Hepatocyte protection of ethyl pyruvate in septic mice

AIM:To study the protective effect of ethyl pyruvate (EP) on hepatocytes in septic mice. METHODS:The cecal ligation-perforation was made in mice as septic model. Ringers ethyl pyruvate solution (REPS) and Ringers lactic solution (RLS) were used to resuscitate septic mice. Anti-oxidative capacity of hepatic tissue and liver function were detected in different groups. RESULTS:Anti-oxidative capacity in septic mice was significantly lower than that in sham group (P<0.01). EP promoted the anti-oxidative capacity of hepatic tissue in septic mice. Malondialdehyde level was lower in REPS group than that in RLS group ［(48.18±5.98) μmol·g-1 protein vs (78.34±11.16) μmol·g-1 protein］, superoxide dismutase ［(5.19±1.41)103 U/g protein vs (3.20±1.08)103 U/g protein］ and total anti-oxidative capacity ［(7.02±1.79)103 U/g protein vs (4.77±1.35)103 U/g protein］ level were higher in REPS group than those in RLS group (P<0.01). Alanine aminotransferase in REPS group were lower than that in RLS group ［(210.06±23.36) U vs (458.86±51.55) U, P<0.01］. CONCLUSION:Ethyl pyruvate is an effective anti-oxidant in septic mice, which significantly increases the anti-oxidative capacity in hepatic tissue and ameliorates liver function.     

Mechanisms of hepatocytic mitochondria damage following septic shock

AIM: To study mechanism of hepatocytic mitochondria damage following septic shock. METHODS: 30 SD rats were randomly divided into three groups: sham operation group, 12 h cecal ligation and puncture (CLP) group and 16 h CLP group. The model of septic shock was made by cecal ligation and puncture. The liver mitochondria respiratory control rate (RCR), phosphate/oxygen (P/O) and ATPase activities were assayed. RESULTS: In 12 h CLP group mean artery pressure (MAP) [(9.54±1.26)kPa] was significantly lower than sham operation group [(14.58±1.32)kPa,P<0.05]. However, mortality was obviously higher than sham operation group (P<0.05), the liver mitochondria respiratory control rate (1.27±0.25), phosphate/oxygen (1.67±0.34) and Na⁺-K⁺-ATPase (40.80±3.45), Ca²⁺-ATPase (58.00±2.43), Mg²⁺-ATPase (78.30±4.16), Ca²⁺-Mg²⁺-ATPase(2.70±2.25) activities decreased strikingly. The difference between 12 h CLP group and sham operation group was significant (P<0.05), 16 h CLP groups was more lower than 12 h CLP group. As RCR, P/O and ATPase activities were significantly reduced, mortality significantly increased. Futhermore, obvious positive correlation was showed between them (r=0.892,P<0.01;r=0.834,P<0.01). CONCLUSION: Liver mitochondria function of ingestion-oxygen and phosphorus-acidification are decreased and membrane fluxion is weaken. Energy metabolism is blocked and Ca²⁺-Mg²⁺ shows imbalanced. All of them cause hepatocytic mitochondria injury following septic shock.     

Effect of heat shock protein 70 expression induced by glutamine on vascular hyporeactivity in rats caused by LPS

AIM: To observe the effect of heat shock protein 70(HSP70) expression induced by glutamine on Escherichia coli lipopolysaccharides(LPS)-induced vascular hyporeactivity in rats.METHODS: Twenty four healthy male Sprague-Dawley rats were randomly divided into: the control group (n=8);LPS shock group (n=8);glutamine(Gln) treated group (Gln 0.75 g·kg-1 iv,n=8).6 h after LPS shock,phenylephrine (PE,0.5-2.5 μg·kg-1 ) was applied intravenously to all groups and the percentage increase in mean arterial pressure(MAP) was detected,respectively.The concentration-response curves of aorta rings were obtained by cumulative addition of phenylephrine (PE),and PE Emax,EC50 were calculated.The blood concentration of malondialdehyde (MDA),TNF-α and IL-6 were assayed in all groups 30 min and 360 min after LPS shock,respectively.The expressions of HSP70 from heart and aorta were also assayed after 6 h LPS shock.RESULTS: The MAP level induced by PE significantly decreased by 51.4% in LPS shock group compared with the control (P<0.05).However,PE induced MAP level increased by 17.5% in Gln group compared with LPS shock group (P<0.05).Emax and EC50 to PE were significant reduced in LPS shock group compared with control group (P<0.05),but significantly improved in Gln group (P<0.05).The expressions of HSP70 from heart and aorta were much higher in Gln group than those in LPS shock group (P<0.05).The blood concentrations of TNF-α,IL-6 and MDA were much lower in Gln group than those in LPS shock group.CONCLUSION: Glutamine effectively improves α-adrenergic receptor-mediated vascular reactivity through inducing the expression of HSP 70,reducing inflammatory cytokine release and peroxide biosynthesis in LPS shock.These results suggest that glutamine have potential beneficial therapeutic effect for septic shock patients.     

Mechanism of mesenteric lymph duct ligation against the renal insufficiency in hemorrhagic shock rats

AIM: To observe the effect of mesenteric lymph duct ligation on free radical and inflammatory mediator in serious hemorrhagic shock rats at different periods, and explore the mechanism of intestinal lymphatic pathway on renal insufficiency. METHODS: 78 male Wistar rats were divided into the sham group, shock group, and ligation group. The model of serious hemorrhagic shock was established in shock group, ligation group, and mesenteric lymph was blocked by ligating mesenteric lymph duct in ligation group after resuscitating. All rats were executed and kidneys were taken out for making homogenate of 10 percent to determine levels of MDA, SOD, NO, NOS, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and myeloperoxidase (MPO) at time points after shock 90 min, after transfusion and resuscitate 0 h, 1 h, 3 h, 6 h, 12 h and 24 h. The expression of inducible nitric oxide synthase (iNOS) mRNA in kindey was detected by RT-PCR. RESULTS: The contents of MDA, NO, NOS, TNF-α, IL-6, MPO and iNOS expressions in renal homogenate of shock group were increased after transfusion and resuscitation, and were higher at 6 h and 12 h, and was significantly higher than that in sham group. The acvitity of SOD was significantly lower than that in sham group (P<0.01, P<0.05). The contents of MDA, NO, NOS, TNF-α, IL-6, MPO and iNOS expression in renal homogenate of ligation group after transfusion and resuscitation 6 h, 12 h and 24 h were significantly lower than those in shock group at same points, and the SOD activity was higher (P<0.01, P<0.05). CONCLUSION: The results demonstrate that the ligation of mesenteric lymph duct can antagonise the development of renal failure in serious hemorrhagic shock rats, and its mechanism might relate to reduce the PMN sequestration, decrease the levels of TNF-α and IL-6, inhibit NO production and expression of iNOS mRNA, suppress the release of free radical and consumption of SOD.     

Change of endogenous hydrogen sulfide/cystathionine-γ-lyase system in acute lung injury induced by LPS in rats

AIM: To observe the changes of endogenous hydrogen sulfide/cystathionine-γ-lyase (H2S/CSE) system while acute lung injury induced by LPS in rats. METHODS: Eighty rats were randomly divided into six groups (n=8): Ⅰ, control group;Ⅱ, LPS 1 h group; Ⅲ, LPS 3 h group; Ⅳ, LPS 6 h group; Ⅴ, LPS 9 h group; Ⅵ, LPS 12 h group. The ALI model of rats was prepared with LPS. The rats were respectively killed at 1, 3, 6, 9 or 12 h after administration of LPS. The morphological changes of lung tissues were observed by light and electron microscope. The lung coefficient and the wet-to-dry weight ratio were measured. The contents of IL-1β and IL-10 in serum, the H2S level in plasma and the CSE activity in lung tissue were respectively detected. RESULTS: ⑴ In LPS 1 h group, the morphology, the lung coefficient, the wet-to-dry weight ratio, the H2S level and the CSE activity showed no changes compared with the control group. The contents of IL-1β and IL-10 were increased compared with the control group (IL-1β, P<0.05;IL-10, P<0.01). ⑵ In LPS 3 h, 6 h, 9 h and 12 h groups, compared with the control group, the lung tissues were significantly damaged, the lung coefficient and the wet-to-dry weight ratio were significantly increased respectively (LPS 3 h, P<0.05; LPS 6 h, 9 h, 12 h, P<0.01). The contents of IL-1β and IL-10 in serum were markedly increased (P<0.01). The H2S level in plasma and the CSE activity in lung tissue were significantly decreased (P<0.01).CONCLUSION: The changes of inflammatory cytokines may be the pathological foundation of the ALI induced by LPS and the endogenous hydrogen sulfide/cystathionine-γ-lyase system is possibly involved in the formation of the ALI.     

中甘21号

AIM: To observe the pathological role of 3-nitrotynosine (3-NT) on Escherichia coli LPS-induced vascular hyporeactivity in rats and the therapeutic effect of antioxidants. METHODS: Forty male SD rats weighting from 200 g to 250 g were randomly divided into four groups: the control group (n=10); LPS shock group (n=10); uric acid-treated group (n=10); melatonin-treated group (n=10). 6 h after LPS shock, phenylephrine (0.5-2.5 μg·kg-1) was applied intravenously to all groups and the percentage increase in MAP was detected, respectively. The concentration-response curve of aorta rings from all groups rats were obtained by cumulative addition of phenylephrine (PE), and PE Emax, EC50 were calculated. The concentrations of plasma malondialdehyde (MDA), nitrate/nitrite and 3-NT were assayed in all groups 6 h after LPS shock. RESULTS: The MAP level induced by PE significantly decreased to 54.60% in LPS shock rats compared with the control (P<0.05). However, PE induced MAP level increased 37.70% and 43.05% in uric acid and melatonin treated rats, respectively, compared with the LPS shock rats (P<0.05). The maximum response and EC50 to PE were significant reduced in LPS shock rats ［Emax, 35.30%±9.80%; EC50, (15.70±4.50)nmol/L］ compared with control group ［Emax, 100%; EC50, (4.71±2.04)nmol/L, P<0.05］; but the reactivity of aorta to PE was improved obviously in uric acid and melatonin treated groups (P<0.05). The plasma concentration of MDA, nitrate/nitrite and 3-NT were much lower in uric acid and melatonin groups than those in LPS shock group (P<0.05). CONCLUSIONS: 3-NT is an important pathological factor on vascular hyporeactivity in LPS shock. Antioxidants effectively improve α-adrenergic receptor-mediated vascular reactivity in LPS shock rats partially by removing lipid peroxidative production, reducing nitric oxide and 3-NT biosynthesis in LPS shock. These results suggest that antioxidants have potential beneficial therapeutic effect for septic shock patients.     

Hypothermic ventricular fibrillation with left ventricular drainage under cardiopulmonary bypass on canine lung preservation without aortic-cross clamping

AIM: To evaluate the protective effect of hypothermic ventricular fibrillation without aortic-cross clamping under cardiopulmonary bypass（CPB） on canine lung.METHODS: Fourteen dogs were randomly divided into two groups.All dogs received a standardized anesthetic technique.A conditional CPB was performed in every instance.Ventricular fibrillation was induced by systemic hypothermia to 28 ℃ and pericardial cooling saline in the experimental group.A standard CPB was performed in control group.The concentration of IL-8 in serum was measured by ELISA.The expressions of NF-κB and ICAM-1 were determined by using immunohistochemical staining.RESULTS: Serum IL-8 level in experimental group was significantly lower than that in control group (P<0.05).In experimental group,the pathological lesion of lung was improved.The results of histochemistry demonstrated that optical densities of NF-κB and ICAM-1 in two groups were much higher than those of pre-CPB (P<0.05),the optical densities of NF-κB and ICAM-1 in control group were much higher than those in experimental group (P<0.05).CONCLUSION: Hypothermic ventricular fibrillation under cardiopulmonary bypass may be an effective method on reducing SIRS and protecting pulmonary function.     

Protective effect of ethyl pyruvate on brain tissues in neonatal rats with hypoxic-ischemic brain damage

AIM：To study the effects of ethyl pyruvate (EP) on brain tissues in neonatal rats with hypoxic-ischemic brain damage (HIBD) and its underlying mechanisms. METHODS：A total of 165 seven-day-old Sprague-Dawley (SD) rats were randomly divided into 3 groups：sham operation group (n=43), HIBD group (n=61) and HIBD+EP group (n=61). The rats in HIBD+EP group were intraperitoneally injected with EP (50 mg/kg) 30 min before operation, and once a day after surgery. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in brain homogenate, water content of brain and apoptotic cells in cortex were detected 3 days later. Ischemic and non-ischemic brain tissues were weighed to assess the extent of brain atrophy 14 days later. RESULTS：Higher level of SOD ［(125.78±18.35)×103 U/(g protein)］ and lower level of MDA ［(4.42±1.04) μmol/(g protein)］ in HIBD+EP group than that in HIBD group ［(97.84±15.50)×103 U/(g protein) and (6.02±0.89) μmol/(g protein), respectively］ was observed (P<0.05)．In addition, the water content of ischemic hemisphere was significantly higher than that of non-ischemic one in HIBD group (P<0.05), and was indistinguishable from that of non-ischemic one after EP treatment (P>0.05), indicating the protective effect of EP against brain edema. The apoptotic cells in cortex and hippocampus in HIBD+EP group ［(96.63±10.08)/field and (41.91±9.96)/field, respectively］ were obviously decreased compared with HIBD group ［(111.54±1.64)/field and (51.73±1.77)/field, respectively］, but still higher than those in sham operation group (P<0.05). The atrophy ratio of ischemic hemisphere in HIBD+EP group was (13.25±5.19)%, significantly lower than that in HIBD group ［(20.32±5.10)%, P<0.05］. CONCLUSION：Ethyl pyruvate is neuroprotective against HIBD in neonatal rats via increasing SOD level, decreasing MDA level, attenuating brain edema, decreasing apoptotic cells in cortex and alleviating atrophy of hypoxic-ischemic hemisphere.     

Heme oxygenase-1 protects renal function in septic rats via influencing expression of thrombomodulin

AIM: To investigate the protective effect of heme oxygenase-1 (HO-1) on the kidney of septic rats and the influence of HO-1 on the expression of thrombomodulin (TM) in the kidney. METHODS: Sepsis in rats was developed with cecal ligation and puncture (CLP). The septic rats were randomly divided into sham group, CLP group, CLP+HO-1 inducer group and CLP+HO-1 inhibitor group (n=18). The plasma levels of creatinine (Cr), cystatin-C (Cys-C), carboxyhemoglobin (COHb), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and TM, and the changes of prothrombin time (PT) and activated partial thromboplastin time (APTT) in each group were measured. Histopathological examination was performed in the kidney. The expression of TM in the kidney tissue was detected by Western blot. RESULTS: Compared with sham group, significantly elevated plasma levels of Cr, Cys-C, TNF-α, IL-1β and TM (P<0.05), shortened PT and APTT (P<0.05), significantly increased microthrombus formation, and lowered TM expression in the kidney (P<0.05) of CLP group were observed. The administration of hemin lowered the plasma levels of Cr, Cys-C, TNF-α, IL-1β and TM (P<0.05), prolonged PT and APTT (P<0.05), attenuated microthrombus formation, and up-regulated the expression of TM in the kidney (P<0.05). In contrast, ZnPP had the opposite effects. CONCLUSION: HO-1 increases the expression of TM in the kidney and exerts anticoagulatory and antiinflammatory effects, thereby improving renal function in the septic rats.     

Changes of IL-4, IL-10, IL-12 levels in rat serum and lung during acute respiratory distress syndrome induced by oleic acid

AIM:To observe the dynamic changes of interleukin-4(IL-4), IL-10, IL-12 in rat serum and lung tissues during acute respiratory distress syndrome (ARDS).METHODS:The ARDS model of rats was induced by intravenous injection of oleic acid. The levels of IL-4, IL-10, IL-12 in serum and the supernatant of lung tissues were measured by enzyme linked immunosorbent assay (ELISA).RESULTS:The Levels of serum and lung IL-10, IL-12 in ARDS rats were increased in 4 h, 8 h, 16 h group compared with control group. The levels in IL-10 in serum in 16 h group and IL-10 in lung tissues of 8 h group were lower than that in 4 h group. The Levels of IL-4 in serum in 4 h, 8 h group were higher than that in control group, while IL-4 in 16 h group was lower than that in 8 h group. IL-4 of lung tissues in 4 h, 8 h, 16 h group were increased significantly, but in 16 h group were lower than that in 8 h group. The biggest changes of pulmonary coefficient and histopathology were observed at 4 h after injection of oleic acid.CONCLUSIONS:IL-4, IL-10 and IL-12 might play important roles in inflammatory reaction induced by oleic acid. The pro-and anti-inflammatory cytokines produced successively during ARDS.The relationship between unbalanced cytokines and lung injury in ARDS needs to be further studied.     

Effect of ghrelin on iNOS expression in alveolar macrophages and lung tissues in rats with sepsis-associated lung injury

AIM: To investigate the effect of ghrelin on inducible nitric oxide synthase (iNOS) expression in alveolar macrophages and lung tissues in sepsis-induced acute lung injury (ALI) rats. METHODS: The septic rat model was established by cecal ligation and puncture (CLP). Male SD rats were divided into sham group, CLP group and CLP+ghrelin group. The rats in the former 2 groups were further divided into 3 subgroups, which were 6 h, 12 h and 20 h post-operation groups. Ghrelin was administered by intraperitoneal injection at 3 h and 15 h after operation in ghrelin group. The samples were harvested 20 h after operation. The mRNA expression of iNOS in alveolar macrophages collected from bronchoalveolar lavage was detected by RT-PCR. The protein levels of lung iNOS were measured by Western blotting. The lung pathological examination was performed 20 h after operation. RESULTS: In CLP group, the mRNA expression levels of iNOS in the alveolar macrophages were 1.33±0.05, 1.44±0.08, 1.57±0.11 at 6 h, 12 h and 20 h after CLP, respectively, which were higher than that in sham group, but did not show time correlation. However, it was lower in CLP group than that in CLP+ghrelin group at 20 h after CLP (2.27±0.37, P<0.05). At 20 h after CLP, the protein level of lung iNOS was decreased in CLP+ghrelin group (0.87± 0.03) as compared with CLP group (1.08±0.05). Compared with sham group, the histopathological score was increased in both CLP group and CLP+ghrelin group, but it was lower in CLP+ghrelin group (5.83±0.477) than that in CLP group (7.83±0.75). CONCLUSION: Ghrelin treatment improves the degree of ALI. During 6 h to 20 h after CLP, the mRNA expression of iNOS in alveolar macrophages was elevated, but the difference was not seen as the time went on. Ghrelin up-regulates the mRNA expression of iNOS in alveolar macrophages and inhibits iNOS expression in lungs of septic rats.     

Effect of ischemic postconditioning on functions of transplanted lung in canine

AIM: To investigate the protective effect of ischemic postconditioning on the functions of canine transplanted lung. METHODS: Twelve cases of the orthotopic left lung transplantation were performed in 24 canines, which were randomly divided into ischemic postconditioning group and control group averagely. Before the reperfusion of lung donors in the canines of ischemic postconditioning group, the ischemia post-conditioning protocol was performed as follows: 10 s reperfusion with 10 s blockade afterwards, and the protocol was performed for 3 cycles. The canines in control group, without intervention of postconditioning, were processed normally. Firstly, the hemodynamics and the graft’s gas exchange and oxygenation were assessed at 0 h, 1 h, 2 h and 4 h after reperfusion. Then, the lung graft was harvested for measuring the wet/dry weight ratio after 4 h reperfusion. Finally, the freshly-obtained pulmonary specimens at 2 h and 4 h after reperfusion were collected and prepared for pathologic observation under microscope with HE staining. RESULTS: The transplantations were completed in 12 canines, the mean time for anastomoses was (35.9±1.7) min. Compared to control group, MPAP and PVRI were improved significantly in I-postC group (P>0.05), and there was no significant difference in MSAP and SVRI between two groups (P>0.05). Compared to control group on the hand of gas exchange and oxygenation, PaO2, PA-aO2 and QS/QT improved significantly in I-postC group (P<0.05), however no significant difference in PaCO2 between two groups was observed (P>0.05). Meanwhile, there were significant differences between two groups in wet/dry weight ratio (P<0.05). Under the light microscopic examination, the changes of pathologic inflammation in the ischemic postconditioning group were less than those in control group. CONCLUSION: Ischemic postconditioning effectively improves the respiratory functions by attenuating lung ischemic reperfusion injury.     

Prostaglandin E2 receptors,EP2 and EP4, regulate expression of surface molecules and cytokines in B-cells of collagen-induced arthritic mice

AIM: To observe the immunoregulatory effects of prostaglandin E₂ receptor (EP) subtypes EP2/EP4 on the B-cells of collagen-induced arthritic(CIA)mice. METHODS: DBA/1 mice were immunized with chicken type II collagen emulsified in Freunds complete adjuvant to induce arthritis. B-cells were isolated from the splenocyte suspension by positive selection using anti-CD19 monoclonal antibody immunomagnetic beads. The expression of MHC II, CD 80 and CD86 was examined by flow cytometry. The mRNA levels of EPs, interferon γ (IFN-γ), tumor necrosis factor α (TNF-α), IL-6, IL-4, IL-10 and transforming growth factor-β (TGF-β) were detected by real-time RT-PCR. RESULTS: The rank of the mRNA levels of EPs was EP2>EP1>EP3>EP4 in B-cells and EP2/EP4 mRNA expression was obviously increased in CIA mice. EP2 antagonists inhibited the expression of MHC II, CD80 and CD86. EP4 antagonist had little effect on CD80. EP2/EP4 antagonists inhibited the mRNA expression of IFN-γ, TNF-α, and IL-6 (P<0.05 or P<0.01) and increased the expression of IL-10 (P<0.01 or P<0.05). Furthermore, the antagonists of EP2 and EP4 also increased the mRNA expression of IL-4 and TGF-β (P<0.01), respectively. CONCLUSION: PGE₂ modulate the pathogenesis of CIA via EP2/EP4 by regulating the expression of surface molecules and cytokines in B-cells. EP2/EP4 may be a new therapeutic target for treating rheumatoid arthritis.     

Protective effects of hypercapnia on acute lung injury and it's mechanisms

AIM: To investigate whether hypercapnia is protective against acute lung injury (ALI) in a rabbit model, and study it's potential mechanisms. METHODS: Twenty-two healthy New Zealand white rabbits were involved in this study, and randomly allocated to control group (group C), normocapnic group (group N) and hypercapnic group (group H). Oleic acid (0.1 mL/kg) was injected intravenously to establish ALI model. Lung mechanics, hemodynamics, blood-gas analysis, the content of malondialdehyde (MDA) and superoxide dismutase (SOD) activity in lung tissue were measured. Apoptosis was analyzed after 3h mechanical ventilation. RESULTS: (1) Peak airway pressure in group H was significantly lower than that in group N (P<0.05) and the dynamic lung compliance was significantly higher than that in group N (P<0.05). (2) PaO₂ in group H was significantly higher than that in group N(P<0.05). (3) The content of MDA was significantly lower but the activity of SOD was significantly higher in group H than that in group N (P<0.05). (4) Apoptosis index in group H was significantly lower than that in group N (P<0.01). (5) Histologic damage was significantly severer in group N than group H. (6) PaCO₂ was correlated with pH, PaO₂, dynamic lung compliance, peak airway pressure and pulmonary permeability index (r=－0.928, P<0.01; r=0.511, 0.526, -0.506, -0.556, P<0.05, respectively). CONCLUSION: Hypercapnia protects lung from oleic acid-induced injury in rabbits. The mechanisms of protection might be associated with improvement of oxidation/anti-oxidation imbalance and inhibition of apoptosis.     

Septic shock down-regulates L -arginine /NOS /NO pathway of platelet and aortic intima in rats

AIM: To investigate alteration and cross link of the aortic and platelet endogenous L -arginine/NOS/NO pathway induced by septic shock.METHODS: The septic shock model was made in rats by caecal ligation and puncture. NO^-₂/NO^-₃ production released from aortic and platelet was measured with Greiss assay. NOS activity and L-arginine transport activity were detected by isotope tracer method. RESULTS: Both in early and late stage of septic shock, NO^-₂/NO^-₃ production, NOS activity, and the L-arginine transport from the aorta intima and platelets were obviously decreased, while those of the aorta media and adventitia were obviously increased (P<0.01), but high-affinity L-arginine transport activity from the aorta intima and platelets was increased in early stage of septic shock (P>0.05 and P<0.05), as compared with the sham group, respectively. The inhibitory effects of NO^-₂/NO^-₃, NOS activity and the L-arginine transport showed a positive correlation between platelet and aortic intima (P<0.01). CONCLUSION: Septic shock down-regulates endogenous L-arginine/NOS/NO pathway in aortic intima and platelet, up-regulates L-arginine/NOS/NO pathway of aortic media and adventitia. Detection of the alteration of endogenous L-arginine/NOS/NO pathway in platelet might act as an indirect method to assess the endothelial dysfunction involving the pathogensis of septic shock.     

Effects of lung recruitment maneuver on pressure-volume curve and lung histopathology in a canine model of ARDS

AIM: To investigate the effect of lung recruitment maneuver (LRM) on pressure-volume curve and lung histopathology in a canine model of acute respiratory distree syndrome (ARDS). METHODS: Twenty-four healthy dogs were randomly divided into extrapulmonary ARDS (ARDSexp) group and pulmonary ARDS(ARDSp) group. The dogs in ARDSexp group were injected with oleic acid through femoral vein and the dogs in ARDSp group inspired hydrochloric acid to induce lung injury. The dogs in both ARDSexp group and ARDSp group were randomly sub-divided into lung protective ventilation strategy (LPVS) group and LPVS+LRM group. Pressure-controlled ventilation (PCV) was employed to LRM.The upper limit of the pressure was set as upper inflection point (UIP), and the positive end-expiratory pressure (PEEP) was set as low inflection point (LIP)＋2 cmH₂O. The duration of LRM was set to be 60 s. LIP, UIP and lung recruited volume were measured before and after LRM. All the dogs were killed after 4 h of ventilation. The histopathological changes and Smith scores of the lungs were measured. RESULTS: After LRM, LIP value was significantly decreased in ARDSp group, and was decreased more significantly in ARDSexp group. The UIP was disappeared after LRM in 4 dogs of ARDSexp group, but the UIP in the dogs of ARDSp group did not change significantly after LRM. Compared with ARDSp group, the lung recruited volume significantly improved, and the lung injury score also significantly decreased after LRM in ARDSexp group. The treatment results were better in ARDSexp group than those in ARDSp group. CONCLUSION: LRM decreases the level of LIP and modifies the P-V curve significantly. We should adjust the parameters of ventilator according to the P-V curve after LRM. LRM improves lung recruited volume and prevents lung injury in ARDSexp and ARDSp, and better treatment effects are obtained in ARDSexp dogs than ARDSp dogs.     

Effect of ischemic post-conditioning on Egr-1 and IL-1β expression in ischemia-reperfusion injured lung in rats

AIM: To investigate the protective effects of ischemic post-conditioning on the expression of early growth response factor 1 (Egr-1) and interleukin-1β(IL-1β) in ischemia-reperfusion injured lung in rats. METHODS: The model of lung ischemia-reperfusion injury was established in 24 rats and the rats were randomly allocated to 3 different groups (n=8 in each group): (1) sham group: only sham operation (thoracotomy) and no ischemia for 3 h; (2)ischemia-reperfusion group (I/R group): interruption of pulmonary perfusion and ventilation for 1 h followed by reperfusion for 2 h; (3) ischemic post-conditioning group (IPostC group): ischemic post-conditioning (5 min of reperfusion and 5 min of ischemia for 3 times) between the end of ischemia and the beginning of the reperfusion followed by reperfusion for 1.5 h. The lung tissues (prepared to small pieces of about 20 mg) were collected and homogenized at the end of the experiment. The concentration of myeloperoxidase (MPO) in the homogenate was determined. The wet to dry weight ratio (W/D) of the lung tissues was also measured at the end of reperfusion. The pathological changes of the lung tissues were observed under light microscope after reperfusion. The mRNA expression of Egr-1 and IL-1β in the lung tissues was detected by RT-PCR. RESULTS: Compared with sham group, the mRNA expression of Egr-1 and IL-1β, the levels of MPO and W/D were significantly increased in I/R group (P<0.05). The inflammatory responses of the lungs in I/R group were significantly severer than those in sham group. Compared with I/R group, the mRNA expression of Egr-1 and IL-1β, the levels of MPO and W/D in IPostC group were significantly decreased (P<0.05). The inflammatory responses of the lungs in IPostC group were also significantly attenuated. CONCLUSION: Ischemic post-conditioning significantly reduces ischemic reperfusion injury of the lung by inhibiting the expression of Egr-1 and IL-1β.     

Effect of ulinastatin plus thymosin-α1 therapy on improving immune function in septic patients

AIM: To investigate the effect of ulinastatin plus thymosin-α1 therapy on improving immune function in septic patients. METHODS: 70 patients were divided into two groups. One group was classical treatment group (CT) with regular therapy and another group was classical treatment plus immunotherapy group (CIT) with ulinastatin plus thymosin-α1 for a week.The immune index before and after treatment on day 0, 1, 3 and 7 was observed, including the clinical and survival data. RESULTS: The most common pathogen of sepsis was bacteria, and infection by fungi was in rare. The common locations of bacteria observed were sputum and abdominal drainage. The level of TNF-α was significant lower in CIT group than that in CT group (P<0.05). IL-10 level was significantly higher in CIT group than that in CT group (P<0.05). IgG level was significant lower in CIT group than that in CT group (P<0.05). No significant difference in the levels of IgA, IgM, C3 and C4 between two groups was observed (P>0.05). CD4+T lymphocytes were significant higher in CIT group than those in CT group (P<0.05). From day 7 to day 28, the lymphocytes and level of HLA-DR in CD14+ monocytes were significant higher in CIT group than those in CT group (P<0.05). The time of mechanical ventilation and vasopressors used in CIT group was shorter than those in CT group (P<0.05). But the length of stay and the cost in ICU showed no significant increase between these two groups (P>0.05). During hospitalization, 20 patients died in the CT group and 13 patients died in CIT group (P<0.05). The long-term survival time in CIT group was longer than that in CT group (P<0.05). CONCLUSION: Immunotherapy in septic patients can decrease TNF-α level and increase IL-10 level. Immunotherapy in septic patients can increase IgG level slightly, CD4+T lymphocyte, and HLA-DR in CD14+ monocytes, which improve the immune paralysis in septic patients. Immunotherapy can shorten the time of mechanical ventilation and vasopressors used, but it doesn’t increase the length of stay and the cost.     

Ulinastatin protects rat pulmonary tissues from paraquat-induced acute injury

AIM: To investigate the protective effects of ulinastatin on the rats with paraquat-induced acute lung injury and its mechanisms. METHODS: The Wistar rats (n=108) were randomly divided into control group, paraquat group and ulinastatin group. The rats in paraquat group and ulinastatin group were given paraquat by gavage, while the rats in control group were given sterile saline by gavage. The rats in ulinastatin group were also given ulinastatin treatment. The serum levels of MDA, SOD, IL-6, IL-10 and TNF-α were measured after 1 d, 3 d, 7 d, 14 d, 21 d and 28 d. The expression levels of p38 MAPK, MMP-2 and TIMP-1 in the lung were also measured. RESULTS: The levels of SOD in 1 d, 3 d and 7 d in paraquat group and ulinastatin group were significantly lower than those in control group (P<0.01). The level of SOD in ulinastatin group was significantly higher than that in paraquat group (P<0.05). The levels of MDA, IL-6, IL-10 and TNF-α in 1 d, 3 d and 7 d in paraquat group and ulinastatin group increased compared with control group (P<0.01), and those in ulinastatin group were significantly lower than those in paraquat group (P<0.05). The levels of p38 MAPK and TIMP-1 in 1 d, 3 d, 7 d, 14 d, 21 d and 28 d in paraquat group and ulinastatin group were higher than those in control group (P<0.01), and those in ulinastatin group was significantly lower than those in paraquat group (P<0.05). The level of MMP-2 in 1 d, 3 d, 7 d, 14 d and 21 d in paraquat group and ulinastatin group increased compared with control group (P<0.01), and that in ulinastatin group was significantly lower than that in paraquat group (P<0.05).CONCLUSION: Ulinastatin protects the lung tissues of rats from paraquat-induced acute lung injury by inhibiting p38 MAPK signaling pathway and ameliorating inflammatory and oxidative responses.