Perioperative restricted fluid therapy preserves immunological function in patients with colorectal cancer.

AIM: To investigate the effect of perioperative restricted fluid therapy on circulating CD4(+)/CD8(+) T lymphocyte ratio, percentage of regulatory T cells (Treg) and postoperative complications in patients with colorectal cancer. METHODS: A total of 185 patients met the inclusion criteria and were included in the randomized clinical trial. These patients were divided into two groups according to receipt of either perioperative standard (S, n = 89) or restricted (R, n = 96) fluid therapy. Clinical data of these patients were collected in this prospective study. Perioperative complications and cellular immunity changes (CD4(+)/CD8(+) and Treg) were analyzed comparatively between the two groups. RESULTS: Both during surgery and on postoperative days, the total volumes of fluids administered in the R group were significantly lower than those in the S group (1620 ± 430 mL vs 3110 ± 840 mL; 2090 ± 360 mL vs 2750 ± 570 mL; 1750 ± 260 mL vs 2740 ± 490 mL; 1620 ± 310 mL vs 2520 ± 300 mL; P < 0.05). Decreased ratios of circulating CD4(+)/CD8(+) T lymphocytes (1.47 ± 0.28 vs 2.13 ± 0.26; 1.39 ± 0.32 vs 2.21 ± 0.24; P < 0.05) and Treg percentage values (2.79 ± 1.24 vs 4.26 ± 1.04; 2.46 ± 0.98 vs 4.30 ± 1.12; P < 0.05) were observed after surgery in both groups. However, in the R group, these values restored more quickly starting from postoperative day 2 (1.44 ± 0.24 vs 1.34 ± 0.27; 2.93 ± 1.08 vs 2.52 ± 0.96; P < 0.05). The proportion of patients with complications was significantly lower in the restricted group (36 of 89 vs 59 of 96, P < 0.01). CONCLUSION: Perioperative restricted intravenous fluid regimen leads to a low postoperative complication rate and better cellular immunity preservation in patients with colorectal cancer.

Monocyte chemotactic protein-1 as possible prognostic markers of the efficacy of antiviral treatment in chronic hepatitis C.

BACKGROUND/AIMS: Antiviral therapy with interferon and ribavirin had been proved to be effective in Hepatitis C treatment. However, the valuable markers for monitoring the efficacy of antiviral therapy are required clinically. The present study aimed to evaluate the association between pretreatment levels of Monocyte chemoattractant protein-1 levels (MCP-1) and the virological response in treated patients with chronic hepatitis C infection. METHODOLOGY: Concentrations of MCP-1 in serum were determined in 165 patients with chronic hepatitis C (CHC) treated with interferon and ribavirin by enzyme linked immunosorbent assay before and 48 weeks after cessation of therapy. RESULTS: Pretreatment MCP-1 levels in patients with sustained virological response (SVR) were significantly lower than in non-responders (Non-SVR) (220.2 +/- 31.7 vs. 305.6 +/- 50.7 pg/mL, p = 0.009) and MCP-1 significantly decreased in patients with SVR (form 220.2 +/- 31.7 pg/mL to 140.2 +/- 26.7 pg/mL; p <0.01) but not in Non-SVR (form 305.6 +/- 50.7 pg/mL to 286.6 +/- 41.9 pg/mL; p = 0.17) after 48 weeks of treatment. By multivariate analysis, non-1 genotype was independent predictors of SVR in all patients. When multivariate analysis was restricted to patients with non-1 genotype, only pretreatment MCP-1 levels were identified as predictive factors of SVR. CONCLUSIONS: MCP-1 may be a prognostic marker of the efficacy of antiviral therapy in CHC patients.

Changes of ammonia levels in patients with acute on chronic liver failure treated by plasma exchange.

BACKGROUND/AIMS: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) is useful to bridge AoCLF patients to liver transplantation. The aim of this study was to assess the effects of PE on plasma ammonia levels (PAL) in AoCLF patients. METHODOLOGY: Seventy patients with AoCLF in 2 groups (PE plus standard medical treatment group, n = 32; and standard medical treatment group, n = 38) were enrolled in study. PAL was detected on admission and on days 7, 14, 21, and 30 during hospitalization. RESULTS: All AoCLF patients showed PAL more than the upper limit of the normal range. More dramatic decreased in the PE survivors (form 116.8 +/- 36.3 to 44.8 +/- 16.3, p < 0.01) than the medical survivors (form 105.7 +/- 30.2 to 57.1 +/- 20.3, p < 0.05) after 30 days of treatment. Furthermore, PAL after medical treatment were still higher than those of PE treatment in the survivors (57.1 +/- 20.3 vs. 44.8 +/- 16.3, p < 0.05). Among the non-survivors in the medical group, PAL remained at high levels throughout the examination period. Importantly, an increased PAL associated with high mortality and reduced survival time of AoCLF patients. CONCLUSIONS: Ammonia may be important in the pathogenesis of the AoCLF and PE may represent a reliable hepatic support device for AoCLF.

[The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia in septic shock].

OBJECTIVE: To explore the use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia due to septic shock. METHODS: In this prospective randomized, double-blind, controlled clinical trial, a total of 65 patients of hypoperfusion induced lactic acidemia due to septic shock admitted between April 2006 and April 2010 were assigned to two groups. Thirty-five patients of "stage" group sodium bicarbonate was used in two stages: in first stage sodium bicarbonate was given by venous drip until pH≥7.15, and in second stage sodium bicarbonate was given by intravenous drip till pH≥7.25 after 6 hours. Thirty patients in control group intravenous drip of sodium bicarbonate was used till pH≥7.15. Early goal-directed therapy(EGDT) was used in the first 6 hours of fluid resuscitation. The number of dysfunction organ, time of mechanical ventilation, maximum sequential organ failure assessment (SOFA) score, delta SOFA score, durations of stay in intensive care unit (ICU) and in hospital, and mortality were recorded in two groups. Blood gas analysis and index of hemodynamics were monitored at 0 hour and 8 hours in both groups. RESULTS: Compared with control group, "stage" group was associated with a lower number of dysfunction organ, time of mechanical ventilation, maximum SOFA score, delta SOFA score, durations of stay in ICU and in hospital, and mortality (number of dysfunction organ: 2.68±0.79 vs. 3.28±0.80, time of mechanical ventilation: 10.32±2.26 days vs. 13.80±2.56 days, maximum SOFA score: 11.01±2.26 vs. 13.11±2.26, delta SOFA score: 1.71±1.25 vs. 3.43±1.27, duration of stay in ICU: 14.0±3.6 days vs. 20.0±3.7 days, duration of stay in hospital: 28.3±12.9 days vs. 41.9±13.2 days, mortality: 34.28% vs. 60.00%, P<0.05 or P<0.01). There were no significant differences in blood gas analysis and index of hemodynamics at 0 hour, and they were improved at 8 hours. Compared with control group, in "stage" group, lactic acid (Lac) was significantly lowered (1.50±1.08 mmol/L vs. 2.93±1.09 mmol/L), and pH, mixed venous oxygen saturation (SvO2), oxygen extraction ratio (O2ER), cardiac index (CI), oxygen delivery (DO2) were significantly increased (pH:7.29±0.05 vs. 7.20±0.05, SvO2: 0.75±0.18 vs. 0.66±0.17, O2ER: 0.32±0.06 vs. 0.25±0.06, CI: 113.36±13.34 ml×s(-1)×m(-2) vs. 83.35±13.34 ml×s(-1)×m(-2), DO2: 840±170 ml×min(-1)×m(-2) vs. 630±171 ml×min(-1)×m(-2), all P<0.01). CONCLUSION: The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia as a result of septic shock can lower the occurrence rate of multiple organ dysfunction syndrome, time of mechanical ventilation, durations of stay in ICU and in hospital, and mortality.

[Efficacy and safety of non-invasive positive pressure ventilation in the care of dyspnea after cardiac surgery].

OBJECTIVE: To study the efficacy and safety of non-invasive positive pressure ventilation (NPPV) in the care of dyspnea after cardiac surgery. METHODS: Among patients who underwent cardiac surgery with cardiopulmonary bypass from December 2004 to December 2006,58 patients developed dyspnea (respiratory rate>25 breaths per minute with "three depressions" sign) and acute respiratory failure after extubation. Among them 30 patients underwent NPPV and 28 patients were treated with face mask oxygen therapy. Intubation and invasive mechanical ventilation were begun when the treatment failed or still hypoxemic [partial pressure of oxygen in artery (PaO(2))<60 mm Hg (1 mm Hg=0.133 kPa)], ventricle arrhythmia, or other indications for endotracheal intubation. RESULTS: No significant differences were found between two groups in age,acute physiology and chronic health evaluation II (APACHE II) score,duration of cardiopulmonary bypass and aortic cross-clamp, and New York Heart Association class (all P>0.05). Compared with face mask oxygen therapy group, NPPV was associated with a lower incidence of arrhythmia (P<0.05) at 120 minutes after treatment, a lesser necessity for reintubation (P<0.01), a shorter length of stay in intensive care unit (ICU) (P<0.01), a lower mortality (P<0.05). Arterial pH and arterial CO(2) partial pressure (PaCO(2)) of two groups began to rise significant at 480 minutes (P<0.05 or P<0.01), PaCO(2) began to rise at 120 minutes (P<0.05). At 30 minutes, significant differences in PaO(2), HCO(-)(3), respiratory rate, heart rate and arterial systolic blood pressure in NPPV group began to appear (P<0.05 or P<0.01). The time of significant differences in PaO(2), HCO(-)(3), respiratory rate, heart rate and arterial systolic blood pressure in face mask oxygen therapy group were respectively 120, 60, 120, 480 and 480 minutes (P<0.05 or P<0.01). Lactate concentration showed a significant drop at 60 minutes in NPPV (P<0.05), but at 480 minutes in face mask oxygen therapy group (P<0.05). CONCLUSION: These results suggest that NPPV is an effective and safe means for improving dyspnea and tissue perfusion, decreasing arrhythmia and necessity for reintubation, shortening the length of stay in ICU and decreasing mortality in dyspneic patients after cardiac surgery.