Objective To investigate the effects, and possible mechanism of action, of vasoactive intestinal peptide (VIP) on acute lung injury in a rodent model of endotoxic shock. Method Endotoxic shock was induced in Sprague-Dawley (SD) rats by intravenous injection of lipopolysacchaiide (LPS) at 10 mg/kg. Three groups (each group with 10 rats), were given injections of either normal saline (Control), LPS 10 mg/kg (LPS group), or LPS 10 mg/kg + VIP 5nmol (VIP). Samples were collected 6 hours after injection. Indices of lung injury including lung wet/dry weight ratio, protein concentration and neutrophil count in bronchoalveolar lavage fluid( BALF) were derived. Assays of TNF-α,IL-1β, IL-10 in serum and BALF were performed using ELISA. Light and electron microscopy were used to detect histopathological changes in lung tissues. Results The lung wet/dry weight ratio, protein concentration and neutrophil count in BALF were significantly raised in the LPS group compared to the Control group (P ＜ 0.05). These indices were significantly lowered in the VIP group compared to the LPS group, though not to the level of the control group. Concentrations of TNF-α, IL-1β, IL-10 in serum and BLAF also increased in the LPS group compared to the control group (P ＜ 0.0S). Levels of TNF-α and IL-1β were significantly lowered in the VTP group compared to the LPS group (P ＜ 0.05), while levels of IL-10 was significantly raised ( P ＜ 0.05). Histopathological changes due to lung injury were not as severe in the VIP group compared to the LPS group. CondusKms VIP plays a protective role during acute lung injury induced by endotoxic shock in rats. Its mechanism of action may be related to down-regulation of proinflammatory cytokines and up-regulation of anti inflammatory cytokines.

Objective To investigate the efficacy of continuous veno-venuous hemodialysis/filtration(CVVHD/F) for the treatment of multiple organ dysfunction syndrome(MODS)caused by severe infection and to explore the mechanism in children.Method Nineteen cases of pediatric septic shock with MODS were treated with CVVHD/F in Children's Hospital Affiliated to Shanghai Jiaotong University from December 2002 to November 2007.The clinical data were studied including mortality rate,serum electrolytes,arterial partial pressure of oxygen (PO2),artery partial pressure of carbon dioxide(PCO2),FiO2/PO2,urine output,blood pressure,doses of vasoactive agents,Cr,BUN,etc.Results Cannulation and CVVHD/F were well performed in a total of 19 cases,with median age 33.4±36.5 months(from 3 months to 8 years) ,with their gender ratio of male(13 cases)to female (6 cases) to be 68.4% and 31.6%.The mean pediatric crifcal illness score(PCIS) was 69.1±10.4 and Median Pediatric Risk of Mortality score(PRMS Ⅲ)12.66±7.85,respectively.The duration of CWHD/F was 92 hours(ranged from 16 hours to480 hours).FiO2/PO2,PCO2,and PO2 were iraproved significantly after 12 to 24 hours CVVHD/F in patients with acute respiratory distress syndrome(ARDS) or lung edema (P<0.05).The concentrations of serum kalium,natrinm and HCO3- level resumed to well-balanced in 24 hours (P<0.05).The serum Cr and BUN were decreased to normal range(P<0.05).The mortality rate was 63.2%.Conclusions CVVHD/F was effective for treatment of septic shock with MODS in pediatric by improving oxygenation,maintaining normal serum electrolytes,conecting metabolic acidosis,increasing the tissue perfusion and eliminating the serum Cr and BUN.