Search

Background There is no available viable treatment for Sepsis-Induced Cardiomyopathy (SIC), a common sepsis complication with a higher fatality risk. The septic patients showed an abnormal activation of the renin angiotensin (Ang) aldosterone system (RAAS). However, it is not known how the Ang II and Ang-(1–7) affect SIC. Methods Peripheral plasma was collected from the Healthy Control (HC) and septic patients and Ang II and Ang-(1–7) protein concentrations were measured. The in vitro and in vivo models of SIC were developed using Lipopolysaccharide (LPS) to preliminarily explore the relationship between the SIC state, Ang II, and Ang-(1–7) levels, along with the protective function of exogenous Ang-(1–7) on SIC. Results Peripheral plasma Ang II and the Ang II/Ang-(1–7) levels in SIC-affected patients were elevated compared to the levels in HC and non-SIC patients, however, the HC showed higher Ang-(1–7) levels. Furthermore, peripheral plasma Ang II, Ang II/Ang-(1–7), and Ang-(1–7) levels in SIC patients were significantly correlated with the degree of myocardial injury. Additionally, exogenous Ang-(1–7) can attenuate inflammatory response, reduce oxidative stress, maintain mitochondrial dynamics homeostasis, and alleviate mitochondrial structural and functional damage by inhibiting nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thus alleviating SIC. Conclusions Plasma Ang-(1–7), Ang II, and Ang II/Ang-(1–7) levels were regarded as significant SIC biomarkers. In SIC, therapeutic targeting of RAAS, for example with Ang-(1–7), may exert protective roles against myocardial damage.

Sepsis-induced cardiomyopathy (SIC) is a serious complication of sepsis with high mortality but no effective treatment. The renin angiotensin (Ang) aldosterone system (RAAS) is activated in patients with sepsis but it is unclear how the Ang II/Ang II type 1 receptor (AT1R) axis contributes to SIC. This study examined the link between the Ang II/AT1R axis and SIC as well as the protective effect of AT1R blockers (ARBs). The Ang II level in peripheral plasma and AT1R expression on monocytes were significantly higher in patients with SIC compared with those in non-SIC patients and healthy controls and were correlated with the degree of myocardial injury. The ARB losartan reduced the infiltration of neutrophils, monocytes, and macrophages into the heart and spleen of SIC mice. Additionally, losartan regulated macrophage polarization from the M1 to the M2 subtype via nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thereby maintaining the mitochondrial dynamics balance in cardiomyocytes and reducing oxidative stress and cardiomyocyte apoptosis. In conclusion, the plasma Ang II level and AT1R expression on plasma monocytes are an important biomarker in SIC. Therapeutic targeting of AT1R, for example with losartan, can potentially protect against myocardial injury in SIC.

Acute myocardial infarction (AMI) is one of the leading causes of death globally, with a mortality rate of over 20%. However, the diagnostic biomarkers frequently used in current clinical practice have limitations in both sensitivity and specificity, likely resulting in delayed diagnosis. This study aimed to identify potential diagnostic biomarkers for AMI and explored the possible mechanisms involved. Datasets were retrieved from the Gene Expression Omnibus. First, we identified differentially expressed genes (DEGs) and preserved modules, from which we identified candidate genes by LASSO (least absolute shrinkage and selection operator) regression and the SVM-RFE (support vector machine-recursive feature elimination) algorithm. Subsequently, we used ROC (receiver operating characteristic) analysis to evaluate the diagnostic accuracy of the candidate genes. Thereafter, functional enrichment analysis and an analysis of immune infiltration were implemented. Finally, we assessed the association between biomarkers and biological processes, infiltrated cells, clinical traits, tissues and time points. We identified nine preserved modules containing 1,016 DEGs and managed to construct a diagnostic model with high accuracy (GSE48060: AUC = 0.923; GSE66360: AUC = 0.973) incorporating two genes named S100A9 and SOCS3. Functional analysis revealed the pivotal role of inflammation; immune infiltration analysis indicated that eight cell types (monocytes, epithelial cells, neutrophils, CD8+ T cells, Th2 cells, NK cells, NKT cells and platelets) were likely involved in AMI. Furthermore, we observed that S100A9 and SOCS3 were correlated with inflammation, variably infiltrated cells, clinical traits of patients, sampling tissues and sampling time points. In conclusion, we suggested S100A9 and SOCS3 as diagnostic biomarkers of AMI and discovered their association with inflammation, infiltrated immune cells and other factors.

Sepsis can cause myocardial injury, which is one of the leading causes of death in critically ill patients. Fish oil rich in omega-3 polyunsaturated fatty acids (PUFAs) in ultralong chains has immunomodulatory effects and can inhibit the production of various critically ill proinflammatory cytokines. Therefore, this study focused on whether ω-3 PUFAs have a protective effect on sepsis-induced cardiomyopathy (SIC).Male 6-8 weeks old C57BL/6 mice were pretreated with 3% special fish oil supplement rat food for seven consecutive days prior to surgery. Cecal ligation and puncture (CLP) was perfromed to induce polymicrobial sepsis.The cardiac function was assessed by echocardiography, apoptosis of cardiomyocyte were detected by TUNEL assay and Western blotting, and the level of TNF-α, IL-6, and IL-1β in plasma was determined 24h after CLP.Pretreatment with omega-3 PUFAs attenuated cardiomyocyte apoptosis, decreased the production of proinflammatory cytokines, attenuated the SIC, and improved the survival rate of septic mice induced by CLP.ω-3 PUFAs alleviate SIC through attenuating cardiomyocyte apoptosis, which provides a new direction for the prevention and treatment of SIC.

Background: The purpose of this study was to investigate the effect of the BOPPPS model (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) with PAL (Peer-assisted learning) and medical humanities methods on Chinese Medical Students in Cardiopulmonary Resuscitation Courses. Methods: Participants were the long-term medical students of Tianjin Medical University who accepted emergency medicine courses from 2015 to 2020. Forward-looking descriptive research and phased CPR curriculum teaching innovation, including the BOPPS with PAL (First Stage), the BOPPS with PAL and medical humanities methods (Second Stage), compared with the traditional teaching model (Basic Stage). Results: The usual and final results improved in First stage compared with Basic stage (↑30.2%, ↑7.5%), the proportion of those with more than 80 points increased in the usual exam, and the proportion of those with 70 points or more increased in the final exam. The usual and final results improved in Second stage compared with First stage (↑12.0%, ↑2.2%), the proportion of those with more than 90 points increased in the usual exam, and the proportion of those with 80 points or more increased in the final exam. Conclusions: The teaching innovation of the CPR curriculum, the application of BOPPPS teaching model, and the peer-assisted learning and medical humanities teaching methods can improve teaching quality of CPR courses in medical colleges.

Autophagy is a highly conserved physiological and biochemical process in which organisms maintain homeostasis of the cellular environment. Autophagy is widely involved in the occurrence and development of many diseases, especially in inflammatory diseases, which is a hot topic in recent years. Autophagy-related genes (ATGs) play important roles in regulating autophagy in many aspects, thus affecting the process and prognosis of inflammatory diseases. This article reviews the regulatory roles and mechanisms of autophagy in inflammatory diseases, as well as the functions and roles of several important ATGs in inflammatory diseases. DOI: 10.11855/j.issn.0577-7402.2019.09.12

Sudden death refers to death that occurs unexpectedly within 6 h of the onset of symptoms and in a normal state of health before. Mortality from sudden cardiac death (SCD) exceed the combined mortality of all major cancers. SCD mostly occurs outside the hospital, and most of them are asymptomatic before the onset of event. SCD has the characteristics of burstiness and unpredictability. The out-of-hospital cardiac arrest survival chain emphasizes timely identification and call for help, mainly chest compressions, defibrillation as soon as possible, and waiting for the professional team to transfer to the hospital as soon as possible after arriving. The hospital cardiac arrest survival chain emphasizes strengthening monitoring, establishing a rapid response system, and multidisciplinary and multi-team collaboration. SCD prevention should focus on high-risk populations. Efforts are made to help patients remove the etiology, take effective measures to control risk factors, detect changes in the condition of high-risk patients, and reduce the incidence of SCD.

Neuropilin-1 (Nrp-1) contributes to maintaining the stability of CD4(+) CD25(+) regulatory T cells (T(regs)). We investigated the impact of Nrp-1 on the stability of CD4(+) CD25(+) T(regs), and the underlying signaling pathways, in a model of sepsis. Splenic CD4(+) CD25(+) T(regs) were either treated with anti-Nrp-1, transfected to silence Nrp-1 and inhibitor of NF-κB kinase subunit beta (IKKβ), or administered ammonium pyrrolidine dithiocarbamate (PDTC), followed by recombinant semaphorin 3A (rSema3A), in a simulation of sepsis. After the creation of a sepsis model in mice, anti-Nrp-1 was administered. The expression of the gene encoding forkhead box protein P-3 foxp3-T(reg)-specific demethylated region (foxp3-TSDR), the apoptosis rate, the expression of Foxp-3, cytotoxic T-lymphocyte-associated protein-4 (CTLA-4), and transforming growth factor β1 (TGF-β1), interleukin 10 (IL-10) and TGF-β1 secretion, and the NF-κB signaling activity of CD4(+) CD25(+) T(regs) were determined. Sepsis simulation with or without rSema3A increased the stability of CD4(+) CD25(+) T(regs), including an increase in the expression of Foxp-3, CTLA-4, and TGF-β1, decreases in apoptosis and the methylation of foxp3-TSDR, increases in the secretion of TGF-β1 and IL-10, and an increase in the immunosuppressive effect on CD4(+) T lymphocytes. Silencing of Nrp-1 or anti-Nrp-1 treatment abrogated lipopolysaccharide (LPS) stimulation with or without an rSema3A-mediated effect. Sepsis simulation increased the DNA-binding activity of NF-κB, as well as the ratios of phosphorylated IKKβ (p-IKKβ) to IKKβ and p-P65 to P65 in vitro and vivo. Silencing of IKKβ expression or PDTC treatment suppressed the stability of CD4(+) CD25(+) T(regs) in LPS-induced sepsis. Weakening Nrp-1 reduced the stability of CD4(+) CD25(+) T(regs) by regulating the NF-κB signaling pathway; thus, Nrp-1 could be a new target for immunoregulation in sepsis.

Background: Improving the capacity of health care, disease diagnosis and treatment of primary medical workers was the key to hierarchical diagnosis and treatment services. Electrocardiogram (ECG) played an important role in the diagnosis of cardiac diseases and should be regarded as the most basic tool for primary clinical medical workers in China. Objectives: To investigate the competency of Chinese medical workers in electrocardiographic interpretation skills, especially in the primary care hospitals, to explore the insufficiency of electrocardiographic interpretation skills and the improvement methods. Methods: A cross-sectional questionnaire study was conducted via the internet from March to October 2019. The questionnaire consists of 6 parts: basic information, equipping with an electrocardiograph, operating electrocardiograph, receiving electrocardiographic theory, testing of electrocardiographic interpretation, and improving electrocardiographic interpretation skills. Results: The effective quantity of this questionnaire was 2307, with an effective rate of 96.57%. The overall reliability was α=0.895. There were no significant differences among primary, private and class-Ⅲ hospitals in the aspects of equipping with an electrocardiograph (χ2=3.794, 3.104, P＞0.05), operating the electrocardiograph (χ2=1.857, P＞0.05) and receiving electrocardiographic theoretical study (χ2=6.701, P＞0.05). Medical workers in private and class-Ⅲ hospitals had a stronger interpretation competency of ECG, including common or life-threatening ECGs (P＜0.01). The development of talent echelon in primary hospitals affected the electrocardiographic interpretation skills of medical workers (P＜0.01). In primary hospitals, the age was mainly ≥ 40 years (79.0%), the education background was mainly bachelor and below degree (80.9%), the professional qualification was mainly physician assistant (58.6%) and primary physician (31.4%). The interpretation competency of ECG of medical workers in private or class-Ⅲ hospitals was higher than that in primary hospitals (P＜0.05 or 0.01). Conclusions: In China, the examination of electrocardiograph had been popularized. Due to the unreasonable development of talent echelon in primary hospitals, the electrocardiographic interpretation skills of primary medical workers were worrying. We should improve electrocardiographic teaching methods with the help of the internet, to enhance the electrocardiographic interpretation skills of primary medical workers.

Objective To observe the effects of XUEBIJING injection on the expression of hepatic gelsolin(GSN) and inflammatory cytokine in septic rats.Methods Seventy-eight male Wistar rats were involved in present study and randomly divided into normal control group(n=6),sham operation group(n=24),cecal ligation puncture(CLP) group(n=24) and XUEBIJING group(n=24).The CLP sepsis models of rats were established with the animals in the latter two groups.XUEBIJING injection was injected intravenously at 2,12,24,36,48 and 60 hours after operation(4ml/kg each) in XUEBIJING group,while rats in sham operation group and CLP groups received same amount of normal saline by intravenous injection.The levels of hepatic GSN and high mobility group box-1(HMGB1) protein at 6,12,24 and 72 hours after operation were determined by ELISA,and limulus test was performed to measure the hepatic LPS levels.Results Compared with normal control and sham operation group,The hepatic GSN levels decreased and LPS and HMGB1 levels increased markedly in CLP groups(P < 0.05).Compared with CLP group,the hepatic GSN levels increased and LPS and HMGB1 levels decreased markedly in XUEBIJING group(P < 0.05).Correlation analysis revealed that a significant negative correlation existed between the hepatic GSN contents and LPS levels at each of time points in CLP group(P < 0.05),while no obvious correlation was found between GSN and HMGB1 levels(P > 0.05).Conclusion XUEBIJING injection may enhance the production of hepatic GSN via inhibition of LPS in septic rats,thereby having beneficial effect on septic response.

This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.In patients with APACHE II score19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (P0.05), whereas the values of procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), PaO2, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P0.01, r=0.732 and P0.01, r=0.762). SBPV and DBPV were correlated with COR (P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT (P0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

It is rare to see a concurrent infection with infectious mononucleosis and community-associated methicillin-resistant Staphylococcus aureus in Tianjin, China. Until now, there is still no any single recorded case of concurrent infectious mononucleosis and community-associated methicillin-resistant Staphylococcus aureus bacteremia.

To probe into the effect of electroacupuncture (EA) at Shuigou (GV 26) on mild and moderate shock.With 3-center randomized control study method, 276 cases were assigned to an EA plus medicine group and a medication group, 138 cases in each group. They were treated respectively with western medicine plus EA at Shuigou (GV 26), and simple western medicine. Their curative effects were observed after treatment for 6 hours.The blood pressure was immediately increased in the EA plus medicine group and the increase of blood pressure was earlier than that in the medication group (P0.001). The markedly effective rate of 52.9% in the EA plus medicine group was significantly higher than 18.1% in the medication group (P0.001).The therapeutic effect of EA at Shuigou (GV 26) plus western medicine on mild and moderate shock is better than that of simple western medicine.

Acute appendicitis, characterized as periumbilical pain, migrating to the right iliac fossa, is one of the most common acute surgical conditions. It is usually diagnosed on the basis of clinical signs and symptoms. However, some patients may present atypically and are prone to be misdiagnosed. We report this first case of acute appendicitis who presented initially with complain of diarrhea accompanying hypokalemia. There have been no published data suggesting its existence in any parts of the world.