Anti-Inflammatory Therapy with High Dose Insulin in Brain Dead Organ Donors
Notice bibliographique
Résumé
Introduction: Brain death is a major stress on the body that is associated with a massive inflammatory response. Severe inflammation can lead to increased graft immunogenicity and increased risk of graft dysfunction. In addition, to the maintenance of normoglycaemia Insulin therapy has expressed anti-inflammatory effects in clinical and experimental studies. The objective is determining if high dose insulin therapy can suppress inflammation and maintain normoglycaemia in brain dead donors. Methods: Pilot study with an open-label prospective-controlled design. Fifteen brain dead organ donors were recruited including 6 study donors and 9 control donors. Insulin therapy was delivered to the study donors using the hyperinsulinemic normoglycaemic clamp (HNC) and was maintained for a minimum of 6 hours and continued till organ retrieval. The anti-inflammatory effect was measured by the change in the cytokine levels in the plasma of these donors. Categorical and continuous variables were expressed as summary statistics (n, median, mean, range, standard deviation) for all donors in both groups. Fisher's exact and Wilcoxon test were performed to assess differences between the groups and a p-value < 0.1 was considered significant. Results: There was no significant difference in donor characteristics between the 2 groups. CVA was the most common cause of brain death (60%). The study group had normal glucose levels (median 4.8 mmol/L) compared to the control group (median 9.0 mmol/L) (p< 0.001). There were no periods of severe hypoglycemia (glucose < 2.5 mmol/l). The levels of several pro-inflammatory mediators including; IL-6, TGF-α and MCP-1 were significantly decreased after 6 hours of treatment compared to their baseline values in the study group (p=0.03), (p=0.03) and (p=0.09), respectively. We observed an opposite trend in circulating levels of the anti-inflammatory factor IL-10 in the study group. The levels of inflammatory markers did not demonstrate a significant change after 6 hours compared to their baseline values in the control group. Conclusion: High dose insulin therapy in the form of HNC was successful in the maintenance of normoglycaemia in brain dead organ donors, without severe hypoglycaemia. Furthermore, the therapy had anti-inflammatory effects on donors, as expressed by decreased the levels of several pro-inflammatory cytokines in the study group.Table: [General demographics and characteristics of donors]Table: [change of cytokine levels at ST1 (after 6hrs)]
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».