ABSTRACT
BACKGROUND: Intestinal tract factors, especially intestinal ischemiareperfusion, can induce the injury of remote organ. Chinese herb, rhubarb,can clear oxygen free radical to promote the proliferation of beaker cell in intestinal mucous membrane, inhibit excessive multiplication of bacterium and endotoxin absorption in the intestinal tract, activate blood circulation and remove blood stasis, improve microcirculation and other ways to protect intestinal mucous membrane barrier, so as to prevent and treat pulmonary injury.OBJECTIVE: To observe the preventing and treating effect of rhubarb on intestinal ischemia/reperfusion-induced pulmonary injury and the effect of rhubarb on tumor necrosis factor and phospholipase A2 (PLA2).DESIGN: A randomized controlled observation.SETTING: Department of Emergency, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.MATERIALS: This experiment was carried out in the Second Military Medical University of Chinese PLA from February to July 2003. Totally 80SD rats were selected and randomly divided into intestinal ischemia/reperfusion group (n=24), sham operation group (n=46), treatment group (n=24) and normal saline group (n=16).METHODS: In the intestinal ischemia-reperfusion group, rats were fasted before operation. They were anesthetized and given a median abdominal incision. Superior mesenteric artery was isolated and occluded by vascular clamp without wound, and then the incision was sutured; 45 minutes later,vascular clamp was taken out to recover blood supply. For the treatment group, modeling was the same as that in the intestinal ischemia/reperfusion group, 600 mg/kg suspension of rhubarb extract was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the normal saline group, modeling was the same as that in the intestinal ischemia/reperfusion group; same dosage of normal saline was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the sham operation group, occlusion of superior mesenteric artery was omitted. Taking pathological change and 125I-labeled bovine serum albumin pulmonary uptake index as the index to evaluate pulmonary injury, TNF content and serum of pulmonary tissue and PLA2 activity of lung and intestinal tissue of animals in each group were measured respectively at different time points.MAIN OUTCOME MEASURES: 125I labeled bovine bovine serum albumin uptake index, tumor necrosis factor content of blood and pulmonary tissue, and PLA2 activity of serum, lung and intestinal tissue RESULTS: ① Pathological and morphological change of pulmonary tissue: There was no obvious abnormality in the sham operation group; In the intestinal ischemia-reperfusion group, 6 hours later, pulmonary interstitial edema, neutrophile infiltration appeared and alveolar edema was also found, and there were a little haemorrhage and exudation of fibrin. Only mild pulmonary interstitial edema and a small quantity of neutrophiles were found in the treatment group. ② Ultramicro-pathological change of pulmonary tissue: There was no obvious change in the sham operation group. In the intestinal ishcemia/reperfusion group, 6 hours later, pulmonary capillary endothelial cells were swelled and neutrophilic granulocyte leaked into pulmonary stroma and alveolar space. There were no above changes in the treatment group. ③ Change of tumor necrosis factor of pulmonary tissue in the sham operation group or treatment group (reperfusion for 30 minutes) was significantly lower than that in the intestinal ischemiareperfusion group (reperfusion for 30 minutes) (0.235±0.114,1.374±0.550,16.315±4.587,P ＜ 0.01). ④125I-BSA pulmonary uptake index in the treatment group was significantly lower than that in the intestinal ischemiareperfusion group and normal saline group (P ＜ 0.01), without significant difference in comparison with sham operation group (P ＞ 0.05).CONCLUSION: Early application of rhubarb is helpful to prevent and treat lung injury following small intestine ischemic reperfusion, so as to inhibit tissue disease course to deve1op multiple organ dysfunction syndrome,which might be implemented through inhibiting the release of TNF and PLA2 and other media.
ABSTRACT
OBJECTIVE To study the clinical characteristics,prevention and treatment of nosocomial fungemia.METHODS Fifty four consecutive patients with nosocomial fungemia were studied in clinical retrospective manner.RESULTS Sixty fungal strains were isolated from blood.Candida was the predominant pathogenic organism(86.7%),6 cases had mixed infection causing by two fungal species(11.1%).Twenty two cases had concomitant bacteremia(40.7%).Overall mortality rate was 68.5%,directly related mortality rate in treatment group was significantly lower than that in nontreatment one(28.9% vs.88.9%,χ2=11.268，P＜0.01).Effective rate of amphotericin B was 68.8%,fluconazole 70.8%,combined treatment 80.0%.CONCLUSIONS Fungal infection has become prominently fatal cause of critically ill patients.Removing predisposing factors,monitoring fungal pathogen and effective antifungal therapy are important measures to reduce the incidence and mortality of fungal infection.Fluconazole and amphotericin B are effective drugs of treating deep fungal infection.
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Objective: To investigate changes of the endothelin-1(ET-1) and its receptor (endothelin receptor subtype A, ET AR ) mRNA expression in some organs(kidney, lung and small intestinal mucous membrane) in the sepsis and septic shock rats. Methods: Twenty-four male rats randomized into sepsis group, septic shock group, control and normal group was infused with endotoxin(LPS) via indwelling right atria catheters except normal and control group. RT-PCR was used to detect kidney, lung and small intestinal mucous membrane tissue mRNA expression of the ET-1 , ET AR and glucose-6-phospho dehydrogenase(G-6-PD) in every group.Serum BUN, Cr, ALT and A were determined. The arterial oxygen tension (PaO 2) and arterial carbon dioxide partial pressure(PaCO 2)were measured in every group. Results: ET-1 mRNA and ET AR mRNA expression in the sepsis group and septic shock group were significantly higher than in normal group. There were significant differences between the normal/control group and sepsis/shock group in BUN,Cr,ALT,PaO 2 and PaCO 2. Conclusion: A higher expression of ET-1 mRNA and ET AR mRNA may be one of the startup factors on multiple organ dysfunction syndrome (MODS) and may play an important role on pathogenesis in sepsis and septic shock.
ABSTRACT
Objective To explore the effective mechanism of tumor necrosis factor-?(TNF-?) and interlukin-8(IL-8) in experimental lung damage by observing changes of TNF-? and IL-8 concentration in lung tissue during abdominal infection. Methods The cecal ligation and perforation were utilized to make the abdominal infection in rats.The rats were sacrificed respectively at 0,24,48,72,96 and 120 hours after operation. The pulmonary vascular permeability and the amount of different cells in bronchoalveolar lavage fluid(BALF) were examined. The concentrations of TNF-? and IL-8 in BALF, lung tissue and plasma were assayed. Results The pulmonary vascular permeability and the neutrophil percentage of BALF increased progressively. The concentrations of TNF-? and IL-8 significantly increased in plasma, lung tissue and BALF. Significant correlation was respectively present between the TNF-? levels and the IL-8 levels in lung and BALF. The levels of TNF-? and IL-8 in lung and BALF were not correlated respectively with those in plasma. Conclusions TNF-? and IL-8 may be implicated in the inflammatory reaction of lung during early stage of abdominal infection. Lung injury derived from intestinal infection could be early discovered through assaying TNF-? and IL-8 concentration in BALF.