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Sepsis is characterized by a systemic inflammatory response followed by immunosuppression of the host. Metabolic defects and mitochondrial failure are common in immunocompromised patients with sepsis. The NLRP3 inflammasome is important for establishing an inflammatory response after activation by the purinergic P2X7 receptor. Here, we study a cohort of individuals with intra-abdominal origin sepsis and show that patient monocytes have impaired NLRP3 activation by the P2X7 receptor. Furthermore, most sepsis-related deaths are among patients whose NLRP3 activation is profoundly altered. In monocytes from sepsis patients, the P2X7 receptor is associated with mitochondrial dysfunction. Furthermore, activation of the P2X7 receptor results in mitochondrial damage, which in turn inhibits NLRP3 activation by HIF-1α. We show that mortality increases in a mouse model of sepsis when the P2X7 receptor is activated in vivo. These data reveal a molecular mechanism initiated by the P2X7 receptor that contributes to NLRP3 impairment during infection.

There still appears to be insufficient interest in the management of postoperative nausea and vomiting. They are considered as inherent and inevitable discomforts after surgical operation. However, this disagreeable complication can be effectively managed. To do this, the risk must be suitably assessed and acted on accordingly. There are a wide variety of prophylactic options available associated with the anaesthetic technique, as well as appropriate anti-emetic treatment. In this article, the risk factors are reviewed and series of operative and postoperative recommendations are made., (Copyright © 2010 AEC. Published by Elsevier Espana. All rights reserved.)