Inflammatory Reaction In Patients Research Articles

Asymptomatic Reactive Hypoglycemia and Inflammatory Reaction in Patients with Coronary Artery Disease.

Hyperglycemia is an established risk factor of coronary artery disease (CAD). However, hyperglycemia with preserved pancreatic β cell function induces hyperinsulinemia to correct the glucose profile and may even result in reactive hypoglycemia (RH), which induces an inflammatory response. In this study, the incidence of RH and its effect on arteriosclerosis were examined in CAD patients with a lengthy oral glucose tolerance test (OGTT).We performed a prospective cross-sectional study on 116 nondiabetic CAD patients [70 ± 9 years, 70% male, HbA1c < 6.5%] using coronary angiography and a 4-hour OGTT. Blood samples were collected prior to and 4 hours after the glucose load to evaluate arteriosclerosis markers. Hypoglycemia following the glucose tolerance test was defined as blood glucose levels < 70 mg/dL. We comparatively examined markers of inflammation and arteriosclerosis between the RH group and the non-RH group.A glucose metabolism disorder was observed in 69% of the patients. Hypoglycemia was observed in 24% (28 individuals) of the patients. All showed a RH pattern with no symptoms. The RH group exhibited significantly elevated insulin levels at 1 hour. Furthermore, a significant increase in the white blood cell (WBC) count during OGTT was observed in the RH group compared with the non-RH group [delta WBC; RH: 4.84 (-4.17-20.75) versus non-RH: -2.17 (-9.23-9.09) %; P = 0.04].Asymptomatic RH and an augmentation of inflammation were observed at an incidence of 24% in CAD patients.

Comparison of Effects of Leukocyte-Rich and Leukocyte-Poor Platelet-Rich Plasma on Pain and Functionality in Patients With Lateral Epicondylitis.

This study aims to compare the effect of leukocyte concentration in platelet-rich plasma (PRP) on pain, functionality and post-injection local inflammatory reactions in patients with lateral epicondylitis. The study included 90 patients (26 males, 64 females; mean age 38.6 years; range 18 to 75 years) with lateral epicondylitis- related pain visual analog scale (VAS) score of ≥5 for more than three months. Patients were randomly assigned into three groups. Normal saline (1.5 mL) was injected in group 1 (control group) while a single dose of leukocyte-poor-PRP (1.5 mL) and leukocyte-rich-PRP (1.5 mL) were injected in groups 2 and 3, respectively. An exercise program was recommended to patients in all three groups. Patients were assessed according to VAS, Patient-Rated Tennis Elbow Evaluation, grip dynamometer and pinchmeter, extensor tendon thickness and cortical derangement at baseline and at fourth and eighth weeks after therapy. All patients were questioned regarding paracetamol use and adverse effects after therapy. No significant differences were detected between groups regarding VAS, Patient-Rated Tennis Elbow Evaluation, grip and pinch measurements, extensor tendon thickness and cortical derangement (p>0.05). In intra-group comparisons, VAS and Patient-Rated Tennis Elbow Evaluation scores obtained at fourth and eighth weeks were significantly decreased in all groups when compared to baseline values (p>0.05). Again, there was no significant difference in the control visit at eighth week when compared to baseline. Assessment of grip and pinch measurements revealed that values obtained at fourth and eighth weeks were significantly increased compared to baseline in all three groups (p<0.05). In leukocyte-rich-PRP group, a significant increase was detected in the values obtained at eighth week compared to those obtained at fourth week, but no significant change was detected in other groups. No significant difference was detected in extensor tendon thickness in any group. No significant difference was detected between groups in terms of paracetamol use and post-injection reactions. According to our study findings, lateral epicondylitis does not seem to affected either leukocyte-rich-PRP or leukocyte-poor-PRP on pain and function in the short term. Leukocyte concentration had no association with post-injection local inflammatory reactions.

Prospective analysis of lipid profile parameters and markers of vascular inflammatory response with prognosis of undesirable coronary events in patients with coronary heart disease after angioplasty with stenting.

The study of the causes of the development of vascular coronary complications after angioplasty with stenting using the evaluation of biochemical parameters in the dynamic observation of patients with IHD with significant coronary stenosis determines the relevance of the study. To analyze the parameters of lipid spectrum and markers of vascular inflammatory reaction in patients with IHD, in groups with stable angina and episode of unstable angina after angioplasty with stenting, to trace the dynamics of biochemical parameters and to reveal the predictors of undesirable coronary events. Patients with IHD with significant coronary stenosis of the arteries (SCS, n = 95) after coronary angiography at the point of maximum increase in the level of markers of the inflammatory reaction (3 months after angioplasty) are divided into 2 groups - patients with persistent stable angina pectoris (SA, n = 77) until the end of the study and patients with developed postvascularization episode of unstable angina (UA, n = 18). The dynamics of observation of biochemical parameters recorded the absence of normalization of the atherogenic spectrum of the lipid profile and the prolonged nature of the vascular inflammatory response to the end point of observation after angioplasty.The method of binary logistic regression revealed that in the general group of patients with IHD, an increase in the level of low density lipoprotein cholesterol by 1 mmol / L significantly increases the probability of significant coronary stenosis in men and raises the risk of UA after angioplasty by 7.38 times. It was found that patients with UA at the initial stage have a significantly higher risk of coronary blood flow instability in the post-vascularization period due to an elevated level of homocysteine. A set of biochemical markers for predicting the significance of coronary stenosis and development of undesirable vascular coronary events after angioplasty in patients with IHD has been identified: male sex, elevated LDL cholesterol and hyperhomocysteinemia.

The intervention effect of Wuling capsule on inflammatory reaction inpatients with post-stroke fatigue

Objective: To use Wuling capsule drugs to give intervening treatment for change and generation mechanism of the patients with post-stroke fatigue. Methods: 140 cases of fatigue patients post stroke treated in our hospital were randomly divided into two groups: control group and observation group, 70 cases in each group. The control group was treated with oral vitamin C, the observation group was treated with Wuling capsule, and the quality of life and the degree of changes of inflammatory cytokines in patients with fatigue the brain after stroke were analysed and compared. Results: compared with the control group, the expression levels of inflammatory cytokines IL-1β and IL-10 in the observation group were significantly decreased, the expression of IL-9 increased significantly, the difference between groups was significant (t=6.552, t=5.844, P<0.05); the Barthel index score increased significantly, there is a statistically significant difference between the two groups (P<0.05). Conclusion: Wuling capsule can effectively inhibit the release rate of inflammatory factor, reduce the expression level of related inflammatory factors, effectively improve the fatigue after stroke and promote the early rehabilitation. It has a reference value in clinical practice.

Sphingosine-1-phosphate is involved in inflammatory reactions in patients with Graves' orbitopathy.

Graves' orbitopathy (GO) is initiated by excessive amount of various inflammatory mediators produced by orbital fibroblasts. This study aimed to assess the crucial role of sphingosine-1-phosphate (S1P) in the inflammatory process of GO. Orbital adipose/connective tissue samples were obtained from 10 GO patients and 10 normal control individuals during surgery. Primary orbital fibroblast culture was done. After the expression of S1P receptors and sphingosine kinase (SphK) was assessed with the treatment of interleukin (IL)-1β, we evaluated the expression of pro-inflammatory factors [intercellular adhesion molecule-1 (ICAM-1), cyclooxygenase-2 (COX-2) and IL-6] after treating S1P. S1P receptor antagonists and SphK 1 inhibitor were pretreated and the expression of the pro-inflammatory factors was assessed. IL-1β exacerbated the inflammatory process by enhancing the expression of S1P receptors and SphK in GO orbital fibroblasts. IL-1β also induced the expressions of ICAM-1, COX-2, and IL-6 in GO orbital fibroblasts, and these expressions were effectively inhibited by S1P receptor antagonists and SphK1 inhibitor. S1P has an important role in the pathological inflammatory process of GO, which is mediated through the SphK1-S1P- S1P receptor pathway. SphK1 inhibitors and S1P receptors or antagonists could be potential approaches for controlling the inflammatory process of GO.

Therapeutic experience of the application of anisodamine on acute lung injury

ObjectiveTo investigate the effect of anisodamine combining with conventional therapy on the degree of lung injury and inflammatory reaction of patients with acute pulmonary contusion. MethodsA total of 48 patients with acute pulmonary contusion treated in our hospital emergency department from April 2011 to October 2015 were enrolled as the research object and were divided into experimental group and control group by using a method of random number table. Experimental group received anisodamine combining with conventional therapy and control group received conventional therapy. In the process of the treatment, the mechanical ventilation time, hospital stays in intensive care unit and the number of cases developed into acute respiratory distress syndrome and multiple organ dysfunction syndromes of patients in two groups were observed. Oxygenation indexes of patients were respectively calculated on Days 1, 2 and 3 after treatment. The contents of inflammatory mediators in serum were detected on Day 3 after treatment. ResultsThe mechanical ventilation time and hospital stays in intensive care unit [(9.52 ± 1.41) vs. (14.57 ± 2.51) days] of patients in experimental group were significantly shorter than those in control group, and the number of cases developed into acute respiratory distress syndrome [1 (4.17%) vs. 9 (37.50%)] and multiple organ dysfunction syndrome [1 (4.17%) vs. 7 (29.17%)] was significantly less than those in control group. Oxygenation indexes (294.52 ± 41.26 vs. 257.63 ± 38.52; 357.74 ± 47.74 vs. 279.87 ± 31.46; 396.71 ± 55.12 vs. 279.87 ± 31.46) of patients were respectively calculated on Days 1, 2 and 3 after treatment, which were significantly higher than those in the control group. On Day 3 after treatment, the contents of serum C-reactive protein [(7.94 ± 1.05) vs. (14.49 ± 2.97) mg/L], tumor necrosis factor α [(264.69 ± 41.58) vs. (417.87 ± 64.51) ng/L], interleukin-6 (IL-6) [(147.72 ± 21.36) vs. (257.68 ± 41.54) ng/L], IL-8 [(93.68 ± 12.52) vs. (145.62 ± 22.65) ng/L], IL-10 [(205.64 ± 31.56) vs. (336.62 ± 51.38) ng/L] and myeloid cells-1 (73.32 ± 10.39 vs. 114.45 ± 18.51) of patients in experimental group were significantly lower than those in the control group. ConclusionsThe anisodamine combining with conventional therapy can relieve the degree of lung injury caused by acute pulmonary contusion, improve ventilatory function, lower the incidence of acute respiratory distress syndrome and multiple organ dysfunction syndrome and inhibit the activation of inflammatory reaction and the release of inflammatory mediators.

Effect of electroacupuncture for immune function of patients treated with laparoscopic radical rectectomy for rectal cancer

To observe the effect of electroacupuncture (EA) combined with general anesthesia for the immune function of patients treated with laparoscopic radical rectectomy for rectal cancer. Fifty patients who would receive selective laparoscopic radical rectectomy for rectal cancer with general anesthesia were randomly divided into an observation group and a control group,25 cases in each one. Fifteen minutes before anesthesia induction,patients in the observation group were treated with EA at Zusanli (ST 36) and Sanyinjiao (SP 6) until the end of operation. Sham acupuncture without piercing the skin was applied at the same acupoints in the control group, and electrodes were connected without stimulation. Interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-6 (IL-6) were quantitatively tested before anesthesia (T0), at the time of abdomen closing (T1) and one hour after anesthesia anabiosis (T2). And serum procalcitonin (PCT) level, leucocyte count and the number of cases with increasing leucocyte (the standard number>10×109/L) were measured on the first day after operation. The levels of IL-4 and IL-6 were increased apparently and the ratio of IFN-γ/IL-4 was decreased at T2 compared with those before treatment in the control group (all P<0.05), but obvious change did not appear in the observation group (all P>0.05). The ratio of IFN-γ/IL-4 was enhanced (P<0.05),and the levels of IL-4 and IL-6 were reduced (both P<0.05) at T2 in the observation group compared with those in the control group. The level of PCT of the observation group was markedly lower than that of the control group on the first day after operation (P<0.05). There was no statistical significance about leucocyte count and the number of cases with increasing leucocyte between the two groups (both P>0.05). EA at Zusanli (ST 36) and Sanyinjiao (SP 6) could alleviate the depressing immune function and inflammatory reaction of patients after laparoscopic radical rectectomy for rectal cancer.

Clinical study on the sedation and analgesia effect of dexmedetomidine combined with sufentanil in severe acute pancreatitis patients with mechanical ventilation

Objective To investigate the sedation and analgesia clinical effects of dexmedetomidine and midazolam sufentanil in severe acute pancreatitis patients with mechanical ventilation. Methods Sixty four patients with mechanical ventilation in severe acute pancreatitis were randomly divided into dexmedetomidine and midazolam groups, and 32 cases in each group. All patients were routinely given sufentanil continuous intravenous analgesia. The patients in dexmedetomidine group received dexmedetomidine 1.0 μg/kg loading dose by intravenous injection and followed with 0.2~0.7 μg/(kg·h) continuous intravenous infusion. The patients in midazolam group received midazolam: 0.05 mg/kg loading dose by intravenous injection and followed with 0.02~0.08 mg/(kg·h) continuous intravenous infusion. The sedation and analgesia effects and inflammation index changes in two groups were observed. Results The analgesia and sedation onset time, awake time and time of live in intensive care unit(ICU) in dexmedetomidine group were significantly superior to the midazolam group (P<0.05). Before weaning from mechanical ventilation the white blood cell count, C-reaction protein (CRP), heart rate, and respiratory frequency index in dexmedetomidine group were significantly better than those in midazolam group (P<0.05). The adverse event's incidence rate in dexmedetomidine group (9.38%) was ignificantly lower s than that in midazolam group (31.25%) (P<0.05). Conclusions The application of dexmedetomidine combined with sufentanil in severe acute pancreatitis patients with mechanical ventilation may play a good role of sedative and analgesic effects, and alleviating the inflammatory reaction of patients, as well as fewer adverse events. Key words: Dexmedetomidine/AD; Sufentanil/AD; Pancreatitis/SU; Analgesia; Conscious sedation; Respiration, artificial

Neutralization of IL-6 and TNF-α ameliorates intestinal permeability in DSS-induced colitis

The cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) have been implicated as important mediators of the inflammatory reaction in patients with intestinal inflammation. The present study was designed to investigate the roles of these cytokines on mucosal barrier function in a mouse model of acute colitis with using anti-cytokine strategies. Mice received 3% dextran sulfate sodium (DSS) in their drinking water for 7days showed morphological alteration of mucosa and increase of intestinal permeability. Administration of IL-6 monoclonal antibody (mAb) or TNF-α mAb significantly attenuated intestinal permeability. IL-6 mAb and TNF-α mAb treatment also effectively suppressed the expression of claudin-2 and myosin light chain kinase (MLCK). Taken together, we indicated that anti-IL-6 and anti-TNF-α therapy prevent intestinal permeability induced by intestinal inflammation.

Brief Report: Severe Inflammation Following Vaccination Against Streptococcus pneumoniae in Patients With Cryopyrin-Associated Periodic Syndromes.

Pneumococcal vaccination is recommended for patients receiving immunosuppressive drugs. We describe unusually severe adverse reactions to pneumococcal vaccination in each of 7 consecutive patients with cryopyrin-associated periodic syndromes (CAPS). Seven consecutive patients with CAPS were vaccinated with pneumococcal polysaccharide or conjugate vaccines. Clinical information was collected retrospectively. Within a few hours after the vaccination, all 7 patients developed severe local reactions at the injection site. Two patients had to be hospitalized for systemic reactions including fever. All symptoms resolved in a period of 3-17 days. Our findings indicate that pneumococcal vaccines can trigger a severe local and systemic inflammatory reaction in patients with CAPS and possibly patients with other autoinflammatory diseases. Careful consideration is warranted when implementing current European League Against Rheumatism immunization guidelines in this patient population.

Effect of glutamine combined with esomeprazole on amino acid metabolism, bacterial translocation and inflammatory reaction in patients with severe acute pancreatitis

Effect of glutamine combined with esomeprazole on amino acid metabolism, bacterial translocation and inflammatory reaction in patients with severe acute pancreatitis

Anti-Inflammatory Effect of the Kampo Japanese Traditional Medicine daikenchuto After Colorectal Resection

Here we analyzed whether Daikenchuto (DKT) suppresses postoperative inflammatory reactions in patients who have undergone elective colorectal surgery. DKT is one of the most frequently prescribed traditional (Kampo) medicines in Japan. DKT is reported to have various beneficial effects on bowel disorders. It was recently reported that DKT also has an anti-inflammatory effect. Consecutive patients with colorectal cancer who underwent elective colorectal resection were separated into two groups. A total of 67 patients began a DKT regimen after surgery (DKT group) and 53 patients did not begin the DKT regimen after surgery (control group). We observed a steady postsurgery increase in the white blood cell (WBC) count of all patients on postoperative day 1 (POD 1), whereas the WBC count decreased at PODs 3 and 7. When we compared the WBC values of the DKT group (6147.2 ± 2217.3 per microliter) and control (7071.1 ± 2828.0 per microliter) groups on POD 7, we found significant differences (P = 0.038). There was no significant side effect due to DKT, except for one case of mildly impaired liver function. Our results suggest that DKT administration may have an anti-inflammatory effect during the postoperative period. Further studies are warranted to investigate the possibility of using DKT as a therapeutic agent based on its anti-inflammatory effect.

Local inflammatory reactions in patients with diabetes and periodontitis.

The impact of diabetes mellitus on the prevalence, severity and progression of periodontal disease has been known for many years and intense efforts have been made to elucidate the underlying mechanisms. It is widely reported that hyperglycemia causes numerous systemic changes, including altered innate immune-cell function and metabolic changes. The aim of this review was to summarize and discuss the evidence for mechanisms that probably play a role in the altered local inflammatory reactions in the periodontium of patients with diabetes, focusing on local changes in cytokine levels, matrix metalloproteinases, reactive oxygen species, advanced glycation end-products, immune-cell functions, the RANKL/osteoprotegerin axis and toll-like receptors. Apart from the systemic effects of diabetes, recent evidence suggests that local changes in the periodontal tissues are characterized by enhanced interactions between leukocytes and endothelial cells and by altered leukocyte functions [resulting in increased levels of reactive oxygen species and of proinflammatory cytokines (interleukin-1β, interleukin-6 and tumor necrosis factor-α)]. These local changes are amplified by the enhanced accumulation of advanced glycation end-products and their interaction with receptors for advanced glycation end-products. Furthermore, the increased levels of proinflammatory cytokines lead to an up-regulation of RANKL in periodontal tissues, stimulating further periodontal tissue breakdown.

Effect of selective gut decontamination in regulation of inflammatory reaction in patients with systemic inflammatory response syndrome

To explore the effect of selective gut decontamination in regulation of inflammatory reaction compared with rhubarb and glycerine enema for catharsis in patients with systemic inflammatory response syndrome ( SIRS ), and to discuss its mechanisms. A prospective randomized controlled trial was conducted. Fifty-seven patients with SIRS admitted to Department of General Surgery of Aviation General Hospital from June 2009 to June 2014 were enrolled. The patients were randomly divided into rhubarb decontaminate group, traditional decontaminate group and blank control group, with 19 cases in each group. Besides the treatment for primary disease, including anti-infection, operation, alleviate pain, nutritional support, and maintaining water and electrolyte balance, the patients in rhubarb decontaminate group received aqueous extract from rhubarb 15-20 g by gastric tube, enema, or peros, twice a day; and those in traditional decontaminate group received glycerine enema or glycerol enema, twice a day; while no gavage or enema was prescribed in blank control group. Peripheral blood was collected before and 72 hours after treatment. Enzyme linked immunosorbent assay (ELISA) was used to determine the concentration of lipopolysaccharide (LPS) and inflammatory mediators. Compared with blank control group and traditional decontaminate group, the levels of interleukins (IL-1, IL-8), LPS, platelet activating factor (PAF), tumor necrosis factor-α (TNF-α), and γ- interferon (IFN-γ) before treatment was similar to that of rhubarb decontaminate group [IL-1 (ng/L): 53.154±5.783, 50.564±5.771, 51.082±6.403, F=0.994, P=0.377; IL-8 (ng/L): 70.492±6.146, 68.376±6.112, 68.673±8.384, F=0.514, P=0.601; LPS (μg/L): 11.630±2.449, 10.858±2.307, 10.463±2.145, F=1.261, P=0.291; PAF (μg/L): 4.173±0.395, 4.051±0.362, 4.078±0.487, F=0.446, P=0.642; TNF-α (ng/L): 132.498±10.772, 129.735±12.881, 127.207±11.514, F=0.963, P=0.388; IFN-γ (μg/L): 45.645±4.558, 43.692±5.578, 43.767±5.028, F=0.904, P=0.411]. The above parameters after treatment were significantly lower than those before treatment in three groups. The effect on the LPS and pro-inflammatory factors of the rhubarb decontaminate group was more obvious than that of the blank control group and traditional decontaminate group [LPS(μg/L): 7.571±1.113 vs. 9.008±1.904, 8.874±1.808, F=4.416, P=0.017; IL-1 (ng/L): 45.309±3.563 vs. 48.731±4.466, 46.112±4.322, F=3.557, P=0.035; IL-8 (ng/L): 60.492±5.346 vs. 65.553±5.384, 63.437±5.462, F=4.213, P=0.020; PAF (μg/L): 3.519±0.250 vs. 3.832±0.356, 3.766±0.309, F=5.450, P=0.007; TNF-α (ng/L): 114.988±8.772 vs. 123.230±10.433, 118.534±9.519, F=3.525, P=0.036; IFN-γ (μg/L): 38.683±3.190 vs. 41.831±4.122, 39.161±3.972, F=3.820, P=0.028]. The usage of selective gut decontamination can inhibit the release of endotoxin and inflammatory mediators in patients with SIRS, and it will get a better effect using rhubarb, and the mechanism may be related to the protection of intestinal mucosal barrier function.

Normal free interleukin-18 (IL-18) plasma levels in dengue virus infection and the need to measure both total IL-18 and IL-18 binding protein levels.

Activated monocytes/macrophages and T lymphocytes that produce a cytokine storm are assumed to play a pivotal role in the pathogenesis of dengue. Interleukin-18 (IL-18) is a proinflammatory cytokine that is increased during dengue and known to induce gamma interferon (IFN-γ), which is crucial for dengue immune response. No data are available regarding the balance between IL-18 and its natural inhibitor IL-18 binding protein (IL-18BP) and how they interact within the inflammatory reaction of patients with dengue virus infections. Circulating levels of IL-18; IL-18BP; free, biologically active IL-18; the IL-18-dependent proinflammatory cytokine IFN-γ; monocyte-derived cytokines; and ferritin were assessed in adult Indonesian dengue patients (n = 95). Healthy individuals (n = 22) and leptospirosis (n = 19) and enteric fever (n = 6) patients served as controls. Total IL-18 levels were increased during dengue, leptospirosis, and enteric fever compared to healthy controls. However, due to a concurrent increase in IL-18BP levels, biologically active IL-18 levels remained similar in the different phases of dengue and in patients with leptospirosis. Biologically active IL-18 levels were also similar in patients with severe and nonsevere dengue. In conclusion, high total IL-18 and IL-18BP levels concur in dengue virus infections, leptospirosis, and enteric fever. This resulted in unchanged levels of free, biologically active IL-18 in dengue and leptospirosis, which underlines the importance of measuring both IL-18 and IL-18BP when studying the role of IL-18 in diseases.

Effect of Liandouqingmai recipe on quality of life and inflammatory reactions of patients with coronary heart disease

ObjectiveTo observe the effect of Liandouqingmai recipe (Chinese herbal medicine compound preparation) on the quality of life (QOL) and inflammatory reaction of patients with coronary heart disease (CHD). MethodsA total of 101 CHD patients were randomized into two groups: treatment group (n=45) receiving standard treatment for CHD plus Liandouqingmai recipe, and control group (n=56) receiving standard treatment only. The control group contained 16 normal healthy subjects. Changes in hs-C-reactive protein (CRP), peripheral blood leucocytes (PBL), and interleukin (IL)-6 and IL-10 levels were measured. The Seattle Angina Questionnaire (SAQ) was used to determine patient QOL before and after treatment for 2 weeks. ResultsBefore treatment, SAQ scores [physical limitation (PL), angina stability (AS), angina frequency (AF), treatment satisfaction (TS), and disease perception (DP)] were not statistically different between groups. After treatment, AS and DP levels of controls were significantly increased compared with the other groups, while PL, AS, AF, TS, and DP levels of the treatment group were significantly increased compared with controls. Treatment group SAQ scores (PL, AS, AF, TS, and DP) were significantly higher than for controls. CHD patient IL-6 and IL-10 levels were significantly higher than controls. Before treatment, mean levels of IL-6, hs-CRP and PBL of the two groups were not statistically different. After treatment, mean levels of IL-6, IL-10, hs-CRP and PBL of the two groups were significantly decreased compared with their before treatment values, and levels of IL-6, hs-CRP, and PBL of the treatment group were lower than controls. Although mean IL-10 levels of both groups decreased, there was no significant difference in between-group and in-group comparisons before and after treatment. Mean levels of IL-6 and IL-10 in the normal group were lower than in CHD patients. SAQ scores of QOL were negatively associated with the inflammatory index (IL-6/IL-10), and there was a significant negative association of IL-10 with AS (r= − 0.15, P<0.05). ConclusionInflammatory reactions in CHD patients are related to angina status. Coadministration of CHD standard treatment and Liandouqingmai recipe increased patient SAQ scores by decreasing IL-6, IL-10, hs-CRP, and PBL levels in CHD patients, which might inhibit endothelial inflammation to improve patient QOL.

Analysis of the effect and safety of atorvastatin in the treatment of septic shock

Objective To explore the clinical efficacy and safety of atorvastatin in the treatment of patients with septic shock.Methods 67 patients with septic shock were randomly divided into the treatment group （34 cases） and control group（33 cases）.The control group was treated with conventional therapy ,and the observation group was administered with atorvastatin based on the control group .Before and after treatment ,the inflammatory index ,cytokines levels,the number of MODS cases,the number of deaths at 28th day,and the incidence of adverse reactions were com-pared between the two groups .Results The heart rate ,respiratory rate ,white blood cell count of the treatment group were significantly better than the control group ,the cytokines levels were significantly lower than the control group ,the differences were statistically significant （t=4.181,3.622,4.879,all P〈0.05）.The incidence rate of MODS of treat-ment group was significantly lower than that of the control group （χ2 =7.153,P〈0.05）.The average hospital stay of the treatment group was （9.3 ±3.1）d,which was significantly less than （12.4 ±3.3）d of the control group（t=3.964,P〈0.05）.The incidence rate of adverse reaction in the treatment group was significantly lower than that of the control group（χ2 =4.566,P〈0.05）.The 28 d mortality rate of the two groups had no significant difference （χ2 =3.345,P〉0.05）.Conclusion Atorvastatin can effectively reduce the degree of inflammatory reaction in patients with septic shock ,decrease the incidence of MODS , and has potential benefits on the prognosis of patients , but still need to be further confirmed by clinical research . Key words: Shock; Infection; Atorvastatin

Ambulatory management of primary spontaneous pneumothorax: the good is (not always) the enemy of the better (evidence)

Pneumothorax is defined as the presence of air in the pleural cavity. A pneumothorax might occur spontaneously in patients without underlying lung disease (primary spontaneous pneumothorax (PSP)) or in patients with an underlying lung disease (secondary spontaneous pneumothorax), most commonly chronic obstructive pulmonary disease. The underlying cause of spontaneous pneumothorax is likely to be the rupture of “emphysema-like changes” (small bullae or blebs) on the pleural surface, which allows air from the lung into the pleural space. Smoking, male sex and height are the major risk factors for the development of a PSP. There is evidence of a pleural inflammatory reaction in patients with PSP, involving an increase in eosinophils and neutrophils as well as elevated inflammatory cytokines compared with blood levels [1]. From an epidemiological point of view, PSP remains a significant health problem, with an annual incidence of 18–28 per 100 000 in males and 1.2–6.0 per 100 000 in females [2, 3]. Primary therapeutic goals for PSP include removal of air from the pleural space and prevention of recurrences. Air evacuation may be achieved by simple manual needle aspiration, by a small bore tube or a conventional chest tube, the tubes being attached to a one-way valve or to a water-seal device, with or without active suctioning [4]. The treatment of PSP would lend itself well to ambulatory management, since patients are usually young, without relevant comorbidities, and the condition itself caries a low morbidity and mortality [5]. Furthermore, outpatient-orientated treatment rather than hospitalisation might be favoured by many patients and would substantially reduce health-cost expenses. Unfortunately, however, the adherence to recommendations of outpatient management of patients with PSP in clinical practice is rather low [5, 6]. The lack …

Unilateral intravitreal dexamethazone implant for bilateral retinitis pigmentosa-related macular edema

Dear Editor, I would like to congratulate Srour et al. for their case series about the treatment of macular edema (ME) secondary to retinitis pigmentosa by intravitreal dexamethasone implant (Ozurdex) (DEX implant) [1]. Retinal pigmentosa (RP) is a group of inherited retinal degenerative diseases caused by several gene abnormalities. The first lesion is peripheral, and the central vision of RP patients is relatively preserved. However, when ME occurs in these patients, central vision is often impaired. The ME could be caused by circulating antiretinal antibodies; this suggests that an autoimmune process may be implicated in the formation ofME in RP [2]. Sustained chronic inflammatory reaction may contribute to the pathogenesis of retinal degeneration in rd10 mice, suggesting there is ocular inflammatory reaction in patients with RP [3]. In this case, a treatment by corticosteroids could be efficient. Indeed, Srour et al. report the efficacy of intravitreal dexamethasone implant for macular edema secondary to retinitis pigmentosa on three patients [1]. Only one had bilateral ME and was treated in each eye. For these three patients treated by DEX implant for ME with RP, the decrease of retina thickness was important, but there was recurrence for two patients. Recently, Saatchi reported the treatment of a bilateral ME by an intravitreal dexamethasone implant in each eye too [4]. We would like to report our original experience [5]. A 22-year old man diagnosed of RP was referred to our department because he had bilateral ME and needed to have good vision to be successful in school (Fig. 2a). Carbonic anhydrase inhibitors (acetazolamide, 500mg daily) and brinzolamide (one drop in each eye twice a day) were not effective. We decided to inject intravitreal Ozurdex (0.7 dexamethasone implant). It was administered without complications on the right eye according to standard procedure (Fig. 1). Spectralis SD-OCT revealed reduction of the ME for both eyes, even in the first week (Fig. 2a and b). On the first month follow-up, best-corrected visual acuity (BCVA) had improved from 20/40 to 20/30 for the right eye and from 20/40 to 20/20 for the left eye, while the retina thickness had decreased from 538 μm to 294 μm for the right eye and from 428 μm to 319 μm for the left eye (Fig. 2c). No cataract progression was observed during the study period. In the case of bilateral ME, Dex implant could provide anatomic and functional patient improvements for both eyes in a unilateral injection. It could be interesting for diseases with bilateral ME. We advise waiting for the efficacy of a first

Amelioration of inflammatory reaction in patients with severe sepsis with inosine

To evaluate the therapeutic effect of inosine in patients with severe sepsis. A prospective study was conducted. Eighty-five severe sepsis patients hospitalized in intensive care unit (ICU) from March 2011 to August 2012 were included and randomized into three groups: 25 cases as conventional therapy group, who were treated with routine treatments; 28 patients were given inosine within 6 hours besides routine treatments; 32 patients were given inosine after 6 hours together with routine treatments. Inosine was given in the latter two groups by intravenous infusion (600 mg twice a day) for 10-14 days or to the end of the research when patients died or discharged from ICU. Before or after the treatment, venous blood was collected for determination of pro-inflammatory factors and organ function parameters. Average duration of stay in ICU and mortality rate were analyzed. Compared with conventional therapy group, the levels of pro-inflammatory factors, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP) were decreased in inosine in both within 6-hour and after 6-hour groups (TNF-α: 9.6 ± 4.1 ng/L, 10.8 ± 2.8 ng/L vs. 18.2 ± 3.3 ng/L, IL-6: 123.0 ± 10.1 ng/L, 132.0 ± 18.4 ng/L vs. 172.0 ± 17.9 ng/L, CRP: 42.0 ± 10.3 mg/L, 45.0 ± 8.6 mg/L vs. 61.0 ± 12.7 mg/L, all P<0.05), but there was no statistical significance in the content of IL-10 (53.0 ± 9.4 ng/L, 56.0 ± 10.8 ng/L vs. 58.0 ± 11.2 ng/L, both P>0.05). The lowering of alanine transaminase (ALT), total bilirubin, B-type natriuretic peptide (BNP), oxygenation index was more marked in inosine within 6-hour and after 6-hour groups than those of conventional therapy group (ALT: 42.0 ± 10.8 U/L, 46.0 ± 7.9 U/L vs. 63.0 ± 9.4 U/L, total bilirubin: 16.3 ± 6.7 μmol/L, 18.3 ± 7.3 μmol/L vs. 28.1 ± 8.5 μmol/L, BNP: 322.0 ± 28.7 ng/L, 347.0 ± 31.4 ng/L vs. 428.0 ± 43.2 ng/L, oxygenation index: 210.0 ± 23.8 mm Hg, 198.0 ± 21.4 mm Hg vs. 163.0 ± 15.2 mm Hg, all P<0.05). However, the difference of these values showed no significant difference between the two inosine groups (all P>0.05). There was no statistical significance in ICU stay days (22.4 ± 6.3 days, 19.8 ± 4.6 days, 23.1 ± 5.2 days) and mortality rate (36.0%, 32.1%, 34.4%) among three groups (all P>0.05). For severe sepsis patients, on the base of routine treatments, normal dose of inosine can lower the level of pro-inflammatory factors and ameliorate organ function, but it cannot decrease average ICU stay days and mortality rate.