Following the publication of the article, the authors noted that there were certain errors in Fig. 5. In particular, the published Fig. 5A-a contains an image of H&E-stained micrographs from wild-type mice after the administration of a low dose of rhH-MGB1, and not after the administration of a high dose of rhH-MGB1, as should be shown. In addition, the data in the published graph of Fig. 5C-a is not correct and in Fig. 5C-b, the significance marker is merged with the error bars and is not evident. Shown below is the new version of Fig. 5 with the correct images: Figure 5. Response of Toll-like receptor 4 (TLR4)-deficient mice to recombinant human high-mobility group box 1 (rhHMGB1) administration. (A) Pancreatic histopathological changes in wild-type (WT) and TLR4-deficient mice 48 h after the administration of a high dose of rhHMGB1. Representative H&E-stained micrographs (original magnification, x200) from the (a) WT and (b) TLR4 -/-groups. The pancreatic tissues in the wild-type group exhibited marked edema, infiltration of inflammatory cells, a mass of necrotic acinar cells and the disappearance of the normal lobe structure in the pancreas; there was a significant reduction in the TLR4-deficient group. (B-a) Histological scores of the pancreas and (b) serum amylase and lipase changes in the WT and TLR4 -/-groups. (C) The activation of nuclear factor-κB (NF-κB) was assessed from the nuclear p65 [(a) western blot analysis] and its downstream, relative levels of tumor necrosis factor-α (TNF-α) and interleukin-1β [(b) ELISA] in the pancreatic tissue from the WT and TLR4 -/-groups. * P<0.01 compared to the WT group. The relative levels of nuclear p65 protein compared to the control group are normalized to histone 3 (H3). The relative levels of TNF-α and IL-1β compared to the control group are normalized to the total protein concentration of each sample. Data are expressed as the means ± SD (n=6/group). Blots shown are from a representative experiment that was repeated 3 times with similar results (n=6/group). WT, WT mice given a high dose of rhHMGB1; TLR4 -/-, TLR4-deficient mice administered a high dose of rhHMGB1.
Background Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery. Methods This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 μg/kg/h until the RASS remained between − 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments. Results We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665–0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672–0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS. Conclusions Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period. Trial registration ChiCTR, ChiCTR1800014314. Registered 5 January 2018, http://www.chictr.org.cn/index.aspx
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