Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study

ABSTRACT BACKGROUND: Hyperchloremia is often encountered due to the frequent administration of intravenous fluids in critically ill patients with conditions such as shock or hypotension in the pediatric intensive care unit, and high serum levels of chloride are associated with poor clinical outcomes. OBJECTIVES: This study aimed to determine the association between hyperchloremia and in-hospital mortality in pediatric patients with major trauma. DESIGN AND SETTING: This retrospective cohort study was conducted at a tertiary university hospital in Turkey. METHODS: Data were collected between March 2020 and April 2022. Patients aged 1 month to 18 years with major trauma who received intravenous fluids with a concentration > 0.9% sodium chloride were enrolled. Hyperchloremia was defined as a serum chloride level > 110 mmol/L. Clinical and laboratory data were compared between the survivors and nonsurvivors. RESULTS: The mortality rate was 23% (n = 20). The incidence of hyperchloremia was significantly higher in nonsurvivors than in survivors (P = 0.05). In multivariate logistic analysis, hyperchloremia at 48 h was found to be an independent risk factor for mortality in pediatric patients with major trauma. CONCLUSIONS: In pediatric patients with major trauma, hyperchloremia at 48-h postadmission was associated with 28-day mortality. This parameter might be a beneficial prognostic indicator.

Comportamiento de los pacientes con distrofia corneal endotelial de Fuchs en la provincia Camagüey

Introducción: La distrofia corneal endotelial de Fuchs se trata de un trastorno degenerativo específico, bilateral y progresivo del endotelio corneal, es la más frecuente pero no siempre es diagnosticada en sus etapas iniciales en las consultas de oftalmología general. Objetivo: Describir el comportamiento clínico de pacientes con distrofia corneal endotelial de Fuchs en la provincia Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal en el Centro Oftalmológico del Hospital Universitario Manuel Ascunce Domenech en la provincia Camagüey desde noviembre 2019 hasta junio 2021. El universo de estudio estuvo constituido por todos los pacientes que asistieron durante el periodo de estudio y la muestra la conformaron 19 pacientes (38 ojos) quienes cumplieron con los criterios de inclusión y exclusión. Las variables estudiadas fueron edad, sexo, color de la piel, agudeza visual con corrección, asociación con glaucoma, paquimetría, biomicroscopía del segmento anterior, microscopía endotelial, microscopía confocal, estadio de la enfermedad y tipo de tratamiento aplicado. Resultados: Predominaron los pacientes entre 40 y 59 años de edad, el sexo femenino y color blanco de la piel. Sobresalió la visión útil, los valores de paquimetría altos y asociados al glaucoma. Se constató la presencia de guttas, edema corneal, bajo conteo celular con polimorfismo y polimegatismo. El estadio 2 estuvo en 47,4 % y el tratamiento médico se aplicó en el 97,4 %. Conclusiones: La distrofia aparece con más frecuencia después de los 40 años de edad, en sexo femenino y color blanco de piel. Predominó la visión útil, valores altos de paquimetrías y asociación con glaucoma. En la biomicroscopía del segmento anterior predominaron las guttas y el edema estromal y la microscopía endotelial y confocal se caracterizaron en su mayoría por el bajo conteo celular, las guttas, polimorfismo y polimegatismo. Prevaleció el estadio 2 y el tratamiento médico.

Introduction: Fuchs endothelial corneal dystrophy is a specific, bilateral and progressive degenerative disorder of the corneal endothelium, it is the most frequent but it is not always diagnosed in its initial stages in general ophthalmology consultations. Objective: To describe the clinical behavior of patients with Fuchs endothelial corneal dystrophy in Camagüey province. Methods: A cross-sectional descriptive observational study was carried out at the Ophthalmological Center of the Manuel Ascunce Domenech University Hospital in Camagüey in the period from November 2019 to June 2021. The study universe consisted of all the patients who attended during the study period and the sample was made up of 19 patients (38 eyes) who met the inclusion and exclusion criteria. The variables studied were age, sex, skin color, corrected visual acuity, association with glaucoma, pachymetry, anterior segment biomicroscopy, endothelial microscopy, confocal microscopy, disease stage, and type of treatment applied. Results: Patients between 40 and 59 years of age, female sex, and white skin color predominated. Useful vision stood out, high pachymetry values and associated with glaucoma, the presence of guttas, corneal edema, low cell count with polymorphism, and polymegatism was confirmed. Stage 2 was 47.4% and medical treatment was applied in 97.4%. Conclusions: Dystrophy appears more frequently after 40 years of age, in females and white skin persons. Useful vision, high pachymetry values, and association with glaucoma prevailed. In the biomicroscopy of the anterior segment, guttas and stromal edema predominated, and endothelial and confocal microscopy were mostly characterized by low cell count, guttas, polymorphism, and polymegatism. Stage 2 and medical treatment prevailed.

Utility of Cough Provocation Tests in Chronic Cough and Respiratory Diseases: A Comprehensive Review and Introduction of New Reference Ranges for the Capsaicin Test.

Cough provocation tests (CPTs) are an objective measurement of the sensitivity of the cough reflex arc. However, they are not established in clinical practice because a large variability of response in healthy subjects limits their diagnostic value. There is a paucity of studies that have investigated CPT reference ranges in healthy subjects. This systematic review describes the variability of the responses to CPTs in healthy subjects and factors that influence it. A new analysis of 134 healthy subjects was conducted to create reference ranges for single-breath capsaicin CPT by calculating the interquartile ranges for the provocative concentration of capsaicin to induce 2 and 5 coughs. Female subjects had a more sensitive cough reflex than male counterparts. The ability of CPTs to distinguish various respiratory diseases from healthy subjects was also reviewed. Cough sensitivity was consistently heightened in the following groups: unselected patients with chronic, refractory, or recurrent cough, unexplained chronic cough, gastro-esophageal reflux-associated cough, cough-variant asthma, lower airway symptoms induced by chemical irritants, and fibrotic interstitial lung diseases. In the following groups, hypersensitivity of the cough reflex was present in those individuals whose symptom profile was predominated by cough: asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and sarcoidosis. In the following conditions, patients usually cough in order to expectorate mucus from their airways, not because of a hypersensitive cough reflex arc: productive cough, asthma, upper airway cough syndrome, COPD, bronchiectasis, cystic fibrosis, and chronic respiratory infections. CPTs have the potential to identify patients with chronic respiratory symptoms due to cough reflex hypersensitivity, thereby providing a targeted approach for therapy.

[Hypertonic saline solution and high dose of diuretic, ¿what do we know and how can we use them in persistent congestion?] / Solución salina hipertónica y dosis altas de diurético, ¿qué sabemos y cómo podemos usarlos en congestión persistente?

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

Hyperosmolar salt solution in treatment of cerebral edema after severe craniocerebral injury / 中华全科医师杂志

Clinical data of 93 patients with severe craniocerebral injury admitted in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhengzhou University from September 2016 to September 2018 were retrospectively analyzed. Forty six patients received 10% hypertonic salt solution 60 ml (hypertonic salt group) and 47 patients received 20% mannitol 125 ml (mannitol group) for relieving early postoperation cerebral edema. The changes of intracranial pressure, central venous pressure, heart rate, mean arterial pressure (MAP), urine volume and serum sodium level at 2, 4 and 6 h after dehydrating agents were compared between two groups. There were no significant differences in the intracranial pressure, central venous pressure, heart rate and urine volume between two groups at 2, 4 and 6 h after the first dehydration treatment (all P>0.05). The MAP values of the two groups were (88±11) and (80±10), (85±10) and (78±9), (79±12) and (73±13) mmHg (1 mmHg=0.133 kPa) at 2, 4 and 6 h after the first dehydration treatment; and the serum sodium levels were (145±5) and (136±4), (144±6) and (133±5), (140±5) and (135±4) mmol/L, respectively. There were significant differences between two groups (all P<0.05). It is suggested that hypertonic salt can reduce intracranial pressure and increase cerebral perfusion better than mannitol in severe craniocerebral injury.

Reorganization of motor unit activity at different sites within the human masseter muscle during experimental masseter pain.

The aims were to test the hypotheses that experimental masseter muscle pain leads to recruitment and/or derecruitment of motor units at different sites within the masseter and that the patterns of change in motor unit activity differ between sites. Single motor unit (SMU) activity was recorded at two sites within the right masseter [superior/anterior, inferior/posterior (IP)] during isometric biting tasks (ramp, step level) on an intraoral force transducer in 17 participants during three experimental blocks comprising no infusion (baseline), 5% hypertonic saline infusion (pain), or isotonic saline infusion (control). A visual analog scale (VAS) was used to score pain intensity. The VAS scores were statistically significantly greater during infusion of hypertonic saline than during infusion of isotonic saline. No significant differences in force levels and rates of force change were found between experimental blocks. In comparison with isotonic saline infusion, SMUs could be recruited and derecruited at both sites during hypertonic saline infusion. The frequency of recruitment or derecruitment, in comparison with no change, was statistically significantly greater at the IP site than at the superior/anterior site. Experimental noxious masseter stimulation results in a reorganization of motor unit activity throughout the muscle, and the pattern of reorganization may be different in different regions of the muscle.

Effect of resuscitation with hypertonic sodium chloride hydroxyethyl starch 40 injection mixed with suberoylanilide hydroxamic acid on oxidative stress responses and histone acetylation in lung tissues in a rat model of lethal hemorrhagic shock after entering high altitude for the first time / 中华麻醉学杂志

Objective To evaluate the effect of resuscitation with hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH40) mixed with suberoylanilide hydroxamic acid (SAHA) on oxidative stress responses of lung tissues and histone acetylation in a rat model of lethal hemorrhagic shock after entering high altitude for the first time.Methods Forty-five healthy male Wistar rats,aged 3-4 months,weighing 250-300 g,were transported from the breeding area at altitude 1500 m to the experimental area at altitude 3 780 m.The rats were divided into 3 groups (n=15 each) using a random number table:sham operation group (group Sham),hemorrhagic shock group (group HS),and resuscitation with HSH40 mixed with SAHA group (group HSH/SAHA).Lethal hemorrhagic shock was induced by removing 40％ of blood volume from the left femoral artery at a constant speed within 10 min,followed by removing 15％ of blood volume from the right femoral vein at a constant speed within 50 min.Only cannulation was performed,and the rats received no blood letting or resuscitation in group Sham.The animals were resuscitated via the right femoral artery after successful establishment of the model,SAHA 7.5/Kg dissolved in HSH40 4 ml/kg was infused within 5 min in group HSH+SAHA.Immediately before blood letting,immediately after blood letting and at 3 h after resuscitation (at the time of death for the rats survived less than 3 h),arterial blood samples were obtained for blood gas analysis,and pH value,partial pressure of arterial carbon dioxide (PaCO2),partial pressure of arterial oxygen (PaO2) and arterial oxygen saturation (SaO2) were recorded.The rats were sacrificed after blood samples were collected from the abdominal aorta at 3 h after resuscitation (at the time of death for the rats died within 3 h after resuscitation),and lungs were removed for examination of the pathologic changes which were scored (with a light microscope) and for determination of wet to dry weight ratio (W/D ratio),activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) and expression of histone H3 acetylation at lysine 9 (Ac-H3K9) in lung tissues (by Western blot).Results Compared with group Sham,the lung injury score,W/D ratio and content of MDA were significantly increased,and the activity of SOD was decreased in HS and HSH+SAHA groups,pH value and PaCO2 were significantly decreased and PaO2 and SaO2 were increased immediately after blood letting and at 3 h after resuscitation in group HS,and PaO2 and SaO2 were significantly increased immediately after blood letting and at 3 h after resuscitation,pH value and PaCO2 were decreased immediately after blood letting,and the expression of Ac-H3K9 was up-regulated in group HSH+SAHA (P＜0.05).Compared with group HS,pH value,PaCO2,PaO2 and SaO2 were significantly increased at 3 h after resuscitation,the lung injury score,W/D ratio and content of MDA were decreased,the activity of SOD was increased,and the expression of Ac-H3K9 was up-regulated in group HSH+SAHA (P＜0.05).Conclusion The mechanism by which resuscitation with HSH40 mixed with SAHA exerts lung protection may be related to inhibiting oxidative stress responses and histone acetylation in lung tissues in a rat model of lethal hemorrhagic shock after entering high altitude for the first time.

Effects of hypertonic saline on expressions of aquaporin 4 and caspase-3 in brain edema area after traumatic brain injury in rats / 中华创伤杂志

Objective To investigate the effect of hypertonic saline on the expressions of aquaporin 4 (AQP4) and caspase-3 in the brain edema area after traumatic brain injury (TBI) in rats Methods Seventy-two male SD rats weighing 220-250 g were selected and randomly divided into three groups (24 rats per group):sham operation group (Group A),traumatic brain injury + normal saline group (Group B) and traumatic brain injury + hypertonic saline group (Group C).Moderate TBI model was induced by Feeney's free falling method.Normal saline and hypertonic saline were delivered respectively.The neurological score was measured at 6,24,and 48 hours after operation.The brain water content was measured,and the blood brain barrier stability was detected by Evans blue staining.AQP4 positive cells was detected by immunohistochemistry.The expressions of AQP4 and caspase-3 protein in brain tissue were detected by Western blot,and the apoptosis of neurons in brain tissue by TUNEL method.Results Compared with Group A,the neurological score of Group B were obviously decreased,while the water content in the brain tissue,Evans blue staining,AQP4 positive cells,AQP4 (6 hours:1.73 ±0.31 vs.0.33 ±0.13;24 hours:2.47 ±0.27 vs.0.33 ±0.14;48 hours:2.18 ± 0.19 vs.0.33 ±0.12),caspase-3 protein expression(6 hours:0.53 ±0.18 vs.0.34 ±0.07;24 hours:0.58 ±0.16 vs.0.33 ± 0.08;48 hours:0.59 ± 0.11 vs.0.33 ± 0.07) and apoptosis index in brain tissue in Group B were significantly increased (all P ＜ 0.05).Compared with Group B,the neurological score of Group C were obviously increased,while the water content in the brain tissue,Evans blue staining,AQP4 positive cells,AQP4 (6 hours:1.51 ±0.27 vs.1.73 ±0.31;24 hours:2.13 ±0.13 vs.2.47±0.27;48 hours:1.84 ±0.22 vs.2.18 ±0.19) and Caspase-3 protein expression (6 hours:0.44±0.09vs.0.53±0.18;24 hours:0.46±0.10vs.0.58±0.16;48 hours:0.48±0.12 vs.0.59 ± 0.11) and apoptosis index in brain tissue of Group C were significantly decreased (all P ＜ 0.05).Conclusion Hypertonic saline can attenuate TBI-induced brain edema and have a significant neuroprotective effect,possibly by down-regulating the expressions of AQP4 and caspase-3.

The safety and efficacy of fluid resuscitation with hypertonic saline in traumatic hypovolemic shock:a meta-analysis / 中国医师杂志

Objective To assess the safety and efficacy of hypertonic saline in traumatic hypovolemic shock with Meta-analysis.Methods Comprehensive electronic search strategies were developed using the following electronic databases:PubMed,EMBASE,Medline,Ovid、Clinical Trials,CNKI,Wan Fang,CBM and FMJS.The Literature published before August of 2017 was searched.The randomized controlled trials (RCTs) about hypertonic saline in traumatic hypovolemic shock were included.A data-extraction sheet was developed based on the preset standards.The data from eligible studies were pooled through Meta-analysis.Results 9 trials with a total of 1600 patients (741cases in observation group,859 cases in control group) met the inclusion criteria.The meta-analysis showed that the hypertonic saline group displayed remarkable increase in the systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group [MD =6.43,95％ CI(1.16,11.70),P ＜0.05],[MD =-5.99,95％ CI (-9.04,-2.95),P ＜0.05].The level of serum sodium [MD =7.94,95％ CI(7.39,8.50),P ＜0.05],serum chloride [MD =9.67,95 ％ CI(8.77,10.57),P ＜ 0.05] and osmolality [MD =18.11,95％ CI (10.73,25.49),P ＜ 0.05] in the hypertonic saline group was increased significantly but acceptable.No significant difference in mortality was found between the hypertonic saline group and the isotonic saline group [OR =0.88,95％ CI(0.69,1.11),P ＞ 0.05].Conclusions Available evidence shows that small volume hypertonic Sodium Chloride saline is safe and effective for resuscitation in patients with traumatic hemorrhagic shock.Since the quality of the inclued studes were not high,more high-quality,multicenter randomized controlled clinical studies need to provide better evidence for the above conclusion.

Combinatorial therapy with two pro-coagulants and one osmotic agent reduces the extent of the lesion in the acute phase of spinal cord injury in the rat.

BACKGROUND: Spinal cord injury (SCI) is a complex disease that leads to a motor, sensitive, and vegetative impairment. So far, single therapies are ineffective for treating SCI in humans and a multifactorial therapeutic approach may be required. The aim of this work was to assess the effect of a triple therapy (TT) associating two pro-coagulant therapies (tranexamic acid and fibrinogen) with an anti-edema therapy (hypertonic saline solution), on the extent of the lesion 24 h post-injury. METHODS: The design of this study is a randomized controlled study. The setting of this study is an experimental study. Male Wistar rats were assigned to receive saline solution for the control group or one of the treatment, or a combination of two treatments or the three treatments (triple therapy group (TT)). Animals were anesthetized and received a weight-drop SCI induced at the level of the 12th thoracic vertebra (Th12). They were treated by single therapies, double therapies, or TT started 5 min after the SCI. RESULTS: The extent of the lesion was assessed 24 h after injury by spectrophotometry (quantification of parenchymal hemorrhage and blood-spinal cord barrier disruption) and by histology (quantification of spared neuronal tissue). As compared with the control group, the TT significantly reduced parenchymal hemorrhage (p < 0.05) and improved the total amount of intact neural tissue, measured 24 h later (p = 0.003). CONCLUSIONS: Combinatorial therapy associating two pro-coagulants (tranexamic acid and fibrinogen) with an anti-edema therapy (hypertonic saline solution) reduces the extent of the lesion in the acute phase of spinal cord injury in the rat.

Perconditioning associated to hypertonic saline solution on liver function improvement after ischemia/reperfusion injury

Abstract Purpose: To evaluate the effects of hypertonic saline solution associated to remote ischemic perconditioning in liver ischemia/reperfusion injury in rats. Methods: 25 male rats (Wistar) were distributed into five groups: Sham group (S); Ischemia/Reperfusion group (I/R) with 30 minutes of liver ischemia; Remote ischemic perconditioning group (Per) with three cycles of 10 minutes of I/R performed during liver ischemia; Hypertonic saline solution group (HSS) treated with hypertonic saline solution (4ml/kg); Remote ischemic perconditioning + Hypertonic saline solution group (Per+HSS) with both treatments. Results: Per+HSS group showed a lower degree of liver dysfunction in relation to I/R group, whereas the technique of remote ischemic perconditioning isolated or associated with saline solution significantly improved liver function and reduced histological damage. Conclusion: Remote ischemic perconditioning associated or not to saline solution promoted reduction of acute liver injury induced by ischemia/reperfusion.

[Hyponatremia in emergency admissions - often dangerous]. / Hyponatriämie in der Notaufnahme ­ häufig gefährlich.

Hyponatremia is the most common electrolyte disorder in clinical practice and associated with increased morbidity and mortality, independent of underlying disease. Untreated acute hyponatremia can cause substantial morbidity and mortality as a result of osmotically induced cerebral edema whilst over rapid correction of chronic hyponatremia can cause serious neurologic impairment and death resulting from osmotic demyelination. Still hyponatremia is often neglected and insufficiently addressed, most likely due to limited understanding of its pathophysiological mechanisms. Being familiar with only few basic principles of body fluid regulation may be a worthwhile investment into the clinical career and save patients' lives.

[Effects of hypertonic sodium saline resuscitation on the liver damage of rats at early stage of severe scald].

Objective: To explore the effects of hypertonic sodium saline (HSS) resuscitation on the liver damage of rats at early stage of severe scald. Methods: Fifty-six SD rats were divided into sham injury group (SI, n=8), lactated Ringer's solution group (LRS, n=24), and group HSS (n=24) according to the random number table. Rats in group SI were sham injured without resuscitation, while rats in the other two groups were reproduced deep partial-thickness to full-thickness scald model with 30% total body surface area on the back. Rats in group LRS were resuscitated with LRS, while rats in group HSS were resuscitated with 300 mmol/L sodium ion solution according to the Parkland formula. Blood of abdominal aorta and liver of 8 rats in group SI immediately post injury and in the other two groups at post injury hour (PIH) 2, 8, and 24 respectively were collected. Then liver water content was determined by dry-wet weight method. Serum content of alanine aminotransferase (ALT) and aspartate transaminase (AST) was detected by automatic biochemical analyzer. Serum content of tumor necrosis factor α (TNF-α), interleukin-1 (IL-1), and high mobility group box 1 (HMGB1) was determined by enzyme-linked immunosorbent assay. Liver content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected by ultraviolet spectrophotometer. Pathologic changes of liver were observed by HE staining. Data were processed with one-way analysis of variance and SNK test. Results: (1) At PIH 2, 8, and 24, liver water content of rats in group LRS was higher than that in group SI and group HSS (P<0.05 or P<0.01). (2) At PIH 2, serum ALT content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum ALT content of rats in group HSS and group LRS was higher than that in group SI (P<0.05 or P<0.01), and serum ALT content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, 8, and 24, serum AST content of rats in group HSS and group LRS was higher than that in group SI (with P values below 0.01). At PIH 2 and 8, serum AST content of rats in group HSS was lower than that in group LRS (P<0.05 or P<0.01). (3) At PIH 2 and 8, serum TNF-α content of rats in group LRS was (123±39) and (153±38) pg/mL respectively, higher than that in group SI [(60±18) pg/mL] and group HSS [(85±10) and (94±16) pg/mL respectively, with P values below 0.01]. At PIH 8, serum TNF-α content of rats in group HSS was higher than that in group SI (P<0.05). At PIH 24, serum TNF-α content of rats in the three groups was similar (with P values above 0.05). At PIH 2, 8, and 24, serum IL-1 content of rats in group LRS was (122±35), (141±30), and (122±31) pg/mL respectively, and that in group HSS was (80±12), (93±15), and (80±11) pg/mL respectively, all higher than that in group SI [(40±17) pg/mL, with P values below 0.01]; serum IL-1 content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, serum HMGB1 content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum HMGB1 content of rats in group LRS was (0.386±0.146) and (0.590±0.188) ng/mL respectively, higher than that in group SI [(0.050±0.027) ng/mL] and group HSS [(0.143±0.038) and (0.309±0.095) ng/mL respectively, with P values below 0.01]. At PIH 24, serum HMGB1 content of rats in group HSS was higher than that in group SI (P<0.01). (4) At PIH 2, 8, and 24, liver MDA content of rats in group HSS and group LRS was higher than that in group SI and their liver SOD content was lower than that in group SI (with P values below 0.01); liver MDA content of rats in group HSS was lower than that in group LRS and their liver SOD content was higher than that in group LRS (with P values below 0.01). (5) Compared with those of rats in group SI, liver cells of rats in group LRS showed massive steatosis at each time point, and liver cell-edema appeared at PIH 8 and 24; while liver cells of rats in group HSS showed little steatosis only at PIH 8 and 24, and the liver cell-edema never appeared. Conclusions: Compared with LRS, HSS resuscitation can alleviate liver injury of rats at the early stage of severe scald through relieving inflammatory mediators and reducing degree of oxidative stress, etc.

Effects of hypertonic sodium saline resuscitation on the liver damage of rats at early stage of severe scald / 中华烧伤杂志

Objective@#To explore the effects of hypertonic sodium saline (HSS) resuscitation on the liver damage of rats at early stage of severe scald.@*Methods@#Fifty-six SD rats were divided into sham injury group (SI, n=8), lactated Ringer′s solution group (LRS, n=24), and group HSS (n=24) according to the random number table. Rats in group SI were sham injured without resuscitation, while rats in the other two groups were reproduced deep partial-thickness to full-thickness scald model with 30% total body surface area on the back. Rats in group LRS were resuscitated with LRS, while rats in group HSS were resuscitated with 300 mmol/L sodium ion solution according to the Parkland formula. Blood of abdominal aorta and liver of 8 rats in group SI immediately post injury and in the other two groups at post injury hour (PIH) 2, 8, and 24 respectively were collected. Then liver water content was determined by dry-wet weight method. Serum content of alanine aminotransferase (ALT) and aspartate transaminase (AST) was detected by automatic biochemical analyzer. Serum content of tumor necrosis factor α (TNF-α), interleukin-1 (IL-1), and high mobility group box 1 (HMGB1) was determined by enzyme-linked immunosorbent assay. Liver content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected by ultraviolet spectrophotometer. Pathologic changes of liver were observed by HE staining. Data were processed with one-way analysis of variance and SNK test.@*Results@#(1) At PIH 2, 8, and 24, liver water content of rats in group LRS was higher than that in group SI and group HSS (P<0.05 or P<0.01). (2) At PIH 2, serum ALT content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum ALT content of rats in group HSS and group LRS was higher than that in group SI (P<0.05 or P<0.01), and serum ALT content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, 8, and 24, serum AST content of rats in group HSS and group LRS was higher than that in group SI (with P values below 0.01). At PIH 2 and 8, serum AST content of rats in group HSS was lower than that in group LRS (P<0.05 or P<0.01). (3) At PIH 2 and 8, serum TNF-α content of rats in group LRS was (123±39) and (153±38) pg/mL respectively, higher than that in group SI [(60±18) pg/mL] and group HSS [(85±10) and (94±16) pg/mL respectively, with P values below 0.01]. At PIH 8, serum TNF-α content of rats in group HSS was higher than that in group SI (P<0.05). At PIH 24, serum TNF-α content of rats in the three groups was similar (with P values above 0.05). At PIH 2, 8, and 24, serum IL-1 content of rats in group LRS was (122±35), (141±30), and (122±31) pg/mL respectively, and that in group HSS was (80±12), (93±15), and (80±11) pg/mL respectively, all higher than that in group SI [(40±17) pg/mL, with P values below 0.01]; serum IL-1 content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, serum HMGB1 content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum HMGB1 content of rats in group LRS was (0.386±0.146) and (0.590±0.188) ng/mL respectively, higher than that in group SI [(0.050±0.027) ng/mL] and group HSS [(0.143±0.038) and (0.309±0.095) ng/mL respectively, with P values below 0.01]. At PIH 24, serum HMGB1 content of rats in group HSS was higher than that in group SI (P<0.01). (4) At PIH 2, 8, and 24, liver MDA content of rats in group HSS and group LRS was higher than that in group SI and their liver SOD content was lower than that in group SI (with P values below 0.01); liver MDA content of rats in group HSS was lower than that in group LRS and their liver SOD content was higher than that in group LRS (with P values below 0.01). (5) Compared with those of rats in group SI, liver cells of rats in group LRS showed massive steatosis at each time point, and liver cell-edema appeared at PIH 8 and 24; while liver cells of rats in group HSS showed little steatosis only at PIH 8 and 24, and the liver cell-edema never appeared.@*Conclusions@#Compared with LRS, HSS resuscitation can alleviate liver injury of rats at the early stage of severe scald through relieving inflammatory mediators and reducing degree of oxidative stress, etc.

Nasal irrigation treatment for gestational rhinitis: a pilot study / 中国耳鼻咽喉头颈外科

OBJECTIVE Gestational rhinitis(GR) is a relatively common condition in women during pregnancy.Patients with GR often complain of nasal obstruction and rhinorrhea.The exact mechanism of GR are not clear.Safe and effective treatments for this disease have not been found to date.The aim of this study is to find an appropriate treatment method for GR.METHODS Thirty patients with GR were randomly divided into two groups.There were 15 patients in hypertonic saline group with a mean age of 28.73 years (range 24-31 years),and 15 patients in normal saline group with a mean age of 25.93 years (range 24-31 years).Hypertonic saline group was treated using 3.0％ saline with a temperature of 40℃ nasal irrigation,and normal saline group was treated with 0.9％ saline with a temperature of 40℃ nasal irrigation.The duration of the intervention period was 4 weeks.Visual Analog Scale(VAS) was used to evaluate the nasal symptoms including nasal obstruction and rhinorrhea,and the health-related quality of life was assessed with the 12-item Short Form Health Survey version 2.0(SF-12v2).Contents of histamine(HIS) and acetylcholinesterase(ACHE) in nasal lavage fluid(NLF) was assessed before and after 4-week treatment in the two groups in the study.RESULTS There were 28 patients completed the study.The total VAS scores of nasal symptoms including nasal obstruction and rhinorrhea decreased,and SF-12v2 score increased in the hypertonic saline group after 2-week,3-week and 4-week interventions.Furthermore,ACHE in NLF was also increased after 4-week treatment,but HIS showed no statistical changes.The VAS scores of nasal obstruction and rhinorrhea and SF-12v2 score after 2-week,3-week and 4-week interventions,and the contents of HIS and ACHE in NLF after 4-week treatment showed no statistical differences in the normal saline nasal irrigation group.There were statistical differences in the VAS scores of nasal obstruction and rhinorrhea,SF-12v2 score and ACHE in NLF after 4-week treatment,and no significant differences in the content of HIS in NLF between the 2 groups.CONCLUSION Hypertonic saline nasal irrigation is a safe and effective treatment for GR.

Atualizações no tratamento de bronquiolite viral aguda / Updates on acute bronchiolitis treatment

Bronquiolite viral aguda consiste em uma afecção viral que acomete lactentes com idade inferior a dois anos, sendo o pico de incidência abaixo de seis meses de vida. O quadro clínico consiste em sintomas de infecção de vias aéreas superiores, que evolui após dois a quatro dias com cansaço, dispneia, taquipneia, além de esforço respiratório. Febre e redução da aceitação da dieta também podem ocorrer. Apneia tem sido relatada em casos graves ou em prematuros. O diagnóstico baseia-se na história clínica e no exame físico, sendo exames complementares reservados quando há suspeita de outros diagnósticos ou de complicações. O tratamento é suportivo, sendo a oxigenoterapia indicada para pacientes com saturação de oxigênio abaixo de 90%. Atualmente, o corticoide oral não tem indicação no tratamento. Broncodilatadores não são indicados de rotina e o uso da salina hipertônica é controverso. O antiviral, ribavirina, tem indicação em casos específicos, devido aos efeitos adversos e ao alto custo. A profilaxia da BVA é fundamental, sendo a lavagem das mãos e o uso de álcool, de máscaras e de luvas essenciais para prevenção da doença. Como medicação profilática, o palivizumabe é indicado apenas em casos selecionados.(AU)

Acute bronchiolitis consists of a viral infection that affects children younger than 2 years old, with the peak of incidence under 6 months. The clinical disease has symptoms of infection of the upper airway, which develops after 2-4 days with fatigue, dyspnea, tachypnea, and respiratory effort. Fever and reduction of dietary compliance, may also occur. Apnea has been reported in severe cases or premature. The diagnosis is based on clinical history and physical examination, reserved additional tests when there is a suspicion of other diagnoses or complications. Treatment is supportive, the oxygen therapy is indicated for patients with oxygen saturation under 90%. Currently, oral corticosteroids has no indication for the treatment. The use of bronchodilators is not routinely indicated and the use of hypertonic saline is controversial. The use of the antiviral ribavirin is indicated in specific cases because there are adverse effects and high costs. Prophylaxis of bronchiolitis is fundamental, and hand-washing, use of alcohol, use of masks and gloves are essential for disease prevention. The use of palivizumab is indicated in selected cases.(AU)

Efeito da solução salina hipertônica associada à pentoxifilina sobre a lesão renal aguda após obstrução e isquemia intestinal em ratos / Effect of hypertonic saline solution associated to pentoxifylline on acute renal failure after obstruction and intestinal ischemia in rats

O tratamento da lesão renal aguda decorrente do processo inflamatório sistêmico e sepse é um desafio à prática clínica. A reanimação volêmica promove o aumento da sobrevida e menos complicações sistêmicas. Entretanto, persiste a controvérsia sobre qual o melhor fluido para a reposição e outras medicações que possam auxiliar nessa terapêutica. O objetivo deste estudo é avaliar os efeitos do Ringer lactato, da solução salina hipertônica e da pentoxifilina sobre a lesão renal aguda decorrente da obstrução e isquemia intestinal, em um modelo experimental. Métodos: Foram utilizados ratos Wistar machos, com peso entre 250 e g. Os animais foram submetidos a laparotomia mediana para obstrução em alça fechada do íleo terminal associada a oclusão do pedículo vascular deste segmento. Após 24 horas, os animais foram reoperados e distribuídos em grupos (n = 8), conforme o tratamento: sem reanimação volêmica (Controle); Ringer lactato - 32 mL / kg (RL); solução salina hipertônica 7,5% - 4 mL / kg (SH); pentoxifilina 25 mg / kg (PTX); Ringer lactato e pentoxifilina (RLPTX); solução salina hipertônica e pentoxifilina (SHPTX). Ao término do tratamento, o segmento intestinal obstruído e isquêmico foi ressecado e o trânsito intestinal foi reconstruído por anastomose primária. Após três horas, os animais foram sacrificados. Amostras de tecido renal foram coletadas para análise histológica com hematoxilina-eosina, imuno-histoquímica com Bcl-2, Bax e TUNEL e dosagem de malondialdeído e nitrito. Resultados: Em relação aos achados histológicos, não houve diferença significante entre os grupos. A avaliação imuno-histoquímica demonstrou que o grupo SHPTX apresentou menos eventos de apoptose e produção de óxido nítrico do que os demais grupos (p < 0,01). Já os grupos com reposição volêmica (RL e SH) também apresentaram menos eventos de apoptose (p < 0,05) do que os grupos Controle e PTX. Conclusão: A pentoxifilina associada à solução salina hipertônica 7,5%, em modelo de...

Treatment of acute kidney injury due to systemic inflammatory response syndrome and sepsis is a challenge in clinical practice. Fluid resuscitation promotes increased survival and lower systemic complications, though some discussions related to best fluid and medications that should be used persist. This study aims to evaluate the effects of Ringer lactate, hypertonic saline solution and pentoxifylline on acute kidney injury due to intestinal obstruction and ischemia in an experimental model. Methods: 48 male Wistar rats weighing between 250 and 300 g were used. The animals underwent laparotomy for closed loop obstruction of the terminal ileum associated with occlusion of the vascular pedicle of this segment. After 24 hours, the animals were re-operated and divided in six groups (n = 8), according to treatment: no fluid resuscitation (Control); Ringer lactate - 32 mL / kg (RL); hypertonic saline solution ,5% - 4 mL / kg (SH); pentoxifylline 25 mg / kg (PTX); Ringer lactate and pentoxifylline (RLPTX); hypertonic saline solution and pentoxifylline (SHPTX). After treatment, the obstructed and ischemic intestinal segment was resected and intestinal transit was restablished by primary anastomosis. After three hours, the animals were euthanized. Kidney tissue samples were collected for histological analysis with hematoxylin-eosin, immunohistochemistry with Bcl-2, Bax and TUNEL and malondialdehyde and nitrite dosage. Results: Regarding histological findings, there was no significant difference between groups. In Immunohistochemical evaluation, the group SHPTX had less apoptosis events and nitric oxide production than the other groups (p < , The groups that received fluid resuscitation (RL and SH) also had fewer apoptotic events (p < than the group Control and the group PTX. Conclusion: Pentoxifylline associated with hypertonic saline 7, , in an experimental rat model of obstruction and intestinal ischemia, attenuates renal injury, especially as...

Effect of hypertonic saline on permeability of blood-brain barrier in a rat model of intracerebral hemorrhage / 中华麻醉学杂志

Objective To investigate the effect of hypertonic saline (HS) on the permeability of blood-brain barrier in a rat model of intracerebral hemorrhage (ICH).Methods Sixty healthy male Sprague-Dawley rats, aged 8 weeks, weighing 260-300 g, were randomly divided into 4 groups (n=15 each) using a random number table: sham operation group (group S), sham operation+HS group (group HS) ,ICH group, and ICH+HS group.ICH was commonly induced in anesthetized rats by intraparenchymal injection of autologous blood 50 μ1.The equal volume of normal saline was given instead in group S.The neurologic deficits were scored on a five-point scale, and a score of 1-3 indicated successful establishment of the model.At 48 h after establishment of the model, the rats were sacrificed, and brains were removed for determination of brain water content, expression of occludin in brain tissues (by Western blot) , and Evans blue content.Results Compared with group S, the brain water content and Evans blue content were significantly increased, and the expression of occludin was down-regulated in ICH and ICH+HS groups, and no significant change was found in the indices mentioned above in group S+HS.Compared with group ICH,the brain water content and Evans blue content were significantly decreased, and the expression of occludin was up-regulated in group ICH +HS.Conclusion HS can inhibit increase in the permeability of bloodbrain barrier, and reduce the cerebral edema in a rat model of ICH.

Effect of suberoylanilide hydroxamic acid combined with hypertonic saline on the hemodynamics of hemorrhagic shock rats / 中国组织工程研究

BACKGROUND:Studies have shown that suberoylanilide hydroxamic acid (SAHA) has protective effects in some vital organs in animals after hemorrhagic shock, and 7.5% hypertonic saline (HS) exerts significant effects on stabilizing the hemodynamics of hemorrhagic shock animals. OBJECTIVE:To evaluate the effect of SAHA combined with HS on the hemodynamics of hemorrhagic shock rats. METHODS: Fifty rats were randomly and equaly divided into five groups: sham, shock non-resuscitation, SAHA, 7.5% HS, and 7.5% HS + SAHA. Each group contained 10 rats. Except the sham group, rats in the remaining four groups were applied to establish hemorrhagic shock models. In the sham group, rats were given anesthesia catheter, not bleeding; in the shock non-resuscitation group, the bleeding was found, but rats were not resuscitated and were kiled after 60 minutes of observations; in the other three groups, rats were respectively resuscitated at 60 minutes after bleeding, through intravenous administration of SAHA within 5 minutes, 7.5% HS and SAHA + 7.5% HS within 20 minutes. Heart rate, mean arterial pressure and left ventricular systolic pressure were monitored through the femoral artery and the right common carotid artery catheter in each group. RESULTS AND CONCLUSION:At 3 hours after resuscitation, the heart rate was the highest in the 7.5% HS + SAHA group, compared with the SAHA and 7.5% HS groups (P < 0.05). After resuscitation, the mean arterial pressure and left ventricular systolic pressure were increased, with long-lasting effect and less fluctuation (P < 0.05). Experimental results show that 7.5% HS combined with SAHA has a superiority than traditional HS and simple drugs for resuscitation after hemorrhagic shock.

A Case of Gastric Intramural Hematoma after Endoscopic Injection of Hypertonic Saline-Epinephrine for Hemostasis

A gastric intramural hematoma is very rare and commonly associated with trauma, anticoagulation therapy, coagulopathy, pancreatic disease, aneurysm and peptic ulcer disease. This is a case of gastric intramural hematoma which occurred in a patient taking aspirin after hypertonic saline-epinephrine injection for bleeding from a biopsy site. We describe a case of gastric intramural hematoma that was successfully managed with conservative therapy.