Impact of delayed veno-venous extracorporeal membrane oxygenation weaning on postoperative rehabilitation of lung transplantation: a single-center comparative study.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a reliable and effective extracorporeal life support during lung transplantation (LTx). However, the clinical benefit of delayed VV-ECMO weaning remains unclear. The current study aims to investigate whether delayed weaning of VV-ECMO is more beneficial to the rehabilitation for lung transplant patients. Patients who underwent LTx with VV-ECMO between January 2017 and January 2019 were included. Enrollment of patients was suitable for weaning off ECMO immediately after surgery. Randomization was performed in the operating room. Postoperative outcomes were compared between the two groups. Besides, univariate and multivariable logistic regressions were performed to estimate risk of postoperative complications. Compared to VV-ECMO weaning immediately after LTx, delayed weaning was associated with shorter hospital length of stay (days, 31 vs. 46; P < 0.05), lower incidence of noninvasive ventilation (4.3% vs. 24.4%; P < 0.05), primary graft dysfunction (PGD) (6.4% vs. 29.3%; P < 0.05), atrial fibrillation (AF) (4.3% vs. 22%, P < 0.05), and respiratory failure (4.3% vs. 19.5%; P < 0.05). Multivariable logistic regressions revealed that VV-ECMO weaning after LTx was independently correlated with increased risk of developing PGD [odds ratio (OR), 5.97, 95% CI 1.16-30.74], AF (OR, 6.87, 95% CI 1.66-28.47) and respiratory failure (OR, 6.02, 95% CI 1.12-32.49) by comparison of delayed VV-ECMO weaning. Patients with delayed VV-ECMO weaning are associated with lower complications and short hospital length of stay, while it relates to longer mechanical ventilation. These findings suggest that delayed VV-ECMO after LTx can facilitate rehabilitation.

Is compromised intestinal barrier integrity responsible for the poor prognosis in critically ill patients with pre-existing hyperglycemia?

BACKGROUND: Compromised intestinal barrier integrity can be independently driven by hyperglycemia, and both hyperglycemia and intestinal barrier injury are associated with poor prognosis in critical illness. This study investigated the intestinal barrier biomarkers in critically ill patients, to explore the role of compromised intestinal barrier integrity on the prognosis of critically ill patients with pre-existing hyperglycemia. METHODS: This was a retrospective observational study. The relationships between intestinal barrier biomarkers and glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), indicators of clinical characteristics, disease severity, and prognosis in critically ill patients were investigated. Then the metrics mentioned above were compared between survivors and non-survivors, the risk factors of 90-day mortality were investigated by logistic regression analysis. Further, patients were divided into HbA1c < 6.5% Group and HbA1c ≥ 6.5% Group, metrics mentioned above were compared between these two groups. RESULTS: A total of 109 patients with critical illness were included in the study. D-lactate and lipopolysaccharide (LPS) were associated with sequential organ failure assessment (SOFA) score and 90-day mortality. LPS was an independent risk factor of 90-day mortality. DAO, NEU (neutrophil) proportion, temperature, lactate were lower in HbA1c ≥ 6.5% Group while D-lactate, LPS, indicators of disease severity and prognosis showed no statistical difference between HbA1c < 6.5% Group and HbA1c ≥ 6.5% Group. CONCLUSIONS: Intestinal barrier integrity is associated with the disease severity and prognosis in critical illness. Compromised intestinal barrier integrity might be responsible for the poor prognosis in critically ill patients with pre-existing hyperglycemia.

Anti-Hyperglycemic Agents in the Adjuvant Treatment of Sepsis: Improving Intestinal Barrier Function.

Intestinal barrier injury and hyperglycemia are common in patients with sepsis. Bacteria translocation and systemic inflammatory response caused by intestinal barrier injury play a significant role in sepsis occurrence and deterioration, while hyperglycemia is linked to adverse outcomes in sepsis. Previous studies have shown that hyperglycemia is an independent risk factor for intestinal barrier injury. Concurrently, increasing evidence has indicated that some anti-hyperglycemic agents not only improve intestinal barrier function but are also beneficial in managing sepsis-induced organ dysfunction. Therefore, we assume that these agents can block or reduce the severity of sepsis by improving intestinal barrier function. Accordingly, we explicated the connection between sepsis, intestinal barrier, and hyperglycemia, overviewed the evidence on improving intestinal barrier function and alleviating sepsis-induced organ dysfunction by anti-hyperglycemic agents (eg, metformin, peroxisome proliferators activated receptor-γ agonists, berberine, and curcumin), and summarized some common characteristics of these agents to provide a new perspective in the adjuvant treatment of sepsis.

Photothermolysis Mediated by Gold Nanorods Conjugated with Epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Induces Apoptosis via the Mitochondrial Apoptosis Pathway in Laryngeal Squamous Cell Cancer.

Gold nanorods (AuNRs) have unique optical properties and biological affinity and can be used to treat tumors when conjugated with other protein molecules. Our previous studies have shown that EGFR monoclonal antibody (EGFRmAb)-modified AuNRs exert strong antitumor activity in vitro by inducing apoptosis. In this study, we tested the effects of EGFRmAb-modified AuNRs on laryngeal squamous cell cancer (LSCC) in vitro and in vivo. The in vitro results showed that EGFRmAb-modified AuNRs inhibited NP-69, BEAS-2B and Hep-2 cell growth and induced mitochondria-dependent apoptosis. The mitochondrial membrane potential was reduced, leading to the release of cytochrome C (Cyt C) and consequent activation of the intrinsic mitochondrial apoptosis pathway. Moreover, we observed that the occurrence of mitochondrial apoptosis is related to the destruction of the lysosome-mitochondria axis. To verify the effects in vivo, we also established a laryngeal tumor model in nude mice by subcutaneous transplantation. In model mice treated with EGFRmAb-modified AuNRs and irradiated with an NIR laser, tumor cell apoptosis and tumor growth were inhibited. These results suggest that EGFRmAb-modified AuNRs induced apoptosis through the intrinsic mitochondrial apoptotic pathway and are a potential candidate for cancer therapy.

Pathways involved in pony body size development.

BACKGROUND: The mechanism of body growth in mammals is poorly understood. Here, we investigated the regulatory networks involved in body growth through transcriptomic analysis of pituitary and epiphyseal tissues of smaller sized Debao ponies and Mongolian horses at the juvenile and adult stages. RESULTS: We found that growth hormone receptor (GHR) was expressed at low levels in long bones, although growth hormone (GH) was highly expressed in Debao ponies compared with Mongolian horses. Moreover, significant downregulated of the GHR pathway components m-RAS and ATF3 was found in juvenile ponies, which slowed the proliferation of bone osteocytes. However, WNT2 and PLCß2 were obviously upregulated in juvenile Debao ponies, which led to premature mineralization of the bone extracellular matrix. Furthermore, we found that the WNT/Ca2+ pathway may be responsible for regulating body growth. GHR was demonstrated by q-PCR and Western blot analyses to be expressed at low levels in long bones of Debao ponies. Treatment with WNT antagonistI decreased the expression of WNT pathway components (P < 0.05) in vitro. Transduction of ATDC5 cells with a GHR-RNAi lentiviral vector decreased the expression of the GHR pathway components (P < 0.05). Additionally, the expression of the IGF-1 gene in the liver was lower in Debao ponies than in Mongolian horses at the juvenile and adult stages. Detection of plasma hormone concentrations showed that Debao ponies expressed higher levels of IGF-1 as juveniles and higher levels of GH as adults than Mongolian horses, indicating that the hormone regulation in Debao ponies differs from that in Mongolian horses. CONCLUSION: Our work provides insights into the genetic regulation of short stature growth in mammals and can provide useful information for the development of therapeutic strategies for small size.

Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019.

The aim of this study was to investigate the correlations between serum calcium and clinical outcomes in patients with coronavirus disease 2019 (COVID-19). In this retrospective study, serum calcium levels, hormone levels and clinical laboratory parameters on admission were recorded. The clinical outcome variables were also recorded. From February 10 to February 28, 2020, 241 patients were enrolled. Of these patients, 180 (74.7%) had hypocalcemia on admission. The median serum calcium levels were 2.12 (IQR, 2.04-2.20) mmol/L, median parathyroid hormone (PTH) levels were 55.27 (IQR, 42.73-73.15) pg/mL, and median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positively correlated with VD levels (P =0.004) but negatively correlated with PTH levels (P =0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidences of organ injury and septic shock, and higher 28-day mortality. The areas under the receiver operating characteristic curves of multiple organ dysfunction syndrome, septic shock, and 28-day mortality were 0.923 (P <0.001), 0.905 (P =0.001), and 0.929 (P <0.001), respectively. In conclusion, serum calcium was associated with the clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH levels.

Bilateral lung transplantation after caesarean section in pregnancy with severe pulmonary arterial hypertension: A case report.

RATIONALE: Pulmonary arterial hypertension (PAH) can lead to an increase in right ventricular load and subsequently heart failure, making severe PAH a contraindication for pregnancy. In addition, PAH may worsen during pregnancy and puerperium, which requires high-quality critical care. This report is the first instance in which a patient with severe PAH, survived a successful atrial septal defect (ASD) repair and bilateral lung transplantation during puerperium. PATIENT CONCERNS: A 42-year-old pregnant woman with congenital heart disease (CHD) and severe PAH was admitted to our hospital for the management of pregnancy and delivery. The patient was diagnosed with severe PAH in 2013, and no significant improvements or deteriorations were found until this pregnancy-related hospital admission. DIAGNOSIS: The patient was diagnosed with CHD and severe PAH in 2013 with color Doppler echocardiography, right cardiac catheterization, and pulmonary perfusion imaging. The patient's mean pulmonary arterial pressure increased to 140 mm Hg during pregnancy, suggesting an exacerbated PAH with high risks to both her and the unborn child. INTERVENTIONS: The patient was treated with PAH-targeting treprostinil injection to reduce pulmonary artery pressure. Caesarean section was performed at 27 weeks and 5 days of gestation. The patient was put under extracorporeal membrane oxygenation (ECMO) with the help of local anesthesia before the operation. The investigators finally conducted a bilateral lung transplantation with a shell incision of the sternum under cardiopulmonary bypass. OUTCOMES: The mother and the neonate survived and recovered well after the operation, and were discharged from the hospital on the fourth month post-hospitalization. LESSONS: Severe PAH is an absolute contraindication for pregnancy. However, for patients who insist on a pregnancy, it could be plausible to proceed with a targeted drug therapy and ECMO after conducting a cesarean section, and finally, a lung transplantation. Multidisciplinary diagnosis and treatment is the key to the successful treatment of a PAH-complicated pregnancy.

Interdigitating dendritic cell sarcoma located in the groin: a case report and literature review.

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare subtype of dendritic cell neoplasms, and current knowledge on this tumor is limited. We herein report a case of an IDCS in a 64-year-old man who presented with a right inguinal mass combined with extensive retroperitoneal, pulmonary, hepatic, renal, and bone marrow infiltration. Because of the advanced stage of the disease, we performed five cycles of chemotherapy, including cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP); doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); and ABVD combined with cisplatin, and one cycle of radiotherapy. The patient's inguinal mass became smaller during the treatment, but there was no change in the extent of infiltration at the other sites. The patient died 8 months after the initial diagnosis. We also herein review the etiology, diagnosis, differential diagnosis, treatment, and prognosis of IDCS, and analyze the characteristics of IDCS in Chinese patients.

Effect of setting high APRV guided by expiratory inflection point of pressure-volume curve on oxygen delivery in canine models of severe acute respiratory distress syndrome.

In the present study, the effect of setting high airway pressure release ventilation (APRV) pressure guided by an expiratory inflection point of pressure-volume (PV) curve following lung recruitment maneuver (RM) on oxygen delivery (DO2) in canine models of severe acute respiratory distress syndrome (ARDS) was examined. Canine models of severe ARDS were established by intravenous injection of oleic acid. After injection of sedative muscle relaxants, a PV curve plotted using the super-syringe technique, and the pressure at lower inflection point (LIP) at the inhale branch and the pressure at the point of maximum curvature (PMC) at the exhale branch were measured. The ventilation mode was biphasic positive airway pressure (BiPAP), an inspiration to expiration ratio of 1:2, and Phigh 40 cm H2O, Plow 25 cm H2O. Phigh was decreased to 30 cm H2O after 90 sec. The dogs were randomized into 3 groups after RM, i.e., Blip group, BiPAP Plow = LIP+2 cm H2O; Bpmc group, BiPAP Plow = PMC; and Apmc group. In the APRV group, Phigh was set as PMC, with an inspiratory duration of 4 sec and expiratory duration of 0.4 sec. PMC was 18±1.4 cm H2O, and LIP was 11±1.3 cm H2O. Thirty seconds after RM was stabilized, it was set as 0 h. Hemodynamics, oxygenation and DO2 were measured at 0, 1, 2 and 4 h after RM in ARDS dogs. The results demonstrated: i) cardiac index (CI) in the 3 groups, where CI was significantly decreased in the Bpmc group at 0, 1, 2 and 4 h after RM compared to prior to RM (P<0.05) as well as in the Blip and Apmc groups (P<0.05). CI in the Blip and Apmc groups was not significantly altered prior to and after RM. ii) Oxygenation at 0, 1, 2 and 4 h in the 3 groups was improved after RM and the oxygenation indices for the 3 groups at 1 and 2 h were not significantly different (P>0.05). However, the oxygenation index in the Blip group at 4 h was significantly lower than those at 0 h for the Apmc and Bpmc groups (P<0.05). Oxygenation for the Apmc group at 4 h was higher than that for the Blip and Bpmc groups (P<0.05). Oxygenation for the Bpmc group was lower than that at 0 h, although the difference was not significant (P>0.05). iii) DO2 in at 0, 1, 2 and 4 h in the Bpmc group was significantly lower than that in the Blip and Apmc groups, and not significantly improved after RM. DO2 in the Blip and Apmc groups after RM was improved as compard to that before RM and that in the Bpmc group. However, DO2 at 4 h in the Blip group was significantly lower than that at 0 h and in the Apmc group (P<0.05). DO2 at 4 h in the Apmc group was higher than that at 0 h and that in the remaining 2 groups (P<0.05). In conclusion, high APRV pressure guided at PMC of PV curve after RM significantly improved DO2 in ARDS dogs.

[The value of changes in end-tidal carbon dioxide pressure induced by passive leg raising test in predicting fluid responsiveness in mechanically ventilated patients with septic shock].

OBJECTIVE: To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock. METHODS: Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output (PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline, after PLR, and after volume expansion. Fluid responsiveness was defined as an increase in cardiac index (CI) of 15% or greater after volume expansion. The correlation between PLR-induced CI change (ΔCIPLR) and PETCO2 (ΔPETCO2-PLR) was analyzed. The value of ΔPETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves. RESULTS: A total of 42 patients were enrolled in this study, of whom, 24 had a CI increase of ≥ 15% after volume expansion (responders). After PLR, CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9)% of CI and (9.6 ± 4.7)% of PETCO2, P < 0.05], while no significant changes were observed (P > 0.05) in the non-response group. Both ΔCIPLR and ΔPETCO2-PLR were significantly higher in responder group than in the non-responder group (both P < 0.05). ΔCI and ΔPETCO2 after PLR were strongly correlated (r = 0.64, P < 0.05). In responders after PLR, the area under ROC curve of ΔPETCO2-PLR was 0.900 ± 0.056 (95%CI 0.775-1.000, P < 0.05). An increase of ≥ 5% in ΔPETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0% and specificity of 88.2%. CONCLUSIONS: The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.

[Extracorporeal membrane oxygenation for acute respiratory distress syndrome: a study of 11 cases].

OBJECTIVE: To evaluate the value of extracorporeal membrane oxygenation (ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS). METHODS: Twenty-five adult patients with severe ARDS admitted to Intensive Care Unit of Wuxi People's Hospital from January 2008 to June 2011 were retrospectively studied. All the cases met the ECMO criteria. Patients were divided into ECMO group and non-ECMO group according to whether they were treated with ECMO or not. ECMO group was further divided into ECMO survivor group and ECMO non-survivor group according to the situation on the 30(th) day after ECMO treatment. Clinical features and prognosis were compared between groups. The statistics software of SPSS 13.0 was used for data analysis. RESULTS: Of the 25 patients, 11 were treated with ECMO. There were 7 males and 4 females, aged from 21 to 61 years, with a mean age of (42 ± 12) years. Mean time of mechanical ventilation before ECMO therapy was (12 ± 8) h, with PaO2/FiO2 of (52 ± 19) mm Hg (1 mm Hg = 0.133 kPa) and PaCO2 (84 ± 11) mm Hg. Six patients treated with ECMO survived. The survival rate between the ECMO group and non-ECMO group was not significantly different (54.5%, 35.7%, χ(2) = 2.232, P > 0.05). Duration of ECMO therapy was (10.4 ± 3.4) d in survivors and (6.2 ± 2.4) d in non-survivors. Early improvement of PaO2 to FiO2 ratio and decrease of PaCO2 were seen in both ECMO survivor group and non-survivor group (t = 2.568 - 22.490, all P < 0.05). In survivor group, serum lactate levels and norepinephrin doses decreased significantly (t = 4.679 - 23.397, all P < 0.05), while the serum lactate levels and norepinephrin doses increased in non-survivor group (t = 4.325 - 29.729, all P < 0.05). CONCLUSIONS: Available data and our experience suggest that ECMO may be an effective salvage treatment for severe ARDS and should be used as early as possible for ARDS patients responding poorly to conventional mechanical ventilation support.

[Effects of recruitment maneuvers in prone position for pulmonary or extra-pulmonary acute respiratory distress syndrome on hemodynamics in dog].

OBJECTIVE: To evaluate the effect of recruitment maneuvers in prone positioning on hemodynamic in dogs with acute respiratory distress syndrome (ARDS) of pulmonary or extra pulmonary origin. METHODS: Forty-eight mongrel dogs were randomly divided into 8 groups with six dogs in each group. Hydrochloric acid was instilled into trachea to reproduce pulmonary ARDS (ARDSp) and oleic acid was intravenously injected to produce extra-pulmonary ARDS (ARDSe). ARDSp and ARDSe dogs were divided into conventional mechanical ventilation group (group A), prone-position ventilation group (group B), sustained inflation (SI) group (group C) and prone-position ventilation + SI group (group D) respectively. Hemodynamic parameters were monitored before injury and 0, 2 and 5 hours after ARDS was reproduced. RESULTS: (1) In group A and group C, central venous pressure (CVP) increased significantly at 5 hours after ARDSp. Five hours after the establishment of ARDSp, pulmonary arterial wedge pressure (PAWP) increased in group C and group D. Mean pulmonary arterial pressure (MPAP) increased remarkably in group A, group C and group D at 2 hours and 5 hours after onset of ARDSp. In group C, intrathoracic blood volume index (ITBI) decreased at 5 hours after the onset of ARDSp. In all the four groups, extravascular lung water index (EVLWI) increased sharply at 0, 2 and 5 hours after onset of ARDSp. In group B and group C, cardiac index (CI) decreased to a greater extent at 2 and 5 hours after onset of ARDSp. CI decreased at 2 hours after onset of ARDSp in group D with statistically significant difference at different time points (all P<0.05). (2) In all four groups, EVLWI increased sharply at 0, 2 and 5 hours after onset of ARDSe. In ARDSe model, there was no significant difference in other hemodynamic parameters between groups (all P>0.05). CONCLUSION: There are less influence on hemodynamics when SI is performed in prone position, and it is even more significantly so in ARDS dogs.

Chemical constituents in the leave of Rhizophora stylosa L and their biological activities / 药学学报

Ten compounds were isolated from the leaves of Rhizophora stylosa, one kind of mangrove plants distributed in the tropical and subtropical areas of the world. Their structures were identified as taraxerone (1), taraxerol (2), beta-sitosterol (3), careaborin (4), cis-careaborin (5), beta-daucosterol (6), isovanillic acid (7), protocatechuic acid (8), astilbin (9) and rutin (10), among which compound 9 and 10 were reported in this plant for the first time. Of these compounds, Compound 2 has been confirmed to have the abilities to inhibit the growth of Hela and BGC-823 with IC50 of 73.4 micromol x L(-1) and 73.3 micromol x L(-1), respectively. Compound 5 could inhibit the growth of BGC-823 and MCF-7 with IC50 of 45.9 micromol x L(-1) and 116.0 micromol x L(-1), respectively. Compound 9 and 10 were firstly reported to stimulate the proliferation of mice splenic lymphocytes markedly in a dose-dependent manner.

An initial prevalence investigation of convulsive epilepsy in rural areas of Tibet Autonomous Region / 中华神经科杂志

Objective To find out the prevalence rate of epilepsy,its treatment gap and quality of life of epilepsy patients in rural areas of Tibet Autonomous Region (TAR).Methods Cluster sampling was adopted to conduct a door-to-door epidemiological survey among 14 822 rural population in Gangka town, Zhaxigang and Quzika village located in Medrogongka and Markham counties of TAR.The quality of life was measured by the 31-item quality of life in epilepsy inventory (QOLIE-31).Results Thirty-seven epilepsy patients were diagnosed as convulsive epileptic patients,and the prevalence was 0.25%.Thirty-five patients (94.59%) were diagnosed as active epilepsy,with a prevalence rate of 0.24%.Only one patient took standard Western Medicine within a week before the survey,and the treatment gap of the active epilepsy was 97.1%.The average QOLIE-31 total score was 42.15?17.63,and the lowest subcomponent score was 22.59?20.31 for seizure worry with the highest subcomponent score 85.83?18.59 for medication effects. Age,occupation,education,economic status,age at epilepsy onset and seizure frequency were significantly correlated with low QOLIE-31 scores (P

[Effect of sustained inflation on inflammatory response of extra pulmonary organs in acute respiratory distress syndrome in rabbit].

OBJECTIVE: To evaluate the influence of sustained inflation (SI) on inflammatory response of extra pulmonary organs in acute respiratory distress syndrome (ARDS) in rabbit. METHODS: The ARDS rabbit model were replicated by saline alveoli-lavage. The rabbits were randomly divided into four groups: 1. normal group; 2. ARDS group; 3. low-volume(V(T)) + best end-expiratory pressure group (LVBP): V(T) 6 ml/kg, PEEP 2 cm H(2)O(1 cm H(2)O=0.098 kPa) greater than the pressure of lower inflection point in pressure-volume curve (Pinf); 4. SI group: same settings as LVBP group plus SI performed every hour. After 4 hours of ventilation, liver and intestine homogenates were prepared to assay tumor necrosis factor (TNF)-alpha and interleukin(IL)-10 levels by enzyme-linked immunoadsorbent assay and their mRNA expression by reverse transcription-polymerase chain reaction. Myeloperoxidase (MPO) and malondialdehyde (MDA) were assessed at the same time. RESULTS: In SI group, TNF-alpha mRNA expression in the liver and intestine tissues (24.82+/-7.88 and 25.06+/-10.57) were decreased significantly compared with ARDS (36.88+/-6.83 and 36.48+/-8.23) and LVBP groups (42.34+/-8.55 and 37.59+/-10.63, all P<0.05). The expression of IL-10 mRNA in the liver and intestine of rabbits in SI group (17.31+/-5.72 and 10.90+/-3.30) was lower than that of ARDS (24.64+/-3.85 and 24.31+/-7.69) and LVBP group (25.03+/-9.38 and 21.83+/-7.34, all P<0.05) significantly. In SI group, the levels of TNF-alpha and IL-10 in liver and intestine tissue were similar to that of the other groups. The contents of MPO and MDA had no difference compared with the other groups too. CONCLUSION: SI can down-regulate inflammatory mediator expression of extra-pulmonary organs in rabbits with ARDS, and it may inhibit the inflammatory response in extra pulmonary organs.

[Change of extravascular lung water in sheep with early acute respiratory distress syndrome].

OBJECTIVE: To determine the change of extravascular lung water (EVLW) and the effect of positive end-expiratory pressure (PEEP) and cardiac output (CO) on EVLW in the sheep with early acute respiratory distress syndrome (ARDS). METHODS: The sheep ARDS model was induced by infusion of endotoxin intravenously, and then divided into ARDS model group (n = 12), PEEP group (n = 21) and dobutamine group (n = 13). The PEEP group was further divided into three subgroups: PEEP 5 cm H(2)O (n = 7), 10 cm H(2)O (n = 8) and 15 cm H(2)O groups (n = 6). EVLW was measured by the single indicator thermodilution technique. The EVLW, hemodynamics and lung mechanics parameters were observed at 6 h after sheep ARDS model was induced, 2 h after mechanical ventilation with PEEP (5, 10, 15 cm H(2)O) respectively and 2 h after CO increase >/= 50% of the base value (induced by dobutamine infusion). RESULTS: (1) When ARDS was induced in sheep, EVLW increased from (12.8 +/- 4.7) ml/kg to (18.1 +/- 7.1) ml/kg (P < 0.01), and EVLW had no significant change (P > 0.05) during the early phase of ARDS (6 h). PaO(2)/FiO(2) was (136.8 +/- 34.9) mm Hg at ARDS 0 h, which was higher than that before infusion of endotoxin [(444.3 +/- 127.7) mm Hg, P < 0.01]. EVLW had no relationship with PaO(2)/FiO(2), but DeltaEVLW after ARDS model induced had good correlation with DeltaPaO(2)/FiO(2) (r = -0.501, P < 0.001). When ARDS was induced, static lung compliance decreased from 26.9 +/- 8.4 to 16.4 +/- 5.0 (P < 0.01). (2) After mechanical ventilation with PEEP 2 h, EVLW in PEEP 10 cm H(2)O group and 15 cm H(2)O group were (14.7 +/- 4.5) ml/kg and (15.3 +/- 3.7) ml/kg respectively, which was significantly less than that before PEEP [(16.5 +/- 4.7) ml/kg and (18.4 +/- 6.0) ml/kg respectively, all P < 0.05]. But EVLW in 5 cm H(2)O group showed no difference during 2 h PEEP application. (3) After CO increase >/= 50% of the base value 1 h and 2 h, EVLW was (16.3 +/- 4.9) ml/kg and (16.9 +/- 6.9) ml/kg respectively, which did not differ from that of the baseline value [(15.1 +/- 4.6) ml/kg, all P > 0.05]. CONCLUSIONS: EVLW in ARDS sheep increased significantly and remained at the same level during the early phase of ARDS. PEEP had a markedly effect in reducing EVLW, while the increase of CO induced by dobutamine did not significantly raise EVLW.

[Effects of positive end-expiratory pressure on lung recruited volume and oxygenation in patients with acute respiratory distress syndrome].

OBJECTIVE: To access alveolar recruitment with positive end-expiratory pressure (PEEP) and to correlate the recruited volume with arterial oxygenation in acute respiratory distress syndrome (ARDS). METHODS: Eleven ventilated patients satisfying criteria of ARDS were included in the study group. Recruited volume of three different PEEP levels [5 cm H2O, 10 cm H2O, 15 cm H2O (1 cm H2O=0.098 kPa)] were measured by pressure-volume curve method. Effects of different PEEP levels on lung mechanics and gas exchange were compared. RESULTS: Lung recruited volume elevated when PEEP increased from 5 cm H2O to 15 cm H2O[(40.2+/-15.3)ml vs. (123.8+/-43.1)ml vs. (178.9+/-43.5)ml, all P<0.05]. Arterial oxygenation index increased with PEEP and a positive correlation was found between recruited volume and changes in arterial oxygenation index (r=0.483, P<0.01). There was no significant difference during the static compliance at different PEEP levels at a fixed tidal volume (P>0.05). Recruited volume at PEEP 15 cm H2O in the patient group with lower inflection point (LIP) was larger than the group without LIP. CONCLUSION: Recruited volume increases with PEEP, and the PEEP-induced increase in arterial oxygenation is significantly correlated to recruited volume.

[A comparison study on quantitative methods for the recruited volume in sheep with acute respiratory distress syndrome].

OBJECTIVE: To compare equal pressure method with pressure-volume curve method to quantify the recruited volume. METHODS: Acute respiratory distress syndrome sheep model was induced by intravenous infusion 3 microg/kg lipopolysaccharide (LPS). Recruited volume of three different levels of positive end-expiratory pressure (PEEP=5, 10, 15 cm H2O) were measured both by pressure-volume curve method and by equal pressure method. RESULTS: The time needed to measure recruited volume by pressure-volume curve method was 5-6 minutes, which was longer than that of equal pressure method. Recruited volume measured by the two methods increased with PEEP. No significant difference was found between the recruited volume measured by equal pressure method and by equal pressure method at PEEP of 5 cm H2O, they were (25.79+/-20.48) ml vs. (63.26+/-54.57) ml (P>0.05), while recruited volume at PEEP of 10 cm H2O and 15 cm H2O measured by equal pressure method were lower than those measured by the pressure-volume curve method, they were (48.64+/-30.51)ml vs. (148.14+/-85.42)ml and (71.50+/-58.09)ml vs. (322.86+/-148.42)ml (all P<0.05) respectively. CONCLUSION: Though equal pressure method is simple, it could not take the place of pressure-volume curve method to quantify recruited volume.

[Effect of lung protective ventilation strategy on pulmonary inflammatory response in a rabbit model of acute respiratory distress syndrome].

OBJECTIVE: To evaluate the effect of lung protective ventilation strategy on pulmonary inflammatory response in acute respiratory distress syndrome (ARDS). METHODS: The ARDS rabbit model was duplicated by saline alveolar-lavage. The rabbits were divided into six groups: (1) normal control group (N group); (2) ARDS group (M group); (3) low-volume with best end-expiratory pressure (PEEP, A group) group: tidal volume (V(T)) 6 ml/kg, PEEP 2 cm H(2)O greater than the pressure of lower inflection point in pressure-volume curve (P(LIP)); (4) normal-volume with best PEEP group (B group): V(T) 6 ml/kg, and PEEP P(LIP) + 2 cm H(2)O; (5) low-volume with high PEEP group (C group): V(T) 6 ml/kg, and PEEP 15 cm H(2)O; and (6) high-volume with zero PEEP group (D group): V(T) 20 ml/kg. Lung wet/dry weight ratios (W/D) were recorded to evaluate lung injury. After 4 h of ventilation, lung homogenates were prepared to detect nuclear factor-kappaB (NF-kappaB) activity by electrophoretic mobility gel shift assay (EMSA), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) levels by enzyme-linked immunosorbent assay (ELISA) and their mRNA expression by reverse transcriptase-polymerase chain reaction (RT-PCR). Myeloperoxidase (MPO) and malondialdehyde (MDA) in lung homogenates were also assessed. RESULTS: After 4 h ventilation, W/D in A group (5.6 +/- 1.1) were significantly lower than those in B group, C group and D group (6.6 +/- 0.8, 6.6 +/- 1.0, 6.9 +/- 1.0, all P < 0.05). But there was no difference between A group and M group (5.8 +/- 0.5). NF-kappaB activity was the highest in D group, and that in A group was 331 +/- 113, which was decreased significantly as compared with B, C and D groups (455 +/- 63, 478 +/- 74, 645 +/- 162, all P < 0.05). The mRNA expression of TNF-alpha and IL-10 and their concentrations in lung homogenates in A group were lower than those in B, C and D groups. In A group, the concentrations of MPO and MDA in lung homogenates were significantly lower than those in B, C and D groups. CONCLUSION: Lung protective ventilation strategy can inhibit lung inflammation and may improve lung injury in ARDS, but low tidal volume with high PEEP may increase lung inflammation.