAE) animal models by using neurobiology score,electroencephalography (EEG),somatosensory evoked potentials in order to provide evidence for early clinical diagnosis of SAE.Methods A total of 30 rats were weighted,numbered,and monitored with EEG electrodes 10 days before modeling.Ten days later,rats were weighted,numbered,and divided randomly (random number) into groups.Rat models of sepsis were made by cecal ligation and puncture (CLP).The changes of their neurological behaviors were observed and EEG was used to monitor at 4,6,8,12 and 24 hours after CLP.The changes of EEG waveform and somatosensory evoked potentials were analyzed and recorded.Rat models of sepsis were divided into sepsis + non-SAE group and SAE group based on the presence or absence of EEG or somatosensory evoked potentials changes ~thin 24 hours.Rats were sacrificed 24 hours later,and histopathological changes of brain tissue were observed under electronic microscopy.Thus,the feasibility of establishing early SAE animal model by monitoring the changes of neurological behaviors,EEG and somatosensory evoked potentials was evaluated.Results SAE could be early diagnosed by using neurobiology score,reduced α wave and markedly increased δ wave on EEG,reduced amplitudes of evoked potentials P1,and significantly prolonged latency of S-P1 and NI-P1.In survived septic rats,6 had changes on neurological behaviors,EEG and somatosensory evoked potentials,and thus were diagnosed as SAE.The incidence of SAE was 46％.Conclusions SAE can be diagnosed in early stage by using neurobiology score,EEG and somatosensory evoked potentials,confirming the SAE rat models to be successfully established.

OBJECTIVE: To investigate the effect of hemin on lung injury following severe acute pancreatitis (SAP) in rats and to explore its rudimentary mechanism. METHODS: Thirty-six rats were randomly divided into 3 groups: a control group, a SAP model group, and a hemin-pretreated group. Rats were sacrificed 12 hours after inducing SAP model. The pathological changes of the pancreas and lungs were observed under light microscope. Expression of heme oxygenase (HO-1) mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR), NF-kappaB activity in the lung tissues was detected by enzyme linked immunosorbent assay (ELISA), and the serum levels of TNF-alpha and IL-6 were measured by ELISA. RESULTS: HO-1 was induced during experimental SAP, NF-kappaB activity in the lung tissues was elevated after the induction of SAP and the serum levels of TNF-alpha and IL-6 were significantly elevated. Hemin further upregulated the expression of HO-1 mRNA, decreased NF-kappaB activity drastically, and inhibited the serum levels of TNF-alpha and IL-6 significantly (P < 0.05). Hemin could treat SAP by alleviating the pancreatic and lung injury. CONCLUSION Hemin moderates the inflammatory reaction and decreases the lung injury following SAP, the mechanism of which may be closely related to the upregulation of expression of HO-1 mRNA, the inhibitory effect on NF-kappaB, and adjustment of cytokines.
Acute Lung Injury ; drug therapy ; etiology ; Animals ; Cytokines ; genetics ; metabolism ; Female ; Heme Oxygenase (Decyclizing) ; genetics ; metabolism ; Hemin ; therapeutic use ; Male ; NF-kappa B ; genetics ; metabolism ; Pancreatitis, Acute Necrotizing ; complications ; drug therapy ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction

Objective To investigate the effect of pretreatment with electroacupuncture at point Neiguan(PC6) on CK and myocardial cell activity in rabbit myocardial ischemia-reperfusion injury and provide an experimental basis for a relatively specific relationship between pericardium meridian points and the heart. Methods Forty New Zealand big ear rabbits were randomly allocated to groups A, B, C, D and E, eight rabbits each. Group A was a sham operation group. Group B was an ischemia-reperfusion model group, in which the left anterior descending coronary artery was occlude for 30 min and reperfused for 60 min. In groups C, D and E, points Neiguan(PC6), Lieque(LU7) and Hegu(LI4) were separately given electroacupuncture stimulation, 20 min every day, at seven days before model making. Creatine kinase (CK) and myocardial formazan contents were compared between the groups. Results There were statistically significant differences in serum CK and myocardial formazan contents between group B, C, D or E and group A (P＜0.01, P＜0.05). There was a statistically significant differences in serum CK content between group C, D or E and group B (P＜0.01). There was a statistically significant differences in myocardial formazan content between groups C and B (P＜0.05). There were statistically significant differences in serum CK and myocardial formazan contents between group D or E and group C (P＜0.01, P＜0.05). Conclusion Electroacupuncture at point Neiguan(PC6) can reduce myocardial ischemia-reperfusion induced injury to myocardial cells to produce a protective effect on the heart.

Objective: To investigate the clinical significance of transcranial Doppler (TCD) in early diagnosis of sepsis-associated encephalopathy(SAE). Methods: Septic patients admitted to the intensive care unit(ICU) were recruited at Xiangya Hospital, Central South University from July 2015 to March 2016. Clinical data and TCD parameters during 24 hours after admission were collected. All patients were screened for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) twice a day. The gold standard of the diagnosis of SAE was positive CAM-ICU evaluation. Patients were divided into SAE group and the non-SAE group. TCD data including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistant index (RI) were analyzed to determine the optimal diagnostic cut-off value. Results: A total of 43 patients were enrolled including 12 in SAE group and 31 in non-SAE group. Vm and Vd were lower in SAE group [Vm: (53.50±12.22) cm/s vs. (61.68±9.63) cm/s, P<0.05; Vd: (33.42±10.87) cm/s vs. (43.16±7.84) cm/s, P<0.01] but PI and RI were significant higher in SAE group[PI:(1.16±0.2) vs. (0.90±0.15), P<0.01;RI:(0.65±0.08) vs. (0.56±0.06), P<0.01] than in non-SAE group. The cut-off values of Vs, Vm, Vd, PI and RI for the diagnosis of SAE were 112cm/s, 55.50cm/s, 34.50cm/s, 1.16, 0.65, respectively, with the relevant sensitivities of 19.4%, 83.9%, 93.5%, 58.3%, 58.3% and the specificities of 100.0%, 50.0%, 58.3%, 96.8%, 96.8%, respectively. The diagnostic AUC of Vd, PI and RI were 0.741, 0.808 and 0.808 respectively. Conclusions The parameter changes of TCD suggest that the pathogenesis of SAE is related to cerebral hypoperfusion, TCD is a helpful method for the early diagnosis of SAE.

Objective To observe and evaluate the predictive value of electroencephalogram (EEG) abnormalities of the EEG monitoring of patients with brain dysfunction in the intensive care unit (ICU).Methods Total of 58 cases with brain dysfunction under EEG were collected from the ICU of the XiangYa Hospital,Central South University from January 2014 to December 2015.EEG was performed to monitor those patients and data was collected,analyzed and classified according to both Synek and Young EEG scales to evaluate its predictive value.The statistical analysis was performed with SPSS 23.0 software (MAC,USA) and statistical significant was considered as P ＜0.05.Numerical values were given as means ± SD and t-test was performed to compare data of different groups.Kaplan-Meier survival estimator was used to draw the survival curve,and the survival analysis was postulated by COX regression analysis.Results Data from 58 patients were collected and classified according to both Synek and Young EEG scales,positive waveforms as periodic discharge or delta-predominant background were found among 50 patients,electrographic seizures were found in 7 patients,patients with EEG abnormality possessed a high level of SI00β and showed statistical differences.The 28-day mortahty was independently associated with Acute Physiology and Chronic Health Evaluation (APACHE]] score) (OR:1.08;95％ CI [1.03 to 1.14])、Synek Grade ＞2 (OR:0.17;95％ CI [0.03 to 0.80])、electrographic seizures (OR:23.70;95％ CI [2.02 to 277.73]) and slow rhythm (OR:8.54;95％ CI [1.72 to 42.32]).Conclusions The 28-day mortality of patients under EEG with brain dysfunction was independently associated with Synek Grade ＞ 2,electrographic seizures and slow EEG rhythm.

Objective To investigate the role of neuroglobin ( NGB) in oxygen-glucose deprivation and reoxygenation ( OGD/R ) induced mitochondrial depolarization and reactive oxygen species ( ROS ) production in a human neuroblastoma cell line (SH-SY5Y).Methods SH-SY5Y cells were transfected with lentivirus to establish a stable cell line of NGB knockdown ( KD).After treated with OGD/R, cells were collected at different time points to analyze NGB mRNA and protein levels.Furthermore, cells were stained with JC-1 and DCFH-DA to evaluate mitochondrial depolarization and ROS production by inverted fluorescence microscope.Also, to determine the neurotoxicity , we measured the lactate dehydrogenase ( LDH) level in the cell culture medium.Results After the treatment of OGD/R, the NGB mRNA and protein started to elevate and peak at 4 h and 8 h (2.04 ±0.35 fold,1.69 ±0.18 fold).Compared with the vector group , NGB KD group had much more mitochondrial depolarization [ JC-1 red/green ( 1.10 ±0.10 ) vs (1.46 ±0.11),P<0.05] and ROS production [DCFH-DA fluorescence (36.30 ±5.32) vs (16.26 ± 2.97),P<0.05].Furthermore, NGB KD groups had a higher level of LDH release [(63.42 ±6.14)%vs (49.65 ±5.09 )%, P <0.05 ].Conclusions NGB plays an important role in the homeostasis of mitochondria.Knockdown of NGB results in increased mitochondrial depolarization , ROS production and neurotoxicity under hypoxia circumstances.

OBJECTIVE: To determine whether central venous-to-arterial carbon dioxide tension difference (Pcv-aCO(2)) could still be used as a goal of fluid resuscitation in septic patients who already had ScvO2 greater than 70% after early resuscitation. METHODS: A prospective observational study was performed on 56 septic patients admitted to the Intensive Care Unit (ICU) in a single University Hospital, who already had ScvO2 greater than 70% after early resuscitation. They were divided into two groups, based on whether the patients' initial Pcv-aCO2 was less than 6 mmHg (low gap group) or greater than or equal to 6 mmHg (high gap group). The following data were collected at 0, 12, and 24 hours (T(0), T(12), T(24)) after study inclusion: hemodynamic indices [mean blood pressure (MAP), heart rate (HR), cardiac output (CO), central venous pressure (CVP)], perfusion-related indexes [ScvO(2), Pcv-aCO2, serum lactate (Lac), Lac clearance rate], organ function- related indices [oxygenation index (PaO2/FiO(2)), serum creatinine (SCr), creatine kinase (CK-MB)], APACHE II score, SOFA score, and 24 hours amounts of fluid infusion. RESULTS: Twenty patients (42.9%) with initial Pcv-aCO(2) ≥ 6 mmHg were included in the high gap group and another thirty-two patients were included in the low gap group. At T12 and T24, ScvO(2) and CO were significantly higher, and Lac and SCr were significantly lower in low gap patients than high gap patients (P<0.05). At T(12) and T(24), Lac clearance rate was significantly higher (P<0.05), and 24-hours amounts of fluid infusion was significantly less [(3449.47 ± 695.41) mL vs (4070.66 ± 757.43) mL, P= 0.002] for the low gap group than for the high gap group, as well as the descrease of SOFA score at T(24) (P<0.05). There was no significant difference of APACHE II score between the 2 groups (P<0.05). CO and Pcv-aCO(2) values were inversely correlated (P< 0.05). CONCLUSION Septic patients targeting only ScvO(2) may still have inappropriate tissue perfusion, especially when Pcv-aCO2 ≥6 mmHg, which indicates insufficient resuscitation. When ScvO(2) > 70% has achieved after early resuscitation, Pcv-aCO2 can still be used as a goal of fluid resuscitation in septic patients .
Adult ; Blood Gas Analysis ; Carbon Dioxide ; blood ; Central Venous Pressure ; Female ; Fluid Therapy ; Hemodynamics ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sepsis ; blood ; physiopathology ; therapy ; Severity of Illness Index ; Vena Cava, Superior