The application of tissue engineering in reversing mitomycin C-induced ischemic conjunctiva.

The purpose of this study is to evaluate the angiogenic potential of collagen-glycosaminoglycan (CG) matrices in mitomycin C-induced ischemic conjunctival defect, in New Zealand white rabbits. After creating a conjunctival defect at the center of ischemic conjunctiva, a CG matrix was implanted into subconjunctival space to evaluate the conjunctival reepithelialization and angiogenesis during the wound healing process. In the grafted group, the vessel count of the healed conjunctiva was substantially elevated by two fold within the initial 4 weeks and the increased vascular content originated mostly from the fornix site. The rate of conjunctival reepithelialization was not retarded in the grafted group, and the final thickness of healed conjunctiva was similar in both grafted and ungrafted groups. The histological studies revealed that the collagen matrix did not elicit pronounced inflammatory reaction and the regenerated conjunctiva showed loosely arranged collagen deposition without significant scar formation. The α SMA staining positive myofibroblasts were identified in the acute inflammatory stage and were absent, 8 weeks after implantation in both groups. The results indicated that the porous collagen scaffold was able to enhance vascularization and physiological recovery of ischemic conjunctival defect, implying a potential alternative therapy for the ischemic leaking bleb after glaucoma filtrating surgery in ophthalmic practices.

Platonin mitigates acute lung injury in haemorrhagic shock rats.

AIM OF THE STUDY: Enhanced oxidative stress and inflammatory response are crucial in mediating the development of acute lung injury induced by haemorrhagic shock with resuscitation. Platonin, a potent antioxidant, possesses potent anti-inflammation capacity. We sought to elucidate whether platonin could mitigate acute lung injury in haemorrhagic shock/resuscitation rats. METHODS: Seventy-two adult male rats were randomized to receive haemorrhagic shock/resuscitation (HS), HS plus platonin (10, 50, or 100µg/kg intravenous injection immediately after resuscitation), sham instrumentation (Sham), or Sham plus platonin (100µg/kg) (n=12 in each group). Haemorrhagic shock was induced by blood drawing and mean blood pressure was maintained at 40-45mmHg for 120min. Then, resuscitation was achieved by shed blood/saline mixtures re-infusion. After monitoring for another 8h, rats were sacrificed. RESULTS: Arterial blood gas and histological findings, in concert with assays of leukocyte infiltration (polymorphonuclear leukocytes/alveoli ratio and myeloperoxidase activity) and lung water content (wet/dry weight ratio), confirmed that haemorrhagic shock/resuscitation caused significant lung injury. Significant increases in concentrations of inflammatory molecules (chemokine, cytokine, and prostaglandin E(2)) as well as nitric oxide and malondialdehyde in lung tissues confirmed that haemorrhagic shock/resuscitation elicited inflammatory response and imposed oxidative stress in rats. Platonin at the dosages of 50 and 100µg/kg, but not 10µg/kg, significantly attenuated the inflammatory response and oxidative stress induced by haemorrhagic shock/resuscitation. Most important, platonin at the dosages of 50 and 100µg/kg, but not 10µg/kg, significantly mitigated the lung injury induced by haemorrhagic shock/resuscitation. CONCLUSIONS: Platonin mitigates acute lung injury in haemorrhagic shock/resuscitation rats.

Anesthetic management of Boerhaave's syndrome.

Boerhaave's syndrome or spontaneous esophageal perforation is a life threatening condition which demands early diagnosis and urgent management. Although very selective patients can be treated nonoperatively, in most patients, better overall results can only be attained with early aggressive surgery. Clinical data and accounts of anesthetic management of this condition scarely appear in medical literature. Managing these patients for surgery is among the most challenging tasks facing the anesthesiologist because they may develop septic syndrome with shock. A rapid-sequence induction is mandatory, and the procedures that may aggravate the injury to esophagus should be avoided. Inotropic support and close attention to fluid balance may be required during operation. Because Boerhaave's syndrome is rare, we report here two cases to illustrate possible anesthetic implications of this disease. Both patients underwent thoracotomy to relieve empyema of mediastinum under general anesthesia. The first patient recovered completely after operation due to early diagnosis and treatment, but the second patient developed multiple organ failure and died after operation due to delayed diagnosis of esophageal rupture and severe sepsis. Because survival is directly related to the time to diagnosis and treatment, all clinicians need to be aware of this lethal disease.