Effect of Early Hemofiltration on Pro- and Anti-inflammatory Responses and Multiple Organ Failure in Severe Acute Pancreatitis

The effects of early hemofiltration on the serum levels of cytokines, pro- and anti-inflammatory balance and organ function in pigs with severe acute pancreatits (SAP) were studied. SAP pig model was induced by retrograde injection of artificial bile into the pancreatic duct. The pigs were randomly divided into SAP hemofiltration treatment group (HF group, n=8) and SAP non-hemofiltration treatment group (NHF group, n=8). In the HF group, the animals were subjected to high-volume and zero-balance hemofiltration therapy. The results showed that as compared with NHF group, MAP, CVP and PaO 2/FiO 2 were significantly increased (P<0.01), while HR, urinary protein content, serum ALT level, pulmonary coefficient and lung wet/dry ratio obviously decreased (P<0.05) in HF group. Under a light microscope, the pulmonary histologic scoring was lower that in HF group (P<0.01) and the lesions of renal and liver tissues were milder. However, there was no significant difference in the pancreatic histologic scoring between the two groups. Six h after establishment of the model, the serum levels of TNF-α, IL-1β were lower, while the IL-10/TNF-α ratio was higher in HF group (all P<0.05). It was suggested that early hemofiltration could effectively remove the serum cytokines TNF-α and IL-1β in SAP pigs, elevate the ratio of IL-10/TNF-α, improve hemodynamics and alleviate the lesions of lung, kidney and liver tissues.

Adult-onset Still's disease evolving with multiple organ failure and death:A case report and review of the literature

BACKGROUND Adult-onset Still’s disease(AOSD)is a rare systemic inflammatory disease,which is characterized by daily fever and arthritis,with an evanescent rash and neutrophilic leukocytosis.To date,there has been no definite laboratory or imaging test available for diagnosing AOSD;the diagnosis is one of exclusion,which can be very challenging.In particular,AOSD patients may experience different complications affecting their clinical picture,management,and prognosis.The treatment of AOSD remains largely empirical and involves therapeutic agents.CASE SUMMARY We report the case of a 36-year-old woman who presented with fever,red rash,arthralgia,and sore throat.Her serum ferritin level and white blood cell count were markedly elevated,and the first diagnosis 22 years prior was"juvenile rheumatoid arthritis of systemic type".The patient was treated with prednisone,sulfasalazine,methotrexate,and leflunomide.After remission of her symptoms,the patient stopped taking the medications,and the disease recurred.Ultimately,the patient was diagnosed with adult-onset Still's disease.Relapse occurred several times due to self-medication withdrawal,and an interleukin-6 antagonist(tocilizumab/Actemra)was administered to control the disease.Recently,she was hospitalized because an incision did not heal,and the patient suddenly developed high fever and diarrhea during hospitalization.The patient's disease progressed violently and quickly developed into macrophage activation syndrome,disseminated intravascular coagulation,shock,and multiple organ failure.The patient had sudden cardiac arrest,and she died despite emergency rescue efforts.CONCLUSION AOSD patients need regular follow-up in the long-term treatment process,and must press formulary standard medication,and do not voluntarily withdraw or reduce the dose.Otherwise it may cause disease back-and-forth or serious lifethreatening complications.Meanwhile,strict management of trauma,infections,tumors,and other diseases may contribute to improved outcomes in patients with complications.

Changes of thromboxane and prostacyclin in the pathogenesis of multiple organ failure in severe burns

Fifty-seven severely burned patients were divided into 2 groups:16 withmultiple organ failure（MOF）,and 41 without MOF.It was found that the levelof thromboxane B2（TXB2）and the ratio between TXB2 and 6-keto-prostaglandinF1α(TBX2/6-keto-PGF1α)in plasma and in visceral tissues were increased and re-mained significantly high in the first 5～7 d postburn in patients with MOF but notso in those without MOF.The circulatory platelet aggregate ratio（CPAR）wasmarkedly decreased in the same period in MOF group.Myocardial enzymes（CPK,LDH,and GOT）were markedly increased in the first 3d and remainedsignificantly high within 7 d postburn.Degeneration,structural destruction,edema,hemorrhage and thrombosis were revealed in cardiac,pulmonary,renal andhepatic tissues succumbing to functional failure.Thirteen out of the 16 cases de-veloped MOF during the 3rd to 7th day posthurn and 11 died in that period.These findings substantiate that persistent increase of thromboxane andthromboxane/prostacyclin ratio is closely related to the origin and development ofMOF after burn injury.

A new combined therapy to 15 patients with multiple organ failure in abdominal surgery

AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsodaminum;short period high doses in large volume dexamethasonum;high doses in large volume of dis- infectant antibiotics;high doses in large volume of abdominal cav- ity washing liquor and support of nutrition metabolism.The mortal- ity rate and cost of MOF were decreased.It is simple,practical and effective. METHODS The study group consisted of 15 patients(10 wom- en,5 men;average age,42.7)who were hospitalized in our hospital.All patients were given“FHDOS”:short period high in large volume Anisodaminum:intravenous injection 40 mg once; another 40rag may be added 30 minutes later according to condition.The total amount may reach 120-240 mg a day,or,in- travenous injection 40 mg every 15 minutes until condition being under control.Short period high doses in large volume Dexamethasonum:intravenous injection 100-200 mg once;this remedy may be continued for 1-3 days;the amount also may de- crease according to condition.High doses in large volume of dis- infectant Antibiotics:select and use antibiotics according to clini- cal condition,inference of Gram's stain;it is necessary to re- peatedly culture bacteria in many parts,and then,to make ad- justment according to culture result and drug-resistance,and to prevent carefully the dual infections from occurring.High doses in large volume of abdominal cavity washing liquor:generally adopt- ing physiological saline 6000o8000ml in washing abdominal cavity. “One support”means full support of nutrition metabolism. RESULTS All the patients in this group survive well after the rescue without any complication. CONCLUSIONS MOF should be prevented,if possible,by stopping or controlling the injury,removing as much necrotic tis- sue as possible,improving blood flow and oxygen consumption, supporting metabolism,and preventing infection or treating it ear- ly and adequately.“FHDOS”is a combined therapy and plays a key role in treating MOF.

Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation

A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L;osmolarity: 390 mosmol/kg;creatinin: 300 μmol/L;glycemia > 6 g/L;transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.

A case report of melioidosis pneumonia with multiple organ failure

Objective:To analyze the clinical and follow-up data of patients with multiple organ failure of melioidosis pneumonia,to strengthen the understanding of melioidosis,and to provide references for the diagnosis and treatment of clinicians,especially doctors in Hai nan province with high incidence,so as to reduce misdiagnosis,improve the diagnosis rate and reduce the mortality.Methods:The clinical symptoms,signs,laboratory examination and follow-up of patients with multiple organ failure were analyzed retrospectively.Results:Multiple organ failure with melioidosis pneumonia was easily misdiagnosed,Treatment cycle is long,easy to relapse.Conclusion:It is very important to analyze and differentiate the anthrax with multiple organ failure,especially in Hai nan province,which can improve the diagnosis rate and reduce the mortality.

Fatal multiple acyl-CoA dehydrogenase deficiency caused by ETFDH gene mutation:A case report

BACKGROUND Multiple acyl-CoA dehydrogenase deficiency(MADD)is a disease of rare autosomal recessive disorder.There are three types of MADD.Type I is a neonatalonset form with congenital anomalies.Type II is a neonatal-onset form without congenital anomalies.Type III is considered to a milder form and usually responds to riboflavin.However,late-onset form could also be fatal and not responsive to treatments.CASE SUMMARY We report a severe case of a young man with onset type III MADD induced by drugs and strenuous exercise characterized by rhabdomyolysis and liver dysfunction.Urine analysis indicated 12 out of 70 kinds of organic acids like glutaric acid-2 were detected.Serum analysis in genetic metabolic diseases revealed 24 out of 43 tested items were abnormal,revealing the elevation of several acylcarnitines and the reduction of carnitine in the patient.By next generation sequencing technology for gene sequencing related to fatty acid oxidation and carnitine cycle defects,a rare ETFDH gene variant was identified:NM_004453:4:C.1448C>T(p.Pro483 Leu).The patient was diagnosed with lateonset GAII.He was not responsive to riboflavin and progressively worsened into multiple organ failure that finally led to death.CONCLUSION Type III MADD can also be fatal and not responsive to treatments.

Full neurological recovery from severe nonexertional heat stroke with multiple organ dysfunction:A case report

BACKGROUND We report a rare case of full neurological recovery from severe nonexertional heat stroke in a 67-year-old woman with an initial Glasgow Coma Scale of 3.This report raises awareness among doctors that when heatstroke is diagnosed,comprehensive treatment should be implemented as soon as possible.Moreover,targeted temperature management,combination therapy with hemodialysis and hemoperfusion,and hyperbaric oxygen therapy may alleviate multiorgan failure and prevent neurological sequelae caused by heatstroke.CASE SUMMARY A previously healthy 67-year-old woman with an initial Glasgow Coma Scale of 3 was found lying prone on the road at noon on a summer day.Laboratory tests revealed multiorgan failure.As soon as heatstroke was diagnosed,comprehensive treatment was implemented.On hospital Day 3,the patient was extubated.Her initial Sequential Organ Failure Assessment score at hospitalization was 14 and decreased to 2 on hospital Day 4.On the seventh day following hospital admission,as the patient’s general condition improved,the levels of laboratory test findings decreased rapidly.Finally,the patient gradually recovered with no other neurological symptoms(the Glasgow Coma Scale at discharge was 15,and her ability to walk independently was restored).CONCLUSION This case demonstrated that targeted temperature management,combination therapy with hemodialysis and hemoperfusion,and hyperbaric oxygen therapy may alleviate multiorgan failure and prevent neurological sequelae caused by heatstroke.

<i>γδ</i>-T Large Granular Lymphocyte Leukemia Associated Hemaphagocytic Syndrome Complicated with Multiple Organ Dysfunction

Hemophagocytic syndrome (HPS) usually presents as a complication of T/NK cell lymphoma. However, γδ-T large granular lymphocyte leukemia (LGL) associated HPS was rarely reported. Herein, we reported a case of γδ-T LGL associated HPS. A previously healthy 21-year-old Chinese man was admitted with high fever, severe pancytopenia and liver dysfunction. He developed disseminated intravascular coaggulation (DIC), shock, gastrointestinal bleeding, acute renal failure as well as central nervous system involvement. Bone marrow aspiration showed infiltration of large granular lymphocytes and hemophagocytic histiocytes. Immunophenotyping analysis by four-color flow cytometry showed the leukemic cells with large side scatter (SSC), CD3+, CD2+, CD8+, CD5-, CD7 partly+, CD4-, CD56-, CD57-. Polymerase chain reaction (PCR) amplification of TCRβ and γ chain gene rearrangement confirmed TCRγδ T cell clone. Thus, a diagnosis of γδ-T LGL associated HPS was established. The patient worsened rapidly and died of multiple organ failure.

脓毒症致多器管功能障碍综合征模型犬急性肾损伤的机制研究

目的注射内毒素导致犬发生脓毒症进而形成多脏器功能衰竭,构建犬的多器官功能障碍综合征(MODS)模型,通过研究肾脏的相关指标,进一步观察MODS犬的肾脏损伤变化,更好的了解MODS犬的肾脏损伤的发生机制,为临床和实验研究提供理论依据。方法14只家犬分为两组,其中MODS模型犬7只(实验组),正常犬7只(对照组)。通过分时段测量肾脏指标进一步了解肾脏损伤的情况。结果与对照组相比,实验组犬尿素氮和肌酐均在实验开始后2 h呈现进行性增高(P<0.05),尿量明显减少(P<0.05),出现多尿期的时间明显延后。病理结果表明脓毒症会导致肾小管发生损伤,但并未发生弥漫性坏死。结论实验犬在造模成功后2 h肾脏指标开始升高,肾脏的确发生了急性损伤,通过病理学也证明了肾脏的损伤,但肾小管并未发生弥漫性坏死。如果想挽救实验犬的肾脏功能需要在2 h前积极寻找引起肾脏损伤的原因,积极治疗原发病,为临床提供了理论支持。肾脏作为机体的重要脏器之一,通过研究它的急性损伤的机制可以更好的理解MODS的发病机理。

血清IL-18、CD64及SIRT3对重症肺炎患者多器官功能衰竭的预测价值

目的探讨血清白细胞介素-18(IL-18)、中性粒细胞分化抗原64(CD64)及沉默信息调节因子相关酶3(SIRT3)对重症肺炎患者多器官功能衰竭(MOFE)的预测价值。方法回顾性选取2020年8月至2022年8月新乡医学院第一附属医院收治的300例重症肺炎患者的临床资料,根据有无MOFE发生分为MOFE组90例和非MOFE组210例。比较两组患者的一般资料及血清IL-18、CD64及SIRT3水平,采用Logistic回归分析重症肺炎患者MOFE影响因素;采用受试者工作特征(ROC)曲线评价血清IL-18、CD64及SIRT3水平对重症肺炎患者MOFE发生的预测价值。结果MOFE组患者的年龄、慢阻肺所占比例、CPIS评分、APCHEⅡ评分明显高于非MOFE组,差异均有统计学意义(P<0.05);MOFE组患者的血清IL-18、CD64水平分别为(22.49±5.04)ng/L、(46.83±5.92)%,明显高于非MOFE组(16.46±3.59)ng/L、(39.06±4.26)%,SIRT3水平为(3.98±0.84)pg/mL,明显低于非MOFE组(4.82±1.25)pg/mL,差异均具有统计学意义(P<0.05);经Logistic回归分析结果显示,年龄、合并慢阻肺、血清IL-18、CD64及SIRT3均为重症肺炎患者MOFE发生的影响因素(P<0.05);血清IL-18、CD64及SIRT3水平预测重症肺炎患者MOFE发生的曲线下面积(AUC)分别为0.804、0.807、0.742,三指标联合预测MOFE发生的AUC为0.926,明显高于血清IL-18、CD64及SIRT3单独预测(Z=22.941、20.837、25.963,P<0.001),此时最佳敏感度、特异度分别为78.89%、91.43%。结论重症肺炎患者血清IL-18、CD64水平升高,SIRT3水平下降,均为MOFE发生的重要因素,联合检测三者水平有助于预测重症肺炎患者MOFE的发生。

A STUDY ON ACID-BASE DISTURBANCE IN PATIENTS WITH POST-TRAUMATIC MULTIPLE ORGAN FAILURE

In order to diagnose accurately the type of acid梑ase disturbance (ABD) in patients with post梩raumatic multiple organ failure (PMOF), arterial blood gases and electrolytes were determined 645 times on 112 patients with PMOF and the data were analyzed with the pre-estimated compensatory formula of ABD and the calculations of anion gap, potential bicarbonate, and blood chlorides. Simple ABD was found in 381 times of determinations and double ABD in 239 when only the formula was used in the analysis, while 264 times of simple ABD, 260 times of double ABD and 96 times of triple ABD were found when the formula was employed in combination with the calculations of anion gap, potential bicarbonate and blood chloride. The mixed types of ABD were increased by 49% (117 times) from 239 to 356 times and triple ABD was increased from 0 to 96 times. The findings indicate that the employment of the combined formula and the calculations of anion gap, potential bicarbonate and blood chloride is of great significance to assess ABD especially its mixed and complicate types in patients with PMOF. It is emphasized that along with the monitoring of blood gases, the determination of blood electrolytes and the calculation of anion gap and potential bicarbonate should be performed to determine the correct type of ABD.

基于损伤控制理论的救治管理对肝脏与胆管外伤患者救治效果的影响

目的 探究基于损伤控制理论的救治管理在肝脏与胆管外伤患者救治中的应用效果。方法 回顾性分析2022年8月—2023年3月收治的肝脏与胆管外伤102例的临床资料,根据临床处理方案分为观察组52例和对照组50例,对照组实施常规急诊救治,观察组实施基于损伤控制理论的救治管理。观察2组救治相关指标、并发症及干预前后损伤严重程度、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]变化情况。结果 观察组手术时间、术后肛门首次排气时间及住院时间均短于对照组,术中出血量少于对照组(P<0.01);干预后,观察组损伤严重程度轻于对照组(P<0.05);干预后,观察组血清MPO、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);观察组多器官功能障碍综合征、失血性休克发生率分别为3.85%(3/52)、1.92%(1/52),低于对照组的18.00%(9/50)、16.00%(8/50),差异有统计学意义(P<0.05)。结论 基于损伤控制理论的救治管理可降低肝脏与胆管外伤患者应激及损伤程度,加速康复进程,改善临床结局。

急性颈髓损伤并发MSOF的类型及原因分析

目的：通过探讨急性颈椎颈髓损伤并发多系统器官衰竭（ｍｕｌｔｉｐｌｅｓｙｓｔｅｍｏｒｇａｎｆａｉｌｕｒｅ，ＭＳＯＦ）发病因素及其类型，为防治伤后ＭＳＯＦ提供依据。方法：对我院１９８２年１月～１９９７年５月收治的３０３例急性外伤性颈椎颈髓损伤并发ＭＳＯＦ的３２例病人进行回顾性分析。结果：颈髓损伤并发ＭＳＯＦ的诱因为肺部感染，高热，水电解质平衡紊乱，低蛋白血症和术后继发性颈髓损害。ＭＳＯＦ的发生率为颈髓损伤病人１０．５６％，死亡２５例，死亡率为ＭＳＯＦ病人７８．１３％。结论：消除ＭＳＯＦ的诱因并对可能发生或已发生功能不全的器官进行有效的功能支持，才能降低颈髓损伤后ＭＳＯＦ的发生率。

急性病毒性肝炎患者心电图异常相关因素及其对预后的预测价值

目的探讨急性病毒性肝炎患者心电图异常相关因素及其对预后的预测价值。方法选取2020年2月—2023年2月收治的伴心电图异常急性病毒性肝炎78例为异常组,无心电图异常急性病毒性肝炎120例为无异常组,收集2组临床资料并分析心电图异常相关因素。随访6个月,将心电图异常78例分为预后良好组[多器官功能障碍综合征(MODS)评分≤12分]、预后不良组(MODS评分>12分),分析心电图异常相关因素对急性病毒性肝炎患者预后影响及预测价值。结果心电图异常78例心电图表现为T波改变(42.31%,33/78)、窦性心动过缓(34.62%,27/78)、窦性心动过缓伴窦性心律不齐(24.36%,19/78)等。Logistic回归分析显示,疾病类型、总胆红素(TBIL)、脑钠肽(BNP)、左心室Tei指数及伴肝硬化、伴门静脉高压是急性病毒性肝炎患者心电图异常的影响因素(P<0.05)。预后良好组、预后不良组疾病类型、TBIL、BNP、左心室Tei指数及伴肝硬化、伴门静脉高压患者所占比例比较差异有统计学意义(P<0.05)。受试者工作特征曲线显示疾病类型、TBIL、BNP、左心室Tei指数、伴肝硬化、伴门静脉高压联合预测急性病毒性肝炎患者预后的曲线下面积为0.943,大于各指标单独预测(P<0.05)。结论急性病毒性肝炎患者心电图异常与疾病类型、TBIL、BNP、左心室Tei指数、伴肝硬化、伴门静脉高压相关,且相关因素对患者预后有一定预测价值。

淋巴细胞亚群和细胞因子检测在脓毒症并发MODS中的应用价值

目的分析淋巴细胞亚群和细胞因子检测在脓毒症并发多器官功能障碍综合征(MODS)中的应用价值。方法收集2022年1月至2023年6月中山大学附属第一医院符合《脓毒症与感染性休克的国际共识》中脓毒症诊断标准的脓毒症患者103例为研究对象,根据是否发生MODS分为MODS组(46例)与非MODS组(57例)。回顾性分析这两组患者的基线资料、淋巴细胞亚群、细胞因子和血清学指标,使用秩和检验比较两组患者淋巴细胞亚群、细胞因子与血清学指标水平,采用受试者工作特征曲线分析淋巴细胞亚群、细胞因子和血清学指标诊断脓毒症并发MODS的效能。结果MODS组CD3^(+)CD19^(-)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T淋巴细胞水平明显低于非MODS组,差异均有统计学意义(P<0.05)。MODS组白细胞介素(IL)-2、IL-6、IL-10、肿瘤坏死因子(TNF)-α水平明显高于非MODS组,差异均有统计学意义(P<0.05)。CD3^(+)CD19^(-)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T淋巴细胞诊断脓毒症并发MODS的曲线下面积(AUC)分别为0.899、0.711、0.676;IL-2、IL-6、IL-10、TNF-α诊断脓毒症患者MODS的AUC分别为0.637、0.797、0.761、0.650;PCT诊断脓毒症并发MODS的AUC为0.720。结论淋巴细胞亚群、细胞因子水平对诊断脓毒症并发MODS有一定价值,其中CD3^(+)CD19^(-)T淋巴细胞诊断灵敏度最高,IL-6诊断特异度最高。

烧伤后肠道功能保护及治疗研究进展

大面积严重烧伤可导致皮肤、皮下组织严重损伤,引发全身炎症反应综合征甚至多器官功能衰竭等。肠道功能障碍是严重烧伤后多器官功能衰竭的始动因素,烧伤后肠道功能保护对防治全身炎症反应综合征及多器官功能衰竭至关重要。目前,烧伤后肠道功能障碍的发病机制尚未完全明确,临床治疗方法也不完善。因此,本文对近年来大面积烧伤后肠道功能保护及治疗的研究进展进行了综述,以期为临床治疗提供理论依据。