ABSTRACT
Capillary leak syndrome (CLS) is a clinical syndrome characterized by impairment of vascular endothelial barrier function, increased vascular permeability, and reversible systemic edema. It is one of the early fatal complications after hematopoietic stem cell transplantation. So far, the exact pathogenesis of CLS has not been elucidated, and the diagnostic criteria and treatment methods have not been unified. At present, it is believed that the fundamental cause of CLS is hypercytokinemia, and the core factor is high permeability of vascular endothelial cells. According to the clinical manifestations, the natural course of CLS can be divided into prodrome, leakage and recovery stages. As far as treatment is concerned, symptomatic and supportive treatment is dominant according to different characteristics of each stage. In this review, the pathogenesis, clinical manifestations, diagnosis and treatment of hematopoietic stem cell transplant-associated CLS were briefly summarized.
Subject(s)
Humans , Capillary Leak Syndrome/diagnosis , Endothelial Cells , Hematopoietic Stem Cell Transplantation/adverse effectsABSTRACT
Objective To discuss the measures to prevent adverse events caused by misused hyperosmolar drugs. Methods Clinical pharmacists were involved in the treatment of one case of skin necrosis caused by hyperosmolar arginine infu-sion,analyzing the cause of the adverse events and proposing solutions and preventative measures.Results Treatment includs external application of Epson salt,debridements,infection prevention and so on were implemented.All bruises were absorbed with good wound healing.Conclusion Clinical pharmacist should play a role in examining prescriptions and ensuring drug safe-ty for patients.
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Objective To investigate the influence of Ulinastatin (UTI) on the hyper-permeability of vascular endothelial cells induced by tumor necrosis factor alpha (TNF-α).Methods Inflammation model was induced by TNF-α in human umbilical vein endothelial cell line (EA.hy926).The experiment was designed into 4 groups:normal group,TNF-α group,UTI group and TNF-α with UTI (U + T) group.Methyl thiazolyl tetrazolium (MTT) method and epithelial voltameter (EVOM) method were used to measure cell viability [absorbance (A) value] and transepithelial electrical resistance (TER) of EA.hy926 cells respectively.The expression of VE-cadherin was measured by reverse transcription polymerase chain reaction (RT-PCR) and immunocytochemistry.Results Compared with normal group,the TER of EA.hy926 cells induced by TNF-α was significantly decreased (67.200 ± 8.937 vs.33.600 ± 8.771,P =0.010).The permeability in EA.hy926 cells increased obviously.The hyper-permeability of EA.hy926 cells induced by TNF-α could be alleviated by UTI at the concentrations of 1-100 U/mL in a dose-dependent manner (40.133 ±7.484 vs.33.600 ±8.771,P=0.382;49.232 ± 3.162 vs.33.600 ± 8.771,P =0.044;63.700 ± 8.515 vs.33.600 ± 8.771,P =0.013).The expression of VE-cadherin mRNA reduced significantly in the TNF-α group (1.089 ±0.018 vs.0.835±0.021,P =0.000) compared with normal group.This effect of TNF-α could be attenuated by UTI.When EA.hy926 cells exposed to UTI at 10 U/mL and 100 U/mL,a significant increase of the expression of VE-cadherin mRNA was observed (0.976 ±0.014 vs.0.835 ±0.021,P =0.001;1.115 ±0.015 vs.0.835 ± 0.021,P =0.000).And the inhibition of UTI manifested a dose-dependent manner (1-100 U/mL).The results of the immunocytochemistry showed that the expression of VE-cadherin in TNF-o group was decreased significantly (0.061 ± 0.013 vs.0.093 ± 0.014,P =0.049) compared with normal group.And the low-expression of VE-cadherin could be alleviated by UTI (0.032 ± 0.004 vs.0.061 ± 0.013,P =0.016).Conclusion The high permeability of EA.hy926 cells induced by TNF-α could be inhibited by UTI at the concentrations of 1-100 U/mL in a dose-dependent manner.
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Objective To compare the characteristic of high permeability dialysis(HPD) and conventional hemodialysis(CHD) and to study whether HPD was more effectively in elimination of the macromolecular, medium and small molecule urinary endotoxin in uremia than CHD.Method 48 cases of hemodialysis patients were randomly divided into two groups: HPD group(26 cases)given by high permeability dialysis, and CHD group(22 cases)given by conventional hemodialysis dialyzer. Two groups were observed prospectively for 2 years and renal function , electrolytes, ? 2 microglubulin, amino acid, protein concentration, endotoxin in blood serum were detected before and after hemodialysis respectively.Results The clearance rates of blood creatinine, blood urea nitrogen, uric acid , ? 2 microglubulin in HPD group were better than that of CHD group. Serum amino acid, endotoxin, serum phosphorum changes were no statistical significance after hemodialysis in two groups. Protein concentration after hemodialysis was higher than that before hemodialysis in two groups. Conclusions High permeability dialysis has all virtues of conventional hemodialysis dialysis and can clear macromolecular and medium molecule endotoxin, but conventional hemodialysis can not do.