Management of Sepsis

University of British Columbia, Critical Care Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
New England Journal of Medicine (Impact Factor: 54.42). 11/2006; 355(16):1699-713. DOI: 10.1056/NEJMra043632
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    ABSTRACT: Toona sinensis (TS) leaves are used as a vegetable and in traditional Chinese medicine. However, in vivo experiments regarding the anti-inflammatory function of TS leaves have not previously been conducted. The aim of this study was to investigate the potential role of TS leaf extract (TSL) in the prevention of sepsis-induced lung injury in vivo and on macrophage activation in vitro. The results showed that oral gavage pretreatment with TSL in rats for 30 days improved the survival of cecal ligation and puncture-induced sepsis, potentially by attenuating sepsis-induced histological lung damage rather than inflammatory cell infiltration. Furthermore, we demonstrated that pretreatment with TSL attenuated the lipopolysaccharide (LPS)-induced expression of inducible nitric oxide synthase, thereby inhibiting nitric oxide production and release in murine macrophage-like RAW 264.7 cells. Interestingly, TSL did not affect the LPS-induced release of other cytokines (e.g., tumor necrosis factor α and interleukin 1β) but increased LPS-induced heme-oxygenase-1 expression. In conclusion, the study provides preliminary data for TSL on cecal ligation and puncture-induced sepsis. The beneficial impact of TSL needs extensive study to get solid evidence.
    The Kaohsiung journal of medical sciences 06/2014; 30(6). DOI:10.1016/j.kjms.2014.02.013 · 0.81 Impact Factor
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    ABSTRACT: Sepsis syndrome is characterized by a systemic inflammatory response to infection potentially leading to acute organ failure and rapid decline to death. Polyclonal intravenous immune globulin, a blood product derived from human donor blood, in addition to antiinfective activities, also exerts a broad antiinflammatory and immunomodulating effect. Intravenous immunoglobulin (IVIg) has been proposed as adjuvant therapy for sepsis even though the clinical studies demonstrating their efficacy and safety are relatively small. Several systematic reviews and meta-analyses of intravenous immunoglobulin treatment in sepsis have been performed. As a result of heterogeneity across studies and inconsistencies in results, the majority have concluded that more evidence, coming from large, well-conducted randomized controlled trials (RCTs), is required. Moreover the appropriate timing of administration and the identification of specific clinical settings represent a key factor to maximizing their beneficial effect. The authors, in this revision, review the basic mechanisms of action of IVIg, the rationale for their use, and their clinical applications.
    European Journal of Internal Medicine 05/2014; 25(6). DOI:10.1016/j.ejim.2014.05.002 · 2.30 Impact Factor
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    ABSTRACT: Exposure to ionizing radiation alone (radiation injury, RI) or combined with traumatic tissue injury (radiation combined injury, CI) is a crucial life-threatening factor in nuclear and radiological accidents. As demonstrated in animal models, CI results in greater mortality than RI. In our laboratory, we found that B6D2F1/J female mice exposed to (60)Co- γ -photon radiation followed by 15% total-body-surface-area skin burns experienced an increment of 18% higher mortality over a 30-day observation period compared to irradiation alone; that was accompanied by severe cytopenia, thrombopenia, erythropenia, and anemia. At the 30th day after injury, neutrophils, lymphocytes, and platelets still remained very low in surviving RI and CI mice. In contrast, their RBC, hemoglobin, and hematocrit were similar to basal levels. Comparing CI and RI mice, only RI induced splenomegaly. Both RI and CI resulted in bone marrow cell depletion. It was observed that only the RI mice treated with pegylated G-CSF after RI resulted in 100% survival over the 30-day period, and pegylated G-CSF mitigated RI-induced body-weight loss and depletion of WBC and platelets. Peg-G-CSF treatment sustained RBC balance, hemoglobin levels, and hematocrits and inhibited splenomegaly after RI. The results suggest that pegylated G-CSF effectively sustained animal survival by mitigating radiation-induced cytopenia, thrombopenia, erythropenia, and anemia.
    Oxidative Medicine and Cellular Longevity 03/2014; 2014:481392. DOI:10.1155/2014/481392 · 3.36 Impact Factor


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