Effects of Early-stage Phased Rehabilitation Training on Acute Respiratory Distress Syndrome:A Systematic Review and Meta-analysis

[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilator-associated pneumonia,pressure ulcers,delirium)in ARDS patients,thus contributing evidence for the clinical application of early-stage phased rehabilitation training.[Methods]The China National Knowledge Infrastructure(CNKI),Wanfang,and other databases were searched.Literature screening,data extraction,and systematic analysis of the included studies were performed using Revman software.[Results]Thirteen randomized controlled trials involving a total of 860 patients were included in this review.The results of the meta-analysis showed that compared to the traditional rehabilitation training group,the early-stage phased rehabilitation training group demonstrated a significant increase in the oxygenation index of ARDS patients[SMD=1.18,95%CI(1.01,1.35),P<0.01],with statistically significant differences.Furthermore,there were significant reductions in ICU length of stay[SMD=-0.70,95%CI(-0.90,-0.50),P<0.01],duration of mechanical ventilation[SMD=-1.15,95%CI(-1.36,-0.94),P<0.01],and occurrence of complications[OR=0.16,95%CI(0.10,0.26),P<0.01],all of which were statistically significant.[Conclusions]Early-stage phased pulmonary rehabilitation training for ARDS patients effectively improves the oxygenation index,shortens ICU length of stay and duration of mechanical ventilation,and reduces complications.These findings support the clinical application and promotion of early-stage phased rehabilitation training.

Acute phase reaction and acute phase proteins

A review of the systemic acute phase reaction with major cytokines involved, and the hepatic metabolic changes, negative and positive acute phase proteins (APPs) with function and associated pathology is given. It appears that APPs represent appropriate analytes for assessment of animal health. Whereas they represent non-specific markers as biological effect reactants, they can be used for assessing nutritional deficits and reactive processes, especially when positive and negative acute phase variables are combined in an index. When such acute phase index is applied to separate healthy animals from animals with some disease, much better results are obtained than with single analytes and statistically acceptable results for culling individual animals may be reached. Unfortunately at present no cheap, comprehensive and easy to use system is available for assessing various acute phase proteins in serum or blood samples at the same time. Protein microarray or fluid phase microchip technology may satisfy this need; and permit simultaneous analysis of numerous analytes in the same small volume sample and enable integration of information derived from systemic reactivity and nutrition with disease specific variables. Applying such technology may help to solve health problems in various countries not only in animal husbandry but also in human populations.

Time-effect relationship of acupuncture on histopathology, ultrastructure, and neuroethology in the acute phase of cerebral hemorrhage

Many clinical studies have addressed the treatment of acute cerebral hemorrhage using acupuncture. However, few studies have examined the relationship between time of acupuncture and curative effect on cerebral hemorrhage. By observing the effect of acupuncture on changes in histopathology, ultrastructure, and neuroethology in a cerebral hemorrhage model of rats, we have directly examined the time-effect relationship of acupuncture. The rat model of cerebral hemorrhage was produced by slowly injecting autologous blood to the right caudate nucleus. The experimental groups were: 3-, 9-, 24-, and 48-hour model groups; and 3-, 9-, 24-, and 48-hour acupuncture groups. The sham-operation group was used for comparison. Acupuncture was performed at the Neiguan(PC6) and Renzhong(DU26) acupoints, twice a day, 6 hours apart, for 5 consecutive days. Brain tissue changes were observed by light microscopy and transmission electron microscopy. Neuroethology was assessed using Bederson and Longa scores. Our results show that compared with the sham-operation and model groups, Bederson and Longa scores were lower in each acupuncture group, with visibly improved histopathology and brain tissue ultrastructure. Further, the results were better in the 3-and 9-hour acupuncture groups than the 24-and 48-hour acupuncture groups. Our findings show that acupuncture treatment can relieve pathological and ultrastructural deterioration and neurological impairment caused by the acute phase of cerebral hemorrhage, and may protect brain tissue during this period. In addition, earlier acupuncture intervention following cerebral hemorrhage(by 3 or 9 hours) is associated with a better treatment outcome.

Non-coding RNAs and other determinants of neuroinflammation and endothelial dysfunction:regulation of gene expression in the acute phase of ischemic stroke and possible therapeutic applications

Ischemic stroke occurs under a variety of clinical conditions and has different pathogeneses,resulting in necrosis of brain parenchyma.Stroke pathogenesis is characterized by neuroinflammation and endothelial dysfunction.Some of the main processes triggered in the early stages of ischemic damage are the rapid activation of resident inflammatory cells(microglia,astrocytes and endothelial cells),inflammatory cytokines,and translocation of intercellular nuclear factors.Inflammation in stroke includes all the processes mentioned above,and it consists of either protective or detrimental effects concerning the“polarization”of these processes.This polarization comes out from the interaction of all the molecular pathways that regulate genome expression:the epigenetic factors.In recent years,new regulation mechanisms have been cleared,and these include non-coding RNAs,adenosine receptors,and the activity of mesenchymal stem/stromal cells and microglia.We reviewed how long non-coding RNA and microRNA have emerged as an essential mediator of some neurological diseases.We also clarified that their roles in cerebral ischemic injury may provide novel targets for the treatment of ischemic stroke.To date,we do not have adequate tools to control pathophysiological processes associated with stroke.Our goal is to review the role of non-coding RNAs and innate immune cells(such as microglia and mesenchymal stem/stromal cells)and the possible therapeutic effects of their modulation in patients with acute ischemic stroke.A better understanding of the mechanisms that influence the“polarization”of the inflammatory response after the acute event seems to be the way to change the natural history of the disease.

Effects of glutamine supplementation on gut barrier,glutathione content and acute phase response in malnourished rats during inflammatory shock

AIM: To evaluate the effect of glutamine on intestinal mucosa integrity,glutathione stores and acute phase response in protein-depleted rats during an inflammatory shock. METHODS: Plasma acute phase proteins (APP),jejunal APP mRNA levels,liver and jejunal glutathione concentrations were measured before and one,three and seven days after turpentine injection in 4 groups of control,protein-restricted,protein-restricted rats supplemented with glutamine or protein powder. Bacterial translocation in mesenteric lymph nodes and intestinal morphology were also assessed. RESULTS: Protein deprivation and turpentine injection significantly reduced jejunal villus height,and crypt depths. Mucosal glutathione concentration significantly decreased in protein-restricted rats. Before turpentine oil,glutamine supplementation restored villus heights and glutathione concentration (3.24 ± 1.05 vs 1.72 ± 0.46 μmol/g tissue,P < 0.05) in the jejunum,whereas in the liver glutathione remained low. Glutamine markedly increased jejunal α1-acid glycoprotein mRNA level after turpentine oil but did not affect its plasma concentration. Bacterial translocation in protein-restricted rats was not prevented by glutamine or protein powder supplementation. CONCLUSION: Glutamine restored gut glutathione stores and villus heights in malnourished rats but had no preventive effect on bacterial translocation in our model.

Connective tissue growth factor reacts as an IL-6/STAT3-regulated hepatic negative acute phase protein

AIM:To investigate the mechanisms involved in a possible modulator role of interleukin(IL) -6 signalling on CYR61-CTGF-NOV(CCN) 2/connective tissue growth factor(CTGF) expression in hepatocytes(PC) and to look for a relation between serum concentrations of these two parameters in patients with acute inflammation. METHODS:Expression of CCN2/CTGF,p-STAT3,p-Smad 3/1 and p-Smad2 was examined in primary freshly isolated rat or cryo-preserved human PC exposed to various stimuli by Western blotting,electrophoretic mobility shift assay(EMSA) ,reporter-gene-assays and reversetranscriptase polymerase chain reaction. RESULTS:IL-6 strongly down-regulated CCN2/CTGF protein and mRNA expression in PC,enhanceable by extracellular presence of the soluble IL-6 receptor gp80,and supported by an inverse relation between IL-6 and CCN2/CTGF concentrations in patients'sera.The inhi-bition of TGFβ1 driven CCN2/CTGF expression by IL-6 did not involve a modulation of Smad2(and Smad1/3) signalling.However,the STAT3 SH2 domain binding peptide,a selective inhibitor of STAT3 DNA binding activity,counteracted the inhibitory effect of IL-6 on CCN2/CTGF expression much more pronounced than pyrrolidine-dithiocarbamate,an inhibitor primarily of STAT3 phosphorylation.An EMSA confirmed STAT3 binding to the proposed proximal STAT binding site in the CCN2/CTGF promoter. CONCLUSION:CCN2/CTGF is identified as a hepatocellular negative acute phase protein which is downregulated by IL-6 via the STAT3 pathway through interaction on the DNA binding level.

Microheterogeneity of acute phase proteins in patients with uIterative colitis

AIM： TO estimate the serum α1-antichymotrypsin （ACT）, α1-acid glycoprotein （AGP） and transferrin （Tf） concentrations and to evaluate the microheterogeneity of these acute phase proteins in patients with ulcerative colitis. METHODS： Twenty-seven patients with ulcerative colitis （UC） and 17 healthy control subjects were studied. The patients were categorised as severe （n = 9）, moderate （n = 10） and mild groups （n = 8） using Truelove and Witts＇ classification of ulcerative colitis. Microheterogeneity of ACT, AGP and Tf was analysed by crossed immunoaffinity electrophoresis （CIAE） with concanavalin A. In all serum samples standard electrophoresis of serum proteins was performed, iron （Fe） concentration, total iron binding capacity （TIBC） and C-reactive protein （CRP） were also measured. RESULTS： Our patients suffering from ulcerative colitis had significantly higher serum ACT and AGP concentrations and lower serum transferrin concentration in comparison to healthy subjects. Changes in concentrations of acute phase proteins were dependent on the activity of the inflammatory process. The glycosylation patterns of transferrin were related to the inflammation status. We also observed the correlation between ACT and AGP concentrations, patterns of transferrin glycosylation and changes in standard protein electrophoresis or blood cell count. CONCLUSION： The glycosylation patterns of transferrin obtained from patients suffering from ulcerative colitis are highly branched and sialylated compared with those obtained from healthy subjects. In contrast, the glycosylation patterns of transferrin do not differ according to the activity index of ulcerative colitis. The microheterogeneity patterns of AGP and ACT are similar in ulcerative colitis patients and healthy subjects.

Impact of Introducing Endovascular Treatment on Acute Phase of Subarachnoid Haemorrhage Outcome

Introduction: Ruptured intracranial aneurysm is an urgent diagnostic and therapeutic condition. Occlusion with coils is the first line treatment for ruptured aneurysms and also should be used to prevent re-rupture, potentially causing severe brain damage. Most aneurysms are subject to this type of treatment. The risk of intraoperative thromboembolic and haemorrhagic complications during treatment with coils is very low. Endovascular treatment with coils is therefore a safe and effective method that can prevent short and long-term haemorrhage. Short and long-term haemorrhage is achieved by early recanalization of cases with neuro-visualisation. Methods: In this article we present a retrospective analysis of the results of endovascular embolization of 137 patients, from 2017 to the present time, in three hospitals of Georgia country (Evex hospitals, New hospitals, New-vision University Hospital) with a diagnosis of acute subarachnoid haemorrhage. Results: In our study, overall postoperative mortality was reported to be 29.9% (41/137 patients). In 45 patients presenting with Hunt-Hess IV-V, the mortality rate was 51.1% (23/45). According to Raymond-Roy Scale, complete occlusion of aneurysm occurs in 66% of cases, residual occlusion of neck in 26%, and partial occlusion in 6%. Conclusion: Aneurysm rupture is an urgent clinical condition requiring rapid diagnosis and treatment. To prevent aneurysm re-rupture, operative intervention should be performed quickly. The recommended time interval is within 72 hours, and, if possible, within 24 hours after aneurysm rupture. Given the spasms typical of subarachnoid haemorraghe endovascular coiling of ruptured aneurysms is a first-line treatment that depends on the angioarchitecture and localization of the aneurysm. The main technique of endovascular treatment is occlusion by coils with or without remodeling balloon assistance. Generally, in acute periods, only aneurysms with coils are associated with relatively high rates of recanalization, so further observation and possible surgical treatment are recommended.

Anti-CD163-dexamethasone conjugate inhibits the acute phase response to lipopolysaccharide in rats

AIM: To study the effect of a new anti-CD163-dexamethasone conjugate targeting activated macrophages on the hepatic acute phase response in rats. METHODS: Wistar rats were injected intravenous with either the CD163 targeted dexamethasone-conjugate(0.02 mg/kg) or free dexamethasone(0.02 or 1 mg/kg) 24 h prior to lipopolysaccharide(LPS)(2.5 mg/kg intraperitoneal). We measured plasma concentrations of tumour necrosis factor-a(TNF-a) and interleukin 6(IL-6) 2 h post-LPS and liver m RNAs and serum concentrations of the rat acute phase protein a-2-macroglobulin(a-2-M) 24 h after LPS. Also, plasma concentrations of alanine aminotransferase and bilirubin were measured at termination of the study. Spleen weight served as an indicator of systemic steroid effects.RESULTS: The conjugate halved the a-2-M liver m RNA(3.3 ± 0.6 vs 6.8 ± 1.1, P < 0.01) and serum protein(201 ± 48 μg/mL vs 389 ± 67 μg/mL, P = 0.04) after LPS compared to low dose dexamethasone treated animals, while none of the free dexamethasone doses had an effect on liver m RNA or serum levels of a-2-M. Also, the conjugate reduced TNF-a(7208 ± 1977 pg/mL vs 21583 ± 7117 pg/mL, P = 0.03) and IL-6(15685 ± 3779 pg/mL vs 25715 ± 4036 pg/mL, P = 0.03) compared to the low dose dexamethasone. The high dose dexamethasone dose decreased the spleen weight(421 ± 11 mg vs 465 ± 12 mg, P < 0.05) compared to controls, an effect not seen in any other group.CONCLUSION: Low-dose anti-CD163-dexamethasone conjugate effectively decreased the hepatic acute phase response to LPS. This indicates an anti-inflammatory potential of the conjugate in vivo.

Diagnostic usefulness of selected proteases and acute phase factors in patients with colorectal adenocarcinoma

BACKGROUND Uncontrolled growth and loss of control over basic metabolic functions,leading to invasive proliferation and metastases,are the salient traits of malignant tumors in general and colorectal cancer in particular.Invasion and metastases hinder effective tumor treatment.While surgical techniques and radiotherapy can be used to remove tumor focus,only chemotherapy can eliminate dispersed neoplastic cells.However,the efficacy of the latter method is limited in the advanced stages of the disease.Therefore,recognition of the mechanisms involved in neoplastic cell spreading is indispensable for developing effective therapies.AIM To use a number of biomarkers involved in cancer progression and identify a panel that could be used for effective early diagnosis.METHODS We recruited 185 patients with colorectal adenocarcinoma(98 men,87 women with median age 63).Thirty-five healthy controls were sex and age-matched.Dukes’staging was as follows:A=22,B=52,C=72,D=39.We analyzed patients'blood serum before surgery.We determined:(1)Cathepsin B(CB)with Barrett's method(fluorogenic substrate);(2)Leukocytic elastase(LE)in a complex with alpha 1 trypsin inhibitor(AAT)using the immunoenzymatic MERCK test;(3)Total sialic acid(TSA)with the colorimetric periodate-resorcinol method;(4)Lipid-bound sialic acid(LASA)with the colorimetric Taut's method;and(5)The antitrypsin activity(ATA)employing the colorimetric test.RESULTS In patients,the values of the five biochemical parameters were as follows:CB=16.1±8.8 mU/L,LE=875±598μg/L,TSA=99±31 mg%,LASA=0.68±0.33 mg%,and ATA=3211±1504 U/mL.Except for LASA,they were significantly greater than those of controls:CB=11.4±6.5 mU/L,LE=379±187μg/L,TSA=71.4±15.1 mg%,LASA=0.69±0.28 mg%,and ATA=2016±690 U/mL.For CB and LASA,the differences between the four Dukes’stages and controls were not statistically significant.The inter-stage differences for CB and LASA were also absent.The receiver operating characteristic(ROC)analysis revealed the potential diagnostic value of CB,TSA,and ATA.The area under ROC,sensitivity,and specificity for these three parameters were:0.85,72%,90%;0.75,66%,77%;and 0.77,63%,84%,respectively.The sensitivity and specificity for the threeparameter panel CB-TSA-ATA were equal to 88.2%and 100%,respectively.CONCLUSION The increased value of CB,TSA,and ATA parameters are associated with tumor biology,invasion,and metastasis of colorectal cancer.The presented evidence suggests the potential value of the CB-TSA-ATA biochemical marker panel in early diagnostics.

A survey of biochemical and acute phase proteins changes in sheep experimentally infected with Anaplasma ovis

Objective: To determine the biochemical and acute phase proteins changes in sheep experimentally infected with Anaplasma ovis(A. ovis). Methods: One Iranian sheep naturally infected with A. ovis(parasitemia 0.02%) but with no other blood parasites based on blood smear and polymerase chain reaction methods was selected as donor, and it was splenectomized to induce high level of parasitemia. Then, three weeks after splenectomy when parasitemia was 6%, donor's blood was intravenously administered to each recipient animal. Five 5-6 months old Iranian male sheep without any blood parasites were selected as recipient animals. The percent of parasites, packed cell volume, serum biochemical parameters(urea, creatinine, bilirubin, aspartate aminotransferase activity, cholesterol, total protein, albumin, globulin, Fe), acute phase proteins(haptoglobin, total iron binding capacity, fibrinogen), were evaluated in sheep before and after being experimentally infected with A. ovis(until day 38). In addition, body weights of sheep were measured on days 0, 20 and 38. Results: In recipient sheep, microscopic examination of erythrocytes revealed a significant rise of parasitemia on days 12 and 15. The lowest level of packed cell volume in sheep was seen on day 15 post infection. A significant rise existed in mean urea and bilirubin(total, direct and indirect) on days 15 and 20. The increase of indirect bilirubin level was higher than direct bilirubin. Furthermore, serum Fe significantly increased on days 20 and 23. The mean total protein concentration significantly increased on day 38. A significant increase was found in the serum globulin concentration from days 20 and 27 to 38. Maximum values of haptoglobin were observed on days 27 and 30. Moreover, aspartate aminotransferase activity(from days 20-30) and cholesterol concentration(on day 20) significantly decreased. However, no significant changes were found in other parameters. Conclusions: Experimental ovine anaplasmosis caused by A. ovis could be associated with some changes in measured parameters, which presumably could be helpful for evaluation on staging of disease.

LPS Regulates Apolipoprotein E and A<i>β</i>Interactionswith Effects on Acute Phase Proteins and Amyloidosis

Interactions between apolipoprotein E (apo E) and amyloid beta (Aβ) are associated with the peripheral clearance of Aβ and are important to the development of neurodegenerative diseases. Interests in acute phase proteins (APP) as biomarkers for the early progression of Alzheimer’s disease indicate that the peripheral Aβ metabolism is perturbed and the role of nutritional diets are important to reduce APPs to maintain peripheral Aβ clearance with relevance to hepatic cholesterol homeostasis and brain amyloidosis. The role of nutriproteomic diets that reverse the effects of high fat diets are associated with the reduction in APPs, cholesterol homeostasis and improved clearance of Aβ. Nutritional diets that reduce the increase in plasma endotoxins (gut microbiotica) such as lipopolysaccarides (LPS) reduce the effects of LPS on cell membranes and increase the cellular uptake of Aβ by interactions with apo E. LPS alter hepatic lipid metabolism with an increase hepatic cytokines and APPs in plasma. Interactions between apo E and Aβ are altered by LPS with increased binding of LPS to apo E with effects on electrostatic alterations in Aβ oligomers. The role of LPS in neurodegenerative diseases includes the effects of LPS on alpha-synuclein metabolism with relevance to Parkinson’s disease and Alzheimer’s

Differences in Acute Phase Reactants between Gout and Pseudogout

Objectives: To define clinical differences in the acute phase response and serum acute phase reactants between gout, pseudogout and crystal-induced arthritis in the presence of non-articular infections (CAI). Patients and Methods: Eleven patients with definite gout, 12 patients with pseudogout and 5 patients with CIA were included in the study. Results: The erythrocyte sedimentation rate (ESR) was significantly different between gout (68.2 ± 49.9 mm/Hr) and CIA (113.8 ± 37.2 mm/Hr) but not between gout and pseudogout (83.9 ± 45.6 mm/Hr) or between pseudogout and CIA. The C-reactive protein (CRP) was significantly increased between gout (10.1 ± 7.9 mg/dL) and pseudogout (18.9 ± 9.8 mg/dL), gout and CIA (36.5 ± 12.4 mg/dL) as well as between pseudogout and CIA. The peripheral white cell count was significantly different between gout (9.27 ± 3.7 k/μL) and CIA (16.5 ± 6.8 k/μL), and between pseudogout (8.9 ± 3.2 k/μL) and CIA. Conclusions: Measurement of ESR and CRP are helpful in crystal-induced arthritis. The CRP has more discriminating utility than the ESR in distinguishing between gout, pseudogout and CIA. Peripheral wbc is most useful for differentiating crystal-induced arthritis from CIA.

Comparative evaluation of acute phase proteins by C-reactive protein(CRP)and serum amyloid A(SAA)in nonhuman primates and feline carnivores

The feasibility of a commercially available assay for C-reactive protein(CRP,CRP for humans:hCRP,and CRP for dogs:vCRP)and a trial reagent of serum amyloid A(SAA,vSAA for animals)were applied to the measurement of acute phase proteins in zoo animals,particularly in nonhuman primates and feline carnivores was evaluate.Results showed that hCRP and vSAA methods were applicable to measure CRP and SAA in Haplorhini.There was a highly signifcant correlation between both parameters with remarkably high correlation coefcient.A higher proportion of Bonnet macaques in Haplorhini,and the linear regression with good correlation between hCRP and vSAA levels were observed.Reference values in healthy Bonnet macaques were hCRP(46.86±30.97 nmol/L)and vSAA(9.06±1.95μg/mL).Although Ring-tailed lemur,which belonging to Strepsirrhini,showed low vSAA concentrations(reference values:1.08±0.47μg/mL),vSAA in patients was apparently elevated.The vCRP and vSAA methods were applicable to measurements of CRP and SAA in feline carnivores for highly signifcant correlation between both parameters.Theses two methods were also been deteded in lions,tigers and cheetahs.vSAA assays can be applied to measure SAA levels in other carnivores and herbivores.In conclusion,vSAA systems have potential utility as diagnostic tools for health screening and prediction in zoo animals.

Surgery in the Acute Phase of Infective Endocarditis: 5 Years after Our Initial Experience

Aim: Comparing the results of acute phase infectious endocarditis surgery between two periods. Methods and Results: The study is about 2 series, series A between 1993 and 1997, and series B between 1998 and 2012, respectively 13 and 51 patients. The two periods were similar concerning the number of patients per year, which was 3.12 cases/year for series A and 3.64 cases/year for series B. The authors noted a change in epidemiological profile, with an increase of median age (31 y.o for series A and 37 y.o for series B), and the emergency of endocarditis on prosthetic valve (none on series A and 8 cases for series B). Surgical indications and results didn’t change too much, hospital mortality rate was 15.3% for series A and 17.6% for series B. Conclusion: Infectious endocarditis is still a major public healthcare problem in developing countries, despite the development of diagnostic tools and patient care. Prevention is still the major asset in the treatment of this disease.

Control Experimental Study on the Application of Acupuncture Therapy to the Treatment of Peripheral Facial Neuritis in Acute Phase and Its Nursing

Objective： This study aimed to prove acupuncture therapy exerted an obvious clinical efficacy in the treatment of peripheral facial neuritis in acute phase. Methods： 60 clinically collected cases were chosen in the study and randomly divided into control group and treatment group. In control group, dexamethasone, vitamin B, vitamin B 12, and mecobalamine were applied in acute phase, and then acupuncture therapy was combined in remission. In treatment group, western medicine combining with acupuncture therapy was used in acute phase, and three courses of treatment were totally applied. Results： The final conditions of two groups were good, and the grouping was balanced, so the comparability between them was good （P〉0.05）; the curative effects of two groups were significantly different： the effect of treatment group was better than that of control group （P〈0.01）. Conclusion： The acute phase was necessarily grasped to apply acupuncture therapy to the treatment of peripheral facial neuritis, and the curative effect would be more significant if acupuncture therapy was more early used.

Acute Phase Response of Rabbit to HgCl_2 and CdCl_2

A variety of changes occur in the rabbit under metal stress which include the appearance of the acute phase protein, C-reactive protein in the serum and significant reduction in the serum litres of albumin and acetylcholinesterase. The phospholipid profile is positively correlated with the higher degree of tissue necrosis encountered in mercury treated rabbit. Cadmium and mercury treatments evoke a similar response pattern in rabbit differing only in the degree of change.

Effects of montelukast sodium combined with pidotimod on acute phase protein and immune function in children with acute bronchitis

Objective: To observe the effects of montelukast sodium combined with pidotimod on acute phase protein (APP) and indexes of immunologic function in pediatric acute bronchitis treatment. Methods: A total of 180 cases children with acute bronchitis acted as research objects were randomly divided into control group (n=65) and observation group (n=63). On the basis of conventional therapy, control group was treated by plus pidotimod. On this base, observation group was treated with montelukast sodium. The changes of acute phase proteins (CRP, HP, a1-AAG and CER) and immune function (CD3+, CD4+, CD8+ and CD4+/CD8+) levels before and after treatment were observed after 2 months. Results: Before treatment, CRP, HP, a1-AAG, CER, CD3+, CD4+, CD8+ and CD4+/CD8+ levels of two groups had no statistically significant difference;CRP, HP, a1-AAG, CER, and CD8+ levels of control and observation groups decreased significantly after treatment, the decreases of observation group were more obvious than that of control group, and the levels after treatment were significantly lower than that of control groups. The levels of CD3+, CD4+ and CD4+/CD8+ in two groups after treatment were significantly higher than those before treatment. For observation group, the levels of CD3+, CD4+ and CD4+/CD8+ increased more significantly after treatment, which were significantly higher than that of the control group. Conclusion: Using Montelukast sodium combined with pidotimod can effectively reduce the children's acute phase protein levels, improve immune function, which has clinical value for the treatment of children with acute bronchitis.

Effects of glucocorticoid combined with antibiotics on serum infection indexes, acute phase proteins and stress hormones in patients with severe pneumonia

Objective: To study the effects of glucocorticoid combined with antibiotics on serum infection indexes, acute phase proteins and stress hormones in patients with severe pneumonia. Methods: a total of 80 patients with severe pneumonia who were hospitalized between August 2014 and January 2017 were retrospectively analyzed and divided into the routine treatment group (n=46) who received conventional antibiotic therapy and the combined treatment group (n=34) who received glucocorticoid combined with antibiotic therapy, and the differences in infection indexes, acute proteins and stress hormones were compared between the two groups of patients before and after treatment. Results: The differences in serum levels of infection indexes, acute phase proteins and stress hormones were not statistically significant between the two groups before treatment. After 1 week of treatment, serum infection indexes CRP and PCT levels of observation group were lower than those of control group;serum acute phase proteins α1-AT, α1-AG and CER levels were lower than those of control group;serum stress hormones Cor, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion:Glucocorticoid combined with antibiotics can effectively inhibit systemic infection and stress and optimize the illness in patients with severe pneumonia.

Estimation of Cytokines Involved in Acute-Phase Wound Infection with Reference to Residence Time of Patients in Hospitals

Background: Cytokines have a major role in mediating immunity as well as inflammation. The main proinflammatory cytokines are activated after injury and implicated in healing interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). High levels of IL-6 are recorded at initial inflammatory response and start decreasing down to eight day of wounding while TNF-α level remained static and IL-1α levels showed a different pattern of change following injury and consequence of infection. Methodology: This study was conducted in Al-Kindy and Al-Wasity hospitals in Baghdad on 200 patients suffering from wounds. One hundred patients were with acute wounds infection and the other 100 patients wounded but without infection and considered as control. Interleukin-1α (IL-1α), interleukin-TNF-α (TNF-α) and interleukin-6 (IL-60) were determined utilizing ELISA kit sandwich methods (Elabscience, USA). Results: The present study revealed that the values of IL-1α, and TNF-α at 48 hours of hospitalization were 23.547 and 27.177 pg/ml among patients with infected wounds respectively, and 7.05 and 28.127 pg/ml among patients without wound infections respectively. While IL-6 showed a highest level at 96 hours of residence in hospital and the value was 183.43 pg/ml for patients with infected wounds, and the value of the same interleukin was 88.696 pg/ml at 72 hours of residence of patients without wound infections. Conclusions: Interleukin-1α elevated after 24 hr of infection and then decreased. Proinflammatory cytokines (IL-6) was detectable within 24 hr of infection. The highest concentration of IL-6 was seen with mixed bacteria and followed by gram negative bacteria and this probably due to lipopolysaccharide secretion caused an increase of IL-6 in blood circulation. Irregular changes were seen in TNF-α values with durations of patients stay in hospitals.