calca-protein--human and Reperfusion-Injury

The origin of the inflammatory peptide procalcitonin (PCT) is still unknown. In the present study PCT concentrations in arterial and hepatic-venous blood were examined in patients undergoing elective partial liver resection (LR) using a fiberoptic pulmonary arterial catheter placed in a liver vein to obtain further information on the origin of PCT.. In 28 patients (21 male/7 female; average age of 58.8+/-8.8 years) undergoing LR, arterial and hepatic venous PCT concentrations were measured during 24 h perioperatively. The parallel blood withdrawals occurred immediately before the Pringle maneuver (Hx), 2 min, 1, 2, 6, 12, and 24 h after Hx. Over the whole period, the oxygen saturation in hepatic venous blood (ShvO2) was monitored. PCT concentrations were assayed by immunoluminometry.. We observed a significant increase in PCT concentration already 6 h after Hx compared to the values before Hx. Twenty-four hours after Hx we found the highest plasma concentrations. It was conspicuous that hepatic venous PCT concentrations were always higher than the arterial ones (significantly from the 6th hour after Hx). There was no correlation between the courses of ShvO2 and PCT rise. A significant correlation was verified between Hx duration and PCT concentration measured 24 h after Hx both in the hepatic venous and arterial blood.. The results of our investigation can be interpreted as evidence that liver (or the hepatosplanchnicus?) is a source of PCT. The mechanism of PCT induction cannot be clarified by our study: whether the induction of PCT was caused by an endotoxin translocation during the impeded splanchnic outflow or by the direct surgery-induced lesion (hypoxia) of the liver remains unclear. However, the latter appears more probable because of the observed correlation between Hx duration and PCT concentration rise.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Catheterization; Female; Hepatic Veins; Humans; Liver; Male; Middle Aged; Oxygen; Postoperative Period; Protein Precursors; Reperfusion Injury; Splanchnic Circulation

This study aims to investigate the effect of lung ischemia reperfusion injury（LIRI） on expression of transient receptor potential vanilloid 1（TRPV1） in the lung and brainstem of rats. Sixteen adult male Sprague Dawley rats weighing 250-320 g were randomly divided into Sham group and ischemia reperfusion group（IR group）. Before ischemia,0.5 hour and 4 hours after the reperfusion, respectively, arterial partial pressure of oxygen（PaO2） and arterial-alveolar oxygen pressure gradient（A-a DO2） were recorded and calculated, respectively. Left lung tissues and the brainstems were obtained at the end of the experiment. Lung tissue malondialdehyde（MDA）, myeloperoxidase（MPO） activities, calcitonin gene related peptide（CGRP） and substance P（SP） levels were assessed. The m RNA and protein expressions of TRPV1 in the lung and brainstem were measured by q RT-PCR and Western blot. Compared with in the Sham group, rats in the IR group had a poorer blood gas exchange（P<0.05） and the MPO activity and MDA level of lung tissues in the IR group were significantly higher than those in the Sham group（P<0.05）. CGRP level in the IR group increased remarkably（P<0.05）,while SP level did not differ statistically between the two groups（P>0.05）. The m RNA and protein expressions of TRPV1 in the lung tissue were upregulated in the IR group（P<0.05）, but there were no differences of those in the brainstem between the two groups（P>0.05）. The results suggest that LIRI could upregulate the expressions of TRPV1 and evoke CGRP release in the lung.

Topics: Animals; Blotting, Western; Brain Stem; Calcitonin Gene-Related Peptide; Capsaicin; Lung; Male; Rats; Rats, Sprague-Dawley; Reperfusion Injury; TRPV Cation Channels

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Coma; Female; Heart Arrest; Humans; Hypothermia, Induced; Hypoxia; Male; Protein Precursors; Reperfusion Injury

To investigate serial serum concentrations of procalcitonin (PCT) and C-reactive protein (CRP) in patients treated with mild hypothermia after cardiac arrest, and to study their association to severe infections, post cardiac arrest syndrome (PCAS) and long-term outcome.. Serum samples from cardiac arrest patients treated with mild hypothermia were collected serially at admission, 2, 6, 12, 24, 36, 48 and 72 h after cardiac arrest. PCT and CRP concentrations were determined and tested for association with three definitions of infection, two surrogate markers of PCAS (circulation-SOFA and time to return of spontaneous circulation (ROSC)) and cerebral performance category (CPC) at six months.. Eighty-four patients were included. PCT displayed an earlier release pattern than CRP with a significant increase within 2h, increasing further at 6h and onwards in patients with poor outcome. CRP increased later and continued to rise during the study period. PCT was strongly associated with circulation-SOFA and time to ROSC, and predicted a poor neurologic outcome with high accuracy (area under the receiver operating characteristic curve of 0.88, 0.86 and 0.87 at 12, 24 and 48 h respectively). No association of PCT or CRP to infection was observed.. Our results suggest that PCT is released early after resuscitation following cardiac arrest, is associated with markers of PCAS but not with infection, and is an accurate predictor of poor outcome. Validation of these findings in larger studies is warranted.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Arrest; Humans; Hypothermia, Induced; Male; Middle Aged; Prospective Studies; Protein Precursors; Reperfusion Injury; Severity of Illness Index; Sweden; Treatment Outcome

The hepatic ischemia-reperfusion syndrome was investigated in 28 patients undergoing elective partial liver resection with intraoperative occlusion of hepatic inflow (Pringle maneuver) using the technique of liver vein catheterization. Hepatic venous oxygen saturation (ShvO2) was monitored continuously up to 24 hours after surgery. Aspartate aminotransferase, glutamate dehydrogenase, gamma-glutamyl transpeptidase, pseudocholinesterase, alpha-glutathione S-transferase, reduced and oxidized glutathione, procalcitonine, and interleukin-6 were serially measured both before and after Pringle maneuver during the resection and postoperatively in arterial and/or hepatic venous blood. ShvO2 measurement demonstrated that peri- and postoperative management was suitable to maintain an optimal hepatic oxygen supply. As expected, we were able to demonstrate a typical enzyme pattern of postischemic liver injury. There was a distinct decrease of reduced glutathione levels both in arterial and hepatic venous plasma after LR accompanied by a strong increase in oxidized glutathione concentration during the phase of reperfusion. We observed increases in procalcitonin and interleukin-6 levels both in arterial and hepatic venous blood after declamping. Our data support the view that liver resection in man under conditions of inflow occlusion resulted in ischemic lesion of the liver (loss of glutathione synthesizing capacity with disturbance of protection against oxidative stress) and an additional impairment during reperfusion (liberation of reactive oxygen species, local and systemic inflammation reaction with cytokine production). Additionally, we found some evidence for the assumption that the liver has an export function for reduced glutathione into plasma in man.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Female; Glutathione Disulfide; Hepatectomy; Humans; Interleukin-6; Liver; Male; Middle Aged; Oxygen; Protein Precursors; Regional Blood Flow; Reperfusion Injury

Neopterin is elevated in infections, autoimmune diseases and post-transplant. Recently neopterin elevation was linked to stress response and malignancy. To determine early changes of serum neopterin caused by surgical stress and to investigate their association with other inflammatory markers and with malignancy, we measured neopterin, C-reactive protein (CRP) and procalcitonin (PCT) levels at four predefined time-points within 24 hours in 27 patients admitted for liver resection. Our results show that neopterin increased during operation and the increase was not related to preoperative neopterin levels. On the first day after surgery neopterin level was not significantly different from postoperative levels. In patients with malignant disease neopterin concentration before operation was higher than in patients with non-malignant disease, however, the increase in neopterin concentration during operation was not different between both patient groups. During surgery CRP and PCT did not increase significantly. On the first postoperative day CRP and PCT were elevated and their levels correlated with neopterin (Pearson's correlation coefficient r=0.51 and r=0.76, respectively). We conclude that neopterin elevation during liver resection contributes major part to the increased levels observed on the first postoperative day. Perioperative neopterin release can/may be related to stress response and hypoxia produced during operation. Using this marker, hypoxic reperfusion damage could be detected earlier and more accurately.

Topics: Adolescent; Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Hypoxia; Liver; Liver Neoplasms; Male; Middle Aged; Neopterin; Prospective Studies; Protein Precursors; Reperfusion Injury; Surgical Procedures, Operative