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ObjectiveTo investigate the risk factors of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) complicated with Yangming Fushi syndrome.Methods A prospective study was conducted. From August 2009 to July 2013, 206 patients with Yangming Fushi syndrome combined with ALI/ARDS were enrolled in the intensive care units ( ICUs ) of the following five hospitals: Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy ( CRRT ), amount of blood transfusion, the level of C-reactive protein ( CRP ), lactulose/mannitol ( L/M ) ratio, the number of organs with dysfunction, oxygenation index ( PaO2/FiO2 ), levels of lactate and serum creatinine ( SCr ) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients. Results There were 124 cases with severe acute pancreatitis ( SAP ), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU, 171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age ( years: 57.26±16.23 vs. 48.07±13.48, t = 3.544, P = 0.000 ), APACHE Ⅱ score ( 20.83±9.73 vs. 12.61±6.63, t = 4.777, P = 0.000 ), the length of invasive mechanical ventilation ( days: 10.97±7.71 vs. 6.91±2.48, t = 2.555, P = 0.015 ) and the number of dysfunction organs ( 3.11±1.21 vs. 1.60±1.34, t = 6.222, P = 0.000 ) in death group were significantly higher. The level of PaO2/FiO2 [ mmHg ( 1 mmHg = 0.133 kPa ): 218.56±64.90 vs. 244.58±85.10, t = -2.024, P = 0.044 ] in the death group was significantly lower than that of the survival group, while the length of ICU stay ( days: 14.33±10.81 vs. 9.11±7.37, t = 2.600, P = 0.010 ), the usage rates of CRRT [ 28.57% ( 10/35 ) vs. 15.20% ( 26/171 ), χ2 = 3.968, P = 0.046 ], vasoactive agents [ 28.57% ( 10/35 ) vs. 12.28% ( 21/171 ), χ2 = 6.511, P = 0.011 ], and blood transfusion ratio [ 42.86% ( 15/35 ) vs. 23.39% ( 40/171 ), χ2 = 7.042, P = 0.008 ] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups ( all P > 0.05 ). Multivariate logistic regression analysis showed that age [ odds ratio ( OR ) = 0.938, 95% confidence interval ( 95%CI ) = 0.898-0.980, P = 0.004 ], APACHE Ⅱ score ( OR = 0.914, 95%CI = 0.839-0.996, P = 0.041 ), the number of dysfunction organs ≥ 3 ( OR = 0.223, 95%CI = 0.066-0.754, P = 0.016 ), and the level of PaO2/FiO2 ( OR = 0.990, 95%CI = 0.982-0.998, P = 0.015 ) were independent risk factors for mortality. Conclusions The age, APACHE Ⅱ score, number of dysfunction organs ≥ 3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.
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Objective To evaluate the relationship between the intestinal motility alterations and intercellular adhesion molecule-1 ( ICAM-1 ) expression within the rat intestinal muscularis after ischemia reperfusion. Methods Thirty Wistar rats were divided randomly into IIR, monoclanal anti-ICAM-1 and sham group (n = 10), HR models were established by clamping-releasing the superior mesenteric artery. Gut transit was measured in vivo and intestinal circular muscle contractions were measured in an organ bath. The expression of ICAM-1 mRNA was detected by RT-PCR and immunohistochemisty. Leukocyte infiltration and myeloperoxidase (MPO) activity were quantified in sham and ischemia/reperfusion rats with and without monoclonal anti-ICAM-1 antibody treatment. Results The gut transit of monoclonal anti-ICAM-1 group was improved obviously as compared with IIR group. Circular smooth muscle contractility stimulated by ICAM-1 mRNA expression was 1.69 ± 0. 57 and 1.76 ± 0. 32 within the muscularis; Leukocyte infiltration into the muscularis was (5.6 ±2. 2) c/f and ( 18. 2 ±3. 1 ) c/f. MPO activity was (2. 03 ±0. 56) U/g and (6. 41 ± 1.25 ) U/g respectively. The differences were all statistically significant between IIR and treatment groups ( P ＜ 0. 05 ). The expression of ICAM-1 protein in IIR and anti-ICAM-1 groups was not significantly different (P ＞ 0. 05). Conclusions The up-regulated expression of ICAM-1 after ⅡR injury calls forth local infiltration of PMN within the intestinal muscularis, leading to intestinal motility dysfunction.
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Objective To investigate the influence of astragalus polysaccharide administration on the the expression of pancreatic Kir6.2 in diabetes rats.Methods Wistar rats were induced diabetes mellitus,then divided into model group,control group,low dose group,and high dose group randomly.After OGTT of them were observed,determination of the Kir6.2 mRNA and protein expression levels in pancreas was performed by RT-PCR and Western blotting.Results The expression of Kir6.2 in model group decreased significantly,and the expressions of Kir6.2 in low dose and hish dose groups were higher than the model group (P<0.05).Conclusion Astragalus polysaccharide displayed up-regulation to the expression of pancreatic Kir6.2.which may be a mechanism on reducing blood glucose.
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Objective To observe the expression of pancreatic K_(ATP) channels (Kir6.2/SUR1) in rats with chronic pancreatitis and explore the intervention of nateglinide on the changes.Methods Wistar rats were induced to suffer from chronic pancreatitis and then randomized into model group, nateglinide group and control group.Then OGTT of them were observed.RT-PCR was used to detect the expression of Kir6.2 and SUR1 mRNA, and western blot to detect the expression of Kir6.2 and SUR1 proteins.Results Model rats displayed impaired glucose tolerance (IGT).The expression of Kir6.2 and SUR1 in model group decreased significantly(P＜0.05), and nateglinide displayed up-reg-ulation to the expression in some degree.Conclusion The expression of pancreatic K_(ATP) channels in rats with chronic pancreatitis diminished, which might be the important mechanism of the development of pancreatogenic diabetes.Nateglinide can up-regulate the expression in some degree, which indicates that it may have latent effect of ameliorating the prognosis of patients with chronic pancreatitis.
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Objective To investigate the effect of Xinhuang Pian on pancreatic apoptosis and the protein expression of Bcl-2 and c-Myc in rat with acute pancreatitis (AP). Methods 90 Wister rats were randomly divided into 3 groups, including control group, AP group and Xinhuang Pian treatment (XP) group.AP model was induced by pancreaticobiliary injection of 5% sodium taurocholate (1ml/kg weight). Rats in XP group were given Xinhuang Pian solution (480 mg/kg weight) lavage 30min after AP induction, The rats were sacrificed at 6, 12, 24 h after AP induction, and serum amylase levels were determed, pancreatic pathological change was observed; apoptosis was determined by TUNEL method. The determination of Bcl-2and c-Myc protein expression was performed by Western blot. Results 12 h after AP induction, serum amylase, pancreatic pathological scores, apoptotic indexes and the protein expression of Bcl-2 and c-Myc were (1927 ± 186) U/L, 0, 0.59 ± 0. 12, 0.406 ± 0. 112, 0. 185 ± 0. 046 in control group; (5611 ± 473) U/L,2.65 ± 0. 56, 3.80 ± 0. 91, 0. 282 ± 0.082, 0. 339 ± 0. 076 in AP group; and (4572 ± 400) U/L, 2.40 ± 0. 75,7.15 ± 0. 86, 0. 220 ± 0.068, 0. 302 ± 0. 090 in XP group. The levels of serum amylase, pancreatic pathological scores, apoptotic indexes and the protein expression of c-myc in AP and XP group were all significantly higher than those in control group (P < 0. 05), while the protein expression of Bcl-2 was significanfiy lower than that in control group ( P < 0.05 ). Compared with AP group, the levels of serum amylase, pancreatic pathological scores, protein expression of Bcl-2 were all significanfiy lower in XP group (P < 0. 05 ), but the apoptotic indexe was significantly higher (P < 0. 05 ), and there was no significat change of expression of c-Myc protein.Conclusions Xinhuang Pian may induce the pancreatic apoptosis through down-regulating Bcl-2 protein expression, and result in the alleviation of pancreatic inflammatory reaction.
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Objective To investigate the effects of Ulinastatin(UTI)on the function of splenic lymphocytes from rats with severe acute pancreatitis(SAP).Method Twenty-eight Wister rats(clean grade)were randomly divided into control,sham operation,SAP,and ulinastatin group.No operation was performed in control group.And rats with sham-operation received laparotomy and catheterization into choledocho-pancreatic duct without injection of sodium deoxycholic.Rats in ulinastatin group received ulinastatin injection(50000 U/kg)via tail vein 30 minutes after pancreatitis induced with DCA injected into pancreatic duct.Rats ofother groups were given equal volume of saline.At 2,4 hours after operation,all animals were killed by neck dislocation,and splenocytes were isolated and cultured in RPMI 1640 medium containing 10%fetal calf serum.Proliferation of splenecytes was determined with MIT cellular proliferation assay.Levels of Th1 cytokines(IL-2,IFN-γ)and Th2 cytokine(IL-10)in supematants of splenoeytesweremeasured by ELISA.Quantitative data were expressed as mean±SE.Statistical analyses were performed by Student's t test with SPSS software(version 10.0 for Windows).A P value less than 0.05 Was considered statistically significant. Results The concentration of IL-2, IL-10 and IFN-γ and proliferative activity of splenocytes in SAP group were significantly lower than that in sham operation group.In contrast,the proliferative as well as the eytokine-releasing capacities of the solenecms from rats treated with UTI were significantly increased compared with those from rats with SAP.Conclusions The deficiencies in proliferation and cytokine release in response to antigen stimulation inaplys an anergic state of splenocytes during SAP.Treatment with UTI contributed to the recovery of the immune function by improving proliferative responses and cytokine release of splenocytes.