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The effects of glucocorticoid on myocardial apoptosis in septic rats

Chinese Journal of Emergency Medicine.2014;23(10):1105-1108. doi:10.3760/cma.j.issn.1671-0282.2014.10.008

Objective To observe the occurrence of myocardial apoptosis and discussing the mechanism of the effects of glucocorticoid on myocardial apoptosis in septic rats in order to provide the rationale for clinical strategy.Methods A total of 60 Wistar rats weighing 230-280 g were randomly (random number) divided into control group and experimental group (n =30 in each group).Cecal ligation and puncture (CLP) was performed in rats to induce sepsis,and Cefoperazone Sodium/Sulbactam Sodium (200 mg/kg) was injected into caudal vein 4 hours after CLP,twice a day.In addition,glucocorticoid was given to rats of experimental group.After rats sacrificed,their left ventricular myocardia were rapidly taken out and myocardial apoptosis rate was measured and the level of Bcl-2 was assayed at 6 h,24 h,and 72 h after CLP.Measured data were analyzed with independent-samples t-test and One-Way ANOVA.Results The rates of myocardial apoptosis in experimental group were obviously lower than those in control groups respectively (F=9.11,t=5.681,P＜0.01) (6ht=11.416,P＜0.01; 24ht=6.217,P＜0.01; 72 h t =3.76,P ＜0.01).The rates of myocardial apoptosis in 24 h in control and 72 h control groups were distinctively higher than those in 6 h control group,respectively (F =13.254,sig =0.000,P ＜0.01 ; sig =0.004,P ＜ 0.01).The rates ofmyocardial apoptosis in group 24 h control were higher than those in 72 h control group (sig =0.039,P ＜ 0.05).The rates of myocardial apoptosis make no difference among experimental group (F =2.488,6/24 h sig =0.132,P ＞ 0.05 ; 24/72 h sig =0.549,P ＞ 0.05 ; 6/72 h sig =0.053,P ＞ 0.05).Conclusions The rate of myocardial apoptosis is peaked at 24 h in sepsis rat,and the rate of myocardial apoptosis can be obviously decreased by administration of glucocorticoid.

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The protective effect of sodium pyruvate solution to intestinal barrier in hemorrhagic shock rats by intraperitoneal resuscitation

Xiaozhou WANG ; Xiaoguang LU ; Xin KANG ; Zhiwei FAN ; Shuai GUO ; Zhengkai LIANG

Chinese Journal of Emergency Medicine.2014;23(10):1120-1124. doi:10.3760/cma.j.issn.1671-0282.2014.10.012

Objective To study the protective effect of sodium pyruvate solution to intestinal barrier in Hemorrhagic shock rats by intraperitoneal resuscitation.Methods A total of 40 Male SD ratswere healthy and clean,were randomly (random number) divided into four groups:sham operation group (group Ⅰ),hemorrhagic shock model group (group Ⅱ),the recovery of the compound sodium chloride intravenous + intraperitoneal recovery of the PD-2 liquid group (group iiⅢ),the recovery of the compound sodium chloride intravenous + sodium pyruvate abdominal recovery group (group Ⅳ) (n =10).In addition to the group Ⅰ,the other three groups are used the HS model by The Wiggers improvement prepared,group Ⅲ,Ⅳ were used the same amount of intravenous recovery,At the same time to the abdominal cavity were respectively injected 20 mL 2.5％ PD-2 liquid and 20 m 2.5％ sodium pymvate solution.After 2 h,each group were taken arterial blood measured arterial blood gases (pH,PaCO2,PaO2) and D-lactic acid,small intestine specimens under the light microscope to observe the morphological changes of the rat small intestinal mucosa.Results Blood gas analysis:group Ⅲ and Ⅳ was significantly increased compared with group Ⅱ in pH levels and PaO2 content (P ＜ 0.01),and comoared to group Ⅲ,pH levels and PO2 levels of group Ⅳ increased more significantly (P ＜ 0.05) ; D-LA content:Group Ⅲ,Ⅳgroup is significantly lower than group Ⅱ (P ＜ 0.01) ; compared with group Ⅲ and group Ⅳ,D-LA significantly decreased (P ＜ 0.05).Light microscope,the group Ⅱ,the rat small intestine layer of a high degree of villous edema,submucosal vascular collapse within the lamina propria glands focal area of necrosis,and large areas of mucosal villi necrosis,defects; group Ⅲ and group Ⅳof small intestinal damage compared to group Ⅱ significantly reduced; Ⅳgroup of the rat small intestine villi edema,lodging and the degree of necrosis in group Ⅲ.Intestinal epithelial damage index score:the Ⅳ group than in group Ⅱ and Ⅲ group (P ＜ 0.01 or P ＜ 0.05).Conclusions The venous recovery and intraperitoneal resuscitation can significantly reduce the plasma D-LA content of hemorrhagic shock in rats,correct acidosis,increase the oxygen partial pressure ; and intestinal mucosal barrier function,the protective of sodium pyruvate solution is better than the PD-2 liquid.

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The roles of using B-type natriuretic peptide to predict the severity of community-acquired pneumonia

Jing LI ; Huan YE ; Li ZHAO

Chinese Journal of Emergency Medicine.2014;23(10):1132-1137. doi:10.3760/cma.j.issn.1671-0282.2014.10.016

Objective To evaluate the roles of B-type natriuretic peptide (BNP) in predicting the severity of community-acquired pneumonia (CAP) by studying the correlation between them.Methods A total of 202 patients with CAP admitted from December 2011 to December 2012 were enrolled in this study.All these patients were checked with laboratory tests for BNP level,C-reactive protein (CRP),white blood cell count (WBC) as well as other markers needed for obtaining pneumonia severity index (PSI).The differences in BNP levels,CRP levels,and WBC were compared among different degrees of pneumonia severity,and the correlation between BNP levels and PSI was investigated by a linear correlation analysis.The patients enrolled were divided into a high-risk group (defined as Ⅳ-Ⅴ grade of PSI) and a low-risk group (defined as Ⅰ-Ⅲgrade of PSI).Meanwhile,they were also divided into a survivor group and a non-survivor group according to outcomes.BNP levels between the two groups were compared,and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI.Results BNP levels increased with CAP severity (r =0.782,P ＜0.01).The mean level of BNP (263.2 ± 119.6) pg/mLof patients in the high-risk group was significantly higher than that of patients (71.5 ± 54.3) pg/mL in the low-risk group (P ＜ 0.01).The patients in the non-survivor group had significantly higher BNP levels compared to the survivor group [(343.86 ± 125.49) vs.(183.00 ±121.71) pg/mL,P ＜ 0.01].In addition,there were positive correlations between BNP levels and PSI (r =0.782,P＜0.001),between BNP levels and CRP levels (r =0.560,P＜0.01),and between BNP levels and WBC (r =0.513,P＜0.001).The BNP level had a high accuracy in predicting the severity of CAP (AUC =0.952).The optimal cut-off point of BNP level for distinguishing high-risk from low-risk patients was 125.0 pg/mL,with a semitivity of 0.891 and a specificity of 0.946.Moreover,BNP level had a definite accuracy in predicting mortality (AUC =0.823).Its optimal cut-off point for predicting death was 299.0 pg/mL,with a sensitivity of 0.675 and a specificity of 0.816; its negative predictive cut-off value was 0.926,and positive predictive value was 0.426.Conclusions BNP level is positively correlated with the severity of CAP.The patient with BNP level above 125.0 pg/mL should be hospitalized immediately and patients with BNP level higher than 299.0 pg/mL are at the high risk of death.Therefore,BNP is a useful biomarker for evaluating the severity of patients with CAP.

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Clinical study of the influence of continuous hemofiltration on gastrointestinal dysfunction of the patients with intra-abdominal hypertension

Xin XU ; Man HUANG ; Pengfei WANG ; Qiuping XU

Chinese Journal of Emergency Medicine.2014;23(10):1138-1142. doi:10.3760/cma.j.issn.1671-0282.2014.10.017

Objective To investigate the effects of continuous hemofihration on gastrointestinal dysfunction for treating patients with intra-abdominal hypertension.Methods A total of 37 patients were divided into two groups randomly (random number),namely control group (n =17) and continuous blood filtration (CBF) group (n =20).The patients of control group were treated with routine treatment,and the patients of CBF group were given CBF for 72 hours in addition to the routine treatment.The intra-abdominal pressure (IAP),gastrointestinal (GI) symptoms,and SOFA score were documented at 0 hour,24 hours,72 hours and 7 days after treatment.Results The MAP of patients in the CBF group was not significantly changed (P =0.218),while the IAP was decreased significantly (P =0.001) and the abdominal perfusion pressure (APP) increased significantly after CBF (P =0.036).Compared with the control group,there were more than 2 GI symptoms markedly relieved after CBF for 24 hours (P =0.049).The SOFA score of CBF group decreased significantly (P =0.037).There were no differences in 28-day and 60-day mortality between two groups.Conclusions The CBF can decrease IAP,increase APP,improve splanchnic blood circulation,and ameliorate gastrointestinal dysfunction.But CBF does not reduce the mortality in comparison with routine treatment.

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A study of reperfusion arrhythmias in patients with acute myocardial infarction during primary percutaneous coronary intervention

Xianlin ZHANG ; Ping ZHANG ; Yuesong WANG ; Xuwu SHAO ; Xuezhong WANG ; Xuebin DONG

Chinese Journal of Emergency Medicine.2014;23(10):1143-1145. doi:10.3760/cma.j.issn.1671-0282.2014.10.018

Objective To analyze the clinical features of patients with acute ST-elevation myocardial infarction treated with percutaneous coronary intervention (PCI) complicating to intraoperative reperfusion arrhythmias (RA).Methods A total of 175 patients with acute ST-elevation myocardial infarction were treated with PCI performed from January 2008 to September 2013.According to the occurrence of RA following PCI,the patients were divided into RA group and non-RA (NRA) group.Comparison of myocardial enzymes,peak troponin,the elevated ST segment returning back,length of hospital stay,incidence of adverse events such as cardiac death,shock,heart failure during hospitalization and within a month of postoperative period was carried out between groups,and the findings from echocardiography on the 30th day after PCI were also compared between two groups.Results PCI time window in RA group was significantly earlier than that of NRA group,and reperfusion arrhythmia was effectively controlled.Compared with NRA group,RA group had greater extent of ST segment normalized,and tbe incidence of adverse events was lower.On the 30th day after PCI,RA group had shorter duration of left ventricular diastole,and reduced left ventricular cavity dimensions and higher ejection fraction (LVEF) value.Conclusions Reperfusion arrhythmias occur immediately after PCI in patients with acute myocardial infarction,but as long as the PCI carried out timely,the prognosis is good.

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The clinical value of Angiopoietin 2 in prediction of the onset of acute respiratory distress syndrome

Ying HUANG ; Zaimei PENG

Chinese Journal of Emergency Medicine.2014;23(10):1151-1154. doi:10.3760/cma.j.issn.1671-0282.2014.10.020

Objective To explore the clinical value of serum Ang-1,Ang-2 and IL-8 in ARDS prediction.Methods Totally 283 critically ill patients admitted in EICU of the Hunan Provincial People's Hospital from January 2012 to July 2013 were enrolled in this study and divided into the non-ARDS group (n =251) and ARDS group (n =32) depending on the development of ARDS.According to the occurrence of death in the following 60 days,the non-ARDS group and the ARDS group were further subdivided into the non-ARDS survival group,the non-ARDS death group,thc ARDS survival group and the ARDS death group.The differences in serum Ang-1,Ang-2 and IL-8 concentrations between these four groups measured by ELISA on admission were analyzed by statistical methods and ROC curve.Results The EICU stays,duration of mechanical ventilation,APACHE Ⅱ score、serum Ang-2 and IL-8 levels in the ARDS group were significantly higher than those in the non-ARDS group,while the Ang-1 level in the ARDS group was significantly lower than that in the non-ARDS group.The serum Ang-2 and IL-8 concentrations in the ARDS death group were significantly higher than those in the non-ARDS survival group and the non-ARDS death group,and the serum Ang-2 concentrations in the ARDS death group were also significantly higher than those in the ARDS survival group.Further ROC curve analysis showed that the area under the curve of Ang-2 for ARDS diagnosis and ARDS death prediction were 0.907 and 0.899 respectively and their diagnostic sensitivity and specificity were 0.969 and 0.725,0.907 and 0.882 respectively,illustrating that Ang-2 possess the best diagnostic efficiency.Conclusions Ang-2 functions as a valuable biomarker for early diagnosis and prognosis of ARDS.

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Influence of the length of time elapsed from ingestion of paraquat to hemoperfusion on prognosis in patients with acute paraquat poisoning

Xiaowei LIU ; Xiaofei LI ; Pei PEI ; Zhi LIU

Chinese Journal of Emergency Medicine.2014;23(11):1198-1203. doi:10.3760/cma.j.issn.1671-0282.2014.11.004

Objective To explore the influence of the length of time elapsed from ingestion of paraquat to hemoperfusion on prognosis in patients with acute paraquat poisoning.Methods The investigation was carried out with retrospective analysis.A total of 303 patients with acute paraquat poisoning were admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2009 to December 2012.According to the length of time between ingestion and hemoperfusion,patients were divided into three groups,Group A:the time interval between ingestion and hemoperfusion ＜ 4 h ; Group B:4h ≤ the time interval between ingestion and hemoperfusion ＜ 8 h; Group C:8 h≤the time interval between ingestion and hemoperfusion ＜ 12 h.Compared the extent of target organ injury,28-d mortality and the survival time of non-survivors among three groups for determining the influence of the length of time elapsed from ingestion to hemoperfusion on the prognosis of patients.Results Totally 303 patients with average age of 34.8 ± 10.8 years old (ranging from 15 to 72 years),and 117 male and 186 female.The median estimated amount of 20％ paraquat ingested was 50 mL (ranging from 10 to 270 mL,IQR:45 mL).The hemoperfusion was employed (3.6 ±1.2) times (ranging from 2 to 5 times) for every paitient within 24 h after ingestion.The overall mortality rate was 68.6％ (208/304)during a 28 days follow-up period,and only 95 of 303 patients survived.The median length of time between paraquat ingestion and hemoperfusion at the emergency department was 6.6 h (ranging from 1.4 to 11.5 h,IQR:3.5 h).However,it was 7.2 h (ranging from 3.1 to 11.5 h,IQR:2.4 h) in non-survivors and 4.9 h (ranging from 1.4 to 7.6 h,IQR:1.5 h) in survivors.The difference was statistically significant (U =2.014,P =0.043).The difference in 28-day mortality among three groups was statistically significant (x2 =9.27,P =0.009),and the difference in average survival time of non-survivors among three groups was statistically significant (F =3.31,P =0.038).The length of time between ingestion and hemoperfusion and the survival time of non-survivors was a negative correlation (r2 =0.421,P =0.045).The difference in ALTmax,SCrmax,AMYmax and PaO2 min,as the severity indicators of acute liver injury,acute kidney injury,acute pancreas injury and acute lung injury among the three groups were statistically significant (all P ＜ 0.05).Conclusions Employment of hemoperfusion within 4 h after ingestion can attenuate the degree of target organ injury,reducing 28 day mortality of patients with acute paraquat poisoning.

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Prognostic value of initial arterial lactate and 6-h lactate clearance rate in acute paraquat poisoning

Min CHEN ; Feng CHEN ; Rijin ZHU ; Xiaoping WANG ; Haiyang SONG

Chinese Journal of Emergency Medicine.2014;23(11):1204-1208. doi:10.3760/cma.j.issn.1671-0282.2014.11.005

Objective To investigate the correlation of the initial arterial lactate (Lac) and 6-h lactate clearance rate (LCR) with prognosis in patients with acute paraquat poisoning (APP).Methods The included 132 APP patients (70 males and 62 females,age ranging 15-71,30 (18) [M (IQR)]treated at a single center between January 2009 and December 2013.Patients were divided into two groups:group A,survivors ＞ 28 days after admission (n =64); and group B,those died ≤ 28 days after admission (n =68).The prognostic values of arterial Lac and 6-h LCR during the acute stage of poisoning were evaluated.Results Paraquat dose ranged from 5-200 mL,20 mL (37.25 mL) [M (IQR)].The average time from poisoning to arrival at the emergency department was ranging 4-312 h,6 h (8.75h) [M (IQR)].Total mortality was 51.51％.There were no differences in age,gender,and length of time elapsed from poisoning to diagnosis between two groups.Survivors had a significantly lower dose of paraquat ingested compared with nonsurvivors (P ＜ 0.05).An ROC curve analysis determined that the dose had an area of 0.86 (95％ CI:0.80-0.92) and the volume cut-off point was 27.5 mL to predict the prognosis in patients with acute paraquat poisoning (75％ sensitivity,85.9％ specificity,Youden index 0.609).The initial arterial lactate level was higher in nonsurvivors than that in survivors.The ROC curve analysis indicated that the initial arterial lactate level had an area of 0.99 (95％ CI:0.99-1.00) and the concentration cut-off point was 5.050 mmoL/L to predicti prognosis in patients with acute paraquat poisoning (sensitivity 98.5％,specificity 100％,Youden index 0.985).The 6 h LCR was lower in nonsurvivors than that in survivors.ROC curve analysis showed that the 6-h LCR had an area of 0.99 (95 ％ CI:0.97-1.00) and the concentration cut-off point was 17.28％ to predict prognosis in APP patients (sensitivity 100％,specificity 97.1％,Youden index 0.971).Conclusions In the early stages of APP,initial arterial Lac and 6-h LCR are closely related to prognosis and may serve as prognostic factors.

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Clinical study of the changes in homeostasis during the course of acute poisoning in patients treated with hemoperfusion

Lijun WANG ; Muming YU ; Yanfen CHAI

Chinese Journal of Emergency Medicine.2014;23(11):1214-1217. doi:10.3760/cma.j.issn.1671-0282.2014.11.008

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning.Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed.The clinical data included blood pH,PvCO2,PvO2,blood lactate,potassium,free-calcium,bicarbonate and blood glucose assayed and recorded at 0 min,30 min and 120 min after hemoperfusion.The statistical software SPSS 18.0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion.Results At the beginning of hemoperfusion therapy,levels of homeostasis indicators were pH (7.36 ± 0.05),PvCO2 (41.0 ± 8.8) mmHg,PvO2 (37.0 ± 11.8)mmHg,lactate (1.35 ± 1.00) mmol/L,potassium (3.1 ± 0.5) mmol/L,sodium (136.3 ± 4.8)mmol/L,free-calcium (0.95 ± 0.11) mmol/L,blood glucose (7.90 ± 3.47) mmol/L,bicarbonate (22.8±3.3) mmol/L.At30min,the levels of those were (7.36±0.04),(40.0±5.7) mmHg,(41.0±7.5) mmHg,(1.11 ±0.57) mmol/L,(3.1±0.4) mmol/L,(137.3 ±5.4) mmol/L,(0.94 ±0.12) mmol/L,(6.20 ± 1.55) mmol/L,(22.2 ±2.3) mmol/L,respectively.At 120 min,the levels of those were (7.35 ± 0.06),(38.0 ± 6.7) mmHg,(46.0 ± 7.9) mmHg,(0.69 ± 0.52)mmol/L,(3.0±0.4) mmol/L,(137.3±5.0) mmol/L,(0.97±0.10) mmol/L,(5.88±1.43)mmol/L,(22.0± 2.2) mmol/L,respectively.Apparently,there were significant statistical difference in PvO2,lactate and blood glucose (P ＜ 0.05) among three different intervals,and no significant statistical differences in other indicators (P ＞ 0.05).Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.

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Empirical study of protcetive effect of olmesartan on acute lung injury induced by paraquat in rats

Chao LAN ; Jinzhu WANG ; Li LI ; Hui PEI ; Guoyu DUAN ; Li HUANG

Chinese Journal of Emergency Medicine.2014;23(11):1222-1227. doi:10.3760/cma.j.issn.1671-0282.2014.11.010

Objective To explore the therapeutic effect of olmesartan (OLM) on acute lung injury induced by paraquat (PQ) in rats in order to study its action mechanism.Methods A total of 70 Wister rats wererandomly (random number) divided into 5 groups,namely control group (C group,n =10),poisoning group (PQ group,n =15),rats treated by OLM with low dose (LD group,n =15),moderate dose (MD group,n=15) and high dose (HD group,n =15).PQ (80 mg/kg) was administered by gavage route in PQ group and in OLM groups for paraquat poisoning modelling,while in C group,equivalent normal saline was given instead.The OLM was administered by gastric instillation in OLM treatment groups (LD group:5 mg/kg; MD group:10 ng/kg; HD group:15 mg/kg) 6 hours after paraquat gavage and once a day for 7 days,while in C group and PQ group,normal saline was used instead.All rats were sacrificed 12 hours after the last dose treatment.The levels of glutathione peroxidase (GSH-Px,energy units),superoxide dismutase (SOD,U/mg pro),malondialdehyde (MDA,nmol/mg pro) in lung tissue,and the levels of serum transforming growth factor beta-1 (TGF-β1,pg/mL) and pH,oxygen partial pressure (PaO2) and bicarbonate ions concentration (HCO3-) were determined.Further,the lung coefficient and lung fibrous tissue hyperplasia grading were calculated.Correlation analysis was carried out to explore the correlation among GSH-Px,SOD,MDA,lung coefficient,lung hyperplasia of fibrous tissue and TGF-β1.The lung tissue were prepared for microscopy observation after Hematoxylin-eosin staining method (HE staining) as well.The difference between groups was compared by one-way analysis of variance,and correlation analysis carried out by using Pearson and Spearman rank correlation coefficient.Results The levels of GSH-Px and SOD in lung tissue of PQ and OLM treatment groups were significantly lower than those in C group,while in OLM treatment groups,those were higher than those of PQ group,and the HD group showed most obvious (all P ＜ 0.05).The level of MDA in lung tissue in PQ and OLM treatment groups were significantly highcr than that in C group while in OLM treatment groups,that was lower than that in PQ group,and the HD group showed most obvious (all P ＜ 0.05),and there were no differences between the LD group and MD group (all P ＞ 0.05).The lung coefficient and lung fibrous tissue hyperplasia grading in PQ and OLM treatment groups were significantly higher than those in C group,while in OLM treatment groups,those were lower than those in PQ group,and the HD group showed most obvious (all P ＜ 0.05).The level of serum TGF-β1 in PQ and OLM treatment groups were significantly higher than that inC group,while in OLM treatment groups,that was lower than that in PQ group,and the HD group showed most evident (all P ＜ 0.05),and there were no differences between the LD group and MD group (all P ＞0.05).The pH,PaO2 and HCO3-in PQ and OLM treatment groups were significantly lower than those in C group,while difference between LD and HD groups was also statistical significance (all P ＜ 0.05),while there were no differences between the PQ group and LD group as well as the LD group and MD group (all P ＞ 0.05).The correlation analysis showed GSH-Px and SOD had negative correlation with TGF-β1 [the correlation coefficient (r) were respectively-0.860 and-0.856,all P＜0.05],while MDA,lung coefficient and lung fibrous tissue hyperplasia grading had positive correlation with TGF-β1 (r were respectively 0.800,0.830 and 0.656,all P ＜ 0.05).Lung tissue section showed the degree of alveolar septa widened,alveolar collapse and inflammatory cells infiltration in OLM treatment groups were milder than those in PQ group,and the mildest in HD group.Conclusions OLM can attenuate the pulmonary edema and pulmonary fibrosis caused by paraquat poisoning and maybe it is associated with reducing the expression of TGF-β1 and inhibiting oxidative stress reaction.

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