Predictive value of systemic immunity index for sepsis in low-medium risk community-acquired pneumonia

Objective:To assess the predictive value of systemic immune inflammation index(SII)for sepsis in low-and medium-risk community-acquired pneumonia.Methods:A total of 589 elderly patients with low-and medium-risk community-acquired pneumonia admitted to the Emergency Department of the Second Affiliated Hospital of Hainan Medical University from January 2020 to January 2023 were included as the research subjects,and the general information and laboratory test results of the patients were collected,and the optimal cut-off value of continuous variables for predicting sepsis in elderly patients with low-and medium-risk community-acquired pneumonia was determined by plotting the receiver work characteristic(ROC)curve,which was converted into dichotomous variables and univariate and multivariate logistic Regression analysis of the influencing factors of sepsis in elderly patients with low-and medium-risk community-acquired pneumonia.Based on this,a nomogram model is constructed to predict the risk of sepsis.The differentiation,consistency and accuracy of the model were verified by calibration curve and subject operating characteristic(ROC)curve,and the clinical utility of the model was determined by decision curve analysis.Results:A total of 589 elderly patients with low-and intermediate-risk community-acquired pneumonia were included in this study,of which 96(16.30%)developed sepsis.There were significant differences in age,diabetes mellitus and chronic obstructive pulmonary disease,Lac,PCT,SII and other indexes between sepsis and non-sepsis groups(P<0.05).Logistics regression analysis showed that age,diabetes mellitus and chronic obstructive pulmonary disease,Lac,and SII were independent risk factors for sepsis in elderly patients with low-and medium-risk community-acquired pneumonia.The nomogram prediction model was used to verify the results,and the AUC was 0.826(95%CI:0.780-0.872),and the calibration curve tended to the ideal curve with good accuracy.The decision curve shows that when the threshold of the model is between 0.10~0.78,the model has the advantage of clinical benefit.Conclusion:The nomogram prediction model constructed based on SII to predict sepsis in elderly patients with low-and medium-risk community-acquired pneumonia has good accuracy,which can predict the occurrence of sepsis early,help early identification of high-risk groups and timely intervention,and thus improve the prognosis of patients.

Proteomic analysis of the effects of accumulated heat in the gastrointestinal tract on lipopolysaccharide-induced pneumonia in mice

Objective:To examine the effects of accumulated heat in GI tract (AHGIT) on lung tissue protein expression in pneumonic mice.Methods:Nebulized lipopolysaccharides (LPS) were administered to induce a pneumonic mouse model (M1),and a high-calorie/protein diet combined with nebulized LPS was used to induce AHGIT pneumonia (M2).Isobaric tag for relative and absolute quantitation (iTRAQ)proteomics was applied to study lung protein expression,followed by bioinformatics analysis.Results:M1 mice developed alveolar damage with prominent septum thickening,vascular dilation,hyperaemia and infiltration of large amounts of inflammatory cells.M2 mice developed more severe pathological responses.A total of 2626 proteins were reliably identified in the lung tissue.Compared with normal mice,the M1 mice had 344 differentially expressed proteins in their lungs,which are involved in the following biological processes:response to organic substance,response to cytokine,response to external stimulus,defense response and immune system process.They are also involved in the following Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways:ECM-receptor interaction,leukocyte transendothelial migration,Fc gamma R-mediated phagocytosis,complement and coagulation cascades,and antigen processing and presentation.Compared with the M1 group,the M2 mice had 164 differentially expressed proteins in their lungs,including 14 upregulated and 150 downregulated proteins.These proteins are involved in the following biological processes:small molecule metabolism,ribose phosphate metabolic process,cell adhesion and biological adhesion.The relevant KEGG pathways included oxidative phosphorylation,Citrate cycle (TCA cycle),complement and coagulation cascades,and vascular smooth muscle contraction.Conclusions:AHGIT aggravated the lung inflammatory damage in the mice with LPS-induced pneumonia.It may affect the mouse substance/energy metabolism,and therefore the immune function,to aggravate the LPS-induced inflammatory damage.

Radiation-induced Oral Mucositis is a Critical Dilemma for Patients and Physicians During Radiotherapy for Nasopharyngeal Carcinoma

The combination of radiotherapy(RT)and chemotherapy is associated with a high cure rate but an increased risk of radiation-induced oral mucositis(RIOM)in patients with nasopharyngeal carcinoma(NPC).As a dose-limiting complication,RIOM remains a critical dilemma for patients and physicians,potentially leading to radiation interruptions and compromised tumor control.In this review,we discuss and analyze the pathological mechanisms and factors affecting prevention/treatment of RIOM.RT may induce RIOM via a positive feedback loop,consequently amplifying superoxide production,the immunoinflammatory response,dysbacteriosis,infection,and epithelial basal cell death.Routine interventions for RIOM focus on oral care,oral-pain relief,nutritional support,and infection control;however,recent novel and effective methods have been proposed according to the pathological mechanisms and influencing factors.Some patients with low-recurrence-risk NPCs may be treated with reduced-dose RT,reduced-dose chemotherapy,or RT alone(without chemotherapy)to prevent severe RIOM.Furthermore,traditional herbal medicine extracts,such as Kangfuxin and honey,may help to control RIOM.In addition to the routine application of antibiotics to treat oral dysbacteriosis and hormones to suppress immune inflammatory responses,edaravone and GC4419 can also be used to scavenge oxygen free radicals and reduce superoxide ions to protect the oral mucosa and limit the occurrence of RIOM.