Despite the continuous improvement in perioperative use of antibiotics and aseptic techniques, the incidence of infection continues to rise as the need for surgery increasing and brings great challenges to orthopedic surgery. The rough or porous structure of the prosthesis provides an excellent place for bacterial adhesion, proliferation and biofilm formation, which is the main cause of infection. Traditional antibiotic therapy and surgical debridement are difficult to determine whether the infected focus have been removed completely and whether the infection will recur. In recent years, nanotechnology has shown obvious advantages in biomaterials and drug delivery. Nano drug carriers can effectively achieve local antimicrobial therapy, prevent surgical infection by local sustained drug release or intelligent controlled drug release under specific stimuli, and reduce the toxic side effects of drugs. The unique advantages of nanotechnology provide new ideas and options for the prevention and treatment of periprosthetic infection. At present, the application of nano-technology in the prevention and treatment of infection can be divided into the addition of nano-drug-loaded materials to prosthesis materials, the construction of drug-loaded nano-coatings on the surface of prosthesis, the perfusable nano-antimicrobial drug carriers, and the stimulation-responsive drug controlled release system. This article reviews the methods of infection prevention and treatment in orthopaedic surgery, especially the research status of nanotechnology in the prevention and treatment of periprosthetic infection.
Objective
To systematically review the diagnostic value of Presepsin for sepsis.
Methods
Literatures were searched from PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, CBM, VIP, and WanFang database, and the time was from inception to June 2017, to collect diagnostic studies about Presepsin for sepsis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by QUADAS-2 tool. Then meta-analysis was performed by using RevMan 5.3 and Meta-Disc 1.4 software. Pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic curve (SROC) were calculated to assess the diagnostic value of individual diagnostic tests.
Results
A total of 23 studies with 2 925 sepsis patients and 1 852 controls were finally included. The results of meta-analysis showed that the pooled Sen, Spe, LR+, LR-, DOR, and AUC was 0.80 ［95% CI was (0.78, 0.81), P<0.000 1］, 0.83 ［95%CI was (0.81, 0. 84), P<0.000 1］, 4.78 ［95%CI was (3.62, 6.31), P<0.000 1］, 0.22 ［95%CI was (0.18, 0.27), P<0.000 1］, 23.64 ［95%CI was (16.00, 34.92), P<0.000 1］, and 0.91 ［95%CI was (0.89, 0.94), P<0.001］, respectively. Subgroup analysis showed that the pooled Sen, Spe, LR+, LR-, DOR, and AUC in Caucasian was 0.83 ［95% CI was (0.80, 0.86), P=0.000 1］, 0.79 ［95% CI was (0.76, 0.82), P<0.000 1］, 4.38 ［95%CI was (2.40, 8.02), P<0.000 1］, 0.23 ［95%CI was (0.16, 0.31), P=0.007 8］, 21.09 ［95% CI was (8.82, 50.41), P<0.000 1］, and 0.91 ［95%CI was (0.87, 0.92), P<0.001］ respectively, and in Asian was 0.79 ［95% CI was (0.77, 0.80), P<0.000 1］, 0.85 ［95%CI was (0.83, 0.87), P<0.000 1］,4.74 ［95%CI was (3.82, 5.89), P=0.011 1］, 0.22 ［95% CI was (0.17, 0.28), P<0.000 1］, 24.95 ［95%CI was (16.07, 38.74), P<0.000 1］, and 0.92 ［95%CI was (0.90, 0.95), P=0.001］ respectively, there was no significant difference between Caucasian and Asian in diagnostic accuracy of Presepsin (Z=0.41, P>0.05).
Conclusion
Current evidence indicates that Presepsin has great early diagnostic value for sepsis.
ObjectiveTo summarize the mechanism of hydrogen sulfide (H2S) in regulating autophagy and ameliorating multi-organ dysfunction in the treatment of sepsis.MethodThe relevant literatures at home and abroad in recent years were systematically searched and read to review the mechanism of H2S in regulating autophagy and ameliorating multi-organ dysfunction during sepsis.ResultsAs a new medical gas signal molecule, H2S could regulate autophagy by regulating multiple signal pathways such as Nrf2, NF-κB, MAPK, AMPK, etc., then ameliorated multi-organ dysfunction in sepsis.ConclusionH2S inhibits inflammation, oxidative stress, and apoptosis by regulating autophagy, thus ameliorating multi-organ dysfunction in sepsis, which is expected to become an effective therapeutic target for sepsis.
Sepsis-associated acute kidney injury (SAKI) is a common complication of patients in intensive care unit, and also an independent risk factor leading to high mortality of sepsis patients. SAKI leads to an extended hospital stay for patients, resulting in a huge medical burden. The pathogenesis of SAKI is complex, and systemic inflammatory response plays an important role in it. At present, blood adsorption is the main method for treating SAKI in intensive care units, but there is no consensus on the relevant treatment strategies. This article summarizes new perspectives and research conclusions on the application of blood adsorption technology in the treatment of SAKI, aiming to provide new references for the blood adsorption treatment strategies of SAKI.
ObjectiveTo investigate the regulation mechanism of neutrophils extracellular traps (NETs) on inflammatory diseases and to provide guidance for the treatment of related inflammatory diseases.MethodThe literatures about the relationship between NETs and inflammatory diseases were reviewed.ResultsNETs played an important role in sepsis, anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, which were related to the development or activity of the diseases. By regulating the formation of NETs pathway, reducing the production of NETs, we could ultimately reduce the inflammation of the disease.ConclusionNETs is involved in the course of sepsis, ANCA-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, but further investigation and clinical inflammatory verification are needed.
Objective To study the diagnostic and prognostic value of serum soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) and cyclooxygenase-2 (COX-2) in abdominal infection-caused sepsis. Methods A total of 170 patients with abdominal infection treated in the First Hospital of Qinhuangdao between January 2019 and March 2022 were retrospectively selected and divided into sepsis group (n=76) and non-sepsis group (n=94) according to whether they were combined with abdominal infection-caused sepsis. In addition, 80 healthy people in the same period were selected as the control group. The levels of serum sTREM-1 and COX-2 in the three groups were detected and the differences were compared. The laboratory indexes, including white blood cell count, high-sensitivity C-reactive protein, and procalcitonin of patients with abdominal infection-caused sepsis were detected. The Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation System Ⅱ and prognosis (survival or death) of patients with abdominal infection-caused sepsis were evaluated. The correlations of serum sTREM-1 and COX-2 with the severity of sepsis were analyzed, and the diagnostic and prognostic value of sTREM-1 and COX-2 in abdominal infection-caused sepsis was assessed. Results The levels of serum sTREM-1 and COX-2 in the sepsis group were higher than those in the control group and the non-sepsis group (P<0.05). The levels of serum sTREM-1 and COX-2 in the sepsis group were positively correlated with white blood cell count, high-sensitivity C-reactive protein, procalcitonin, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation System Ⅱ score (P<0.05). The serum levels of sTREM-1 and COX-2 of patients who died during hospitalization in the sepsis group were higher than those of the surviving patients. The areas under the receiver operating characteristic curves of the serum sTREM-1 and COX-2 levels for diagnosing sepsis caused by abdominal infection were 0.814 [95% confidence interval (CI) (0.746, 0.882), P<0.001] and 0.848 [95%CI (0.788, 0.905), P<0.001], respectively, with critical values of 1.879 pg/mL and 18.75 ng/mL, respectively, and those for predicting the prognosis of patients with sepsis caused by abdominal infection were 0.775 [95%CI (0.659, 0.890), P<0.001] and 0.784 [95%CI (0.679, 0.889), P<0.001], respectively, with critical values of 2.283 pg/mL and 23.02 ng/mL, respectively (P<0.05). Conclusion The serum levels of sTREM-1 and COX-2 have certain value in the diagnosis and prognosis prediction of abdominal infection-caused sepsis.
ObjectiveTo analyze the prognostic factors of patients with bacterial bloodstream infection sepsis and to identify independent risk factors related to death, so as to potentially develop one predictive model for clinical practice. Method A non-intervention retrospective study was carried out. The relative data of adult sepsis patients with positive bacterial blood culture (including central venous catheter tip culture) within 48 hours after admission were collected from the electronic medical database of the First Affiliated Hospital of Dalian Medical University from January 1, 2018 to December 31, 2019, including demographic characters, vital signs, laboratory data, etc. The patients were divided into a survival group and a death group according to in-hospital outcome. The risk factors were analyzed and the prediction model was established by means of multi-factor logistics regression. The discriminatory ability of the model was shown by area under the receiver operating characteristic curve (AUC). The visualization of the predictive model was drawn by nomogram and the model was also verified by internal validation methods with R language. Results A total of 1189 patients were retrieved, and 563 qualified patients were included in the study, including 398 in the survival group and 165 in the death group. Except gender and pathogen type, other indicators yielded statistical differences in single factor comparison between the survival group and the death group. Independent risk factors included in the logistic regression prediction model were: age [P=0.000, 95% confidence interval (CI) 0.949 - 0.982], heart rate (P=0.000, 95%CI 0.966 - 0.987), platelet count (P=0.009, 95%CI 1.001 - 1.006), fibrinogen (P=0.036, 95%CI 1.010 - 1.325), serum potassium ion (P=0.005, 95%CI 0.426 - 0.861), serum chloride ion (P=0.054, 95%CI 0.939 - 1.001), aspartate aminotransferase (P=0.03, 95%CI 0.996 - 1.000), serum globulin (P=0.025, 95%CI 1.006 - 1.086), and mean arterial pressure (P=0.250, 95%CI 0.995 - 1.021). The AUC of the prediction model was 0.779 (95%CI 0.737 - 0.821). The prediction efficiency of the total score of the model's nomogram was good in the 210 - 320 interval, and mean absolute error was 0.011, mean squared error was 0.00018. Conclusions The basic vital signs within 48 h admitting into hospital, as well those homeostasis disordering index indicated by coagulation, liver and renal dysfunction are highly correlated with the prognosis of septic patients with bacterial bloodstream infection. Early warning should be set in order to achieve early detection and rescue patients’ lives.
Objective To investigate the protective mechanism of ulinastatin（UTI） in pulmonary microvascular endothelial cells （PMVECs） attacked by serum from the patients with severe sepsis. Methods PMVECs were cultured in vitro and randomly divided into 4 groups，ie. a normal group （culture medium with 10% fetal bovine serum，group N），a health group （culture medium with 10% healthy human serum，group H），a patient group （culture medium with 10% human septic shock serum，group S），and a ulinastatin group （culture medium with 1000 U/mL UTI and 10% human septic shock serum，group U）. The proliferation activity of PMVECs was measured by MTT expressed by optical density （OD）. The concentration of TNF-α in supernatant of culture medium was examined by ELISA at 0，1，2，4，6 hours. The expression of NF-κB was examined by immunohistochemistry at 1 hour. Results Compared with group N，the cell proliferation activity of group S decreased significantly，and the cell proliferation activity of group U decreased slightly at each time poi nt. Compared with group N，the cell proliferation activity of group S and group U at 1，4，6 hours were significant different （Plt;0.05 ）. Compared with group S，the cell proliferation activity of group U at 1，2，6 hours increased significantly （Plt;0.05）. Obviously positive expression of NF-κB in PMVECs could be seen in group S，a little positive expression in group S，and no expression in group N and group H. Compared with group N，the TNF-α levels of group S and group U increased significantly at each time point with significant differences （Plt;0.01）. Compared with group S，the TNF-α levels were significantly reduced at each time point in group U （Plt;0.01）. Conclusions UTI can reduce the release of TNF-α by inhibiting NF-κB activation，thus reduce PMVECs injury attacked by serum from severe sepsis patients.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
Objective To investigate the effects of ulinastatin on Treg/Th17 and immune status in patients with severe sepsis.Methods A total of 80 patients with severe sepsis, who were hospitalized in ICU during October 2011 to July 2012, were randomly divided into a routine group and a ulinastatin group. The patients in the ulinastatin group were intravenously administered 30mg ulinastatin three times per day for 5 days in addition to routine bundle treatment. The expression of Treg, Th17 and HLA-DR were detected on the first day in ICU and 5 days after treatment. 20 healthy individuals served as controls. Results Compared with the control group, the severe sepsis group had overexpression of Treg and Th17 ( P lt;0. 01) , higher ratio of Treg/Th17( P lt;0. 01) , and decreased HLA-DR expression of CD14 monocyte ( P lt; 0. 01) . In the severe sepsis patients, ulinastatin injection reduced the abnormal expression of Treg and Th17 ( P lt; 0. 01) , decreased the ratio of Treg/Th17( P lt; 0. 01) , and improved the expression of HLA-DR ( P lt; 0. 01) more effectively compared with the routine treatment. Ulinastatin also lowered 28-day mortality of the patients with sepsis, but the difference between the ulinastatin group and the routine group was not significant. Conclusions In severe sepsis patients, there were abnormal overexpression of Treg and Th17, imbalance of Treg/Th17, and underexpression of HLA-DR which imply an immune suppression. Ulinastatin can decrease the expression of Treg and Th17, inverses the ratio of Treg/Th17, and improve the expression of HLA-DR, so as to improve the prognosis of severe sepsis patients.
