Eradicating Helicobacter pylori via 13C-urea breath screening to prevent gastric cancer in indigenous communities: a population-based study and development of a family index-case method.

OBJECTIVE: Screening and eradication of Helicobacter pylori help reduce disparities in the incidence of gastric cancer. We aimed to evaluate its acceptability and feasibility in the indigenous communities and develop a family index-case method to roll out this programme. DESIGN: We enrolled residents aged 20-60 years from Taiwanese indigenous communities to receive a course of test, treat, retest and re-treat initial treatment failures with the 13C-urea breath tests and four-drug antibiotic treatments. We also invited the family members of a participant (constituting an index case) to join the programme and evaluated whether the infection rate would be higher in the positive index cases. RESULTS: Between 24 September 2018 and 31 December 2021, 15 057 participants (8852 indigenous and 6205 non-indigenous) were enrolled, with a participation rate of 80.0% (15 057 of 18 821 invitees). The positivity rate was 44.1% (95% CI 43.3% to 44.9%). In the proof-of-concept study with 72 indigenous families (258 participants), family members of a positive index case had 1.98 times (95% CI 1.03 to 3.80) higher prevalence of H. pylori than those of a negative index case. The results were replicated in the mass screening setting (1.95 times, 95% CI 1.61 to 2.36) when 1115 indigenous and 555 non-indigenous families were included (4157 participants). Of the 6643 testing positive, 5493 (82.6%) received treatment. According to intention-to-treat and per-protocol analyses, the eradication rates were 91.7% (89.1% to 94.3%) and 92.1% (89.2% to 95.0%), respectively, after one to two courses of treatment. The rate of adverse effects leading to treatment discontinuation was low at 1.2% (0.9% to 1.5%). CONCLUSION: A high participation rate, a high eradication rate of H. pylori and an efficient rollout method indicate that a primary prevention strategy is acceptable and feasible in indigenous communities. TRIAL REGISTRATION NUMBER: NCT03900910.

[Human Health Rights: Discussing Health Inequality for Taiwanese Indigenous Peoples and the Appropriateness of Current Epidemic Policies].

Many studies from around the world demonstrate that COVID-19 has had significantly higher rates of infection, hospitalization, and mortality among indigenous and other vulnerable groups than among mainstream population groups. This situation has exposed and reinforced pre-existing health inequalities. This article investigates the rates of infection and mortality among different cultural groups during the COVID-19 pandemic, and then deconstructs the key elements related to systemic or structural racism. The impacts on the human rights and health of indigenous peoples and issues of policy formulation and resource equity during the epidemic are also mentioned. Based on the identified root causes of health inequality, suggestions for reducing health inequality for Taiwanese indigenous peoples are proposed. Further, during epidemics, policymakers must design and implement culturally appropriate epidemic prevention policies, systems, and strategies for indigenous and other disadvantaged populations.

Protective Effect of Calcitriol on Organ Damage Induced by 5-Fluorouracil Treatment.

Chemotherapy is a major therapeutic strategy for patients with cancer. Owing to the severe inflammatory response of chemotherapy, patients experience extreme discomfort during treatment, and this may interrupt treatment completion. The vitamin D3 has a role in anti-inflammation, but no study has explored whether vitamin D3 has beneficial effects on patients undergoing chemotherapy. In this study, we investigated the effect of calcitriol (Vit-D) on inflammatory responses during 5-fluorouracil (5-FU) treatment. Rats were divided into five groups and treated with 1:1 dilution of 5-FU with equal amount of 0.9% saline, 1:3 dilution of 5-FU with 0.9% saline threefold dilution, 5-FU, Vit-D, or 5-FU + Vit-D. A single dose of 15 mg/kg of 5-FU was intravenously administered for 4 h, and the blood biochemical substances and inflammatory cytokines were assessed after the intervention. The 5-FU group had higher AST, ALT, LDH, and CPK levels than those in the 5-FU + Vit-D group. The 5-FU + Vit-D group had a lower TNF-α value than the 5-FU. The IL-6 levels in the 5-FU + Vit-D group were also significantly lower than those in 5-FU. Calcitriol administration during 5-FU therapy can alleviate the production of inflammatory cytokines and liver damage.

[Gorgeous Colorful Rainbow: The Beauty and Sorrow of Indigenous People`s Health].

Residing across this island for over 8,000 years, Taiwan`s indigenous people represent the world`s northernmost population of Austronesian islanders. Although Taiwan`s more than 500,000 indigenous citizens today account for only 0.11% of the 300 million Austronesians worldwide, Taiwan and Taiwan`s long-thriving Austronesian culture played an indispensable role in the historical migrations of ancient Austronesian peoples from Mainland Asia and their proliferation throughout the Pacific (Council on Indigenous Peoples, n.d.). The cultural diversity of Taiwan`s indigenous people allowed their many ethnic groups to adapt to the island`s climatic and environmental diversity, ranging from high, temperate mountains to tropical coastlines, for thousands of years. These groups have adapted well to local conditions, developing living habits, livelihood patterns, life customs, and ceremonies suited to their lives. Traditional wisdom and knowledge, like a colorful rainbow, have shone from ancient times up through the present and are woven deeply through the unique life values of the 16 ethnic tribal groups on Taiwan Island. However, the modernization and transformation of Taiwan`s economy during the past three decades have left indigenous citizens significantly behind mainstream society in many important aspects, including average lifespan, income, education level, and access to medical resources, with mainstream society enjoying more social advantages and a longer average life span (Health Promotion Administration, 2017). Thus, social determinants have promoted various inequalities in health, and the rainbow is no longer beautiful under the impact of modern values. The inequitable distribution of healthcare resources and inadequate human resources have cast a shadow of sadness over this originally beautiful rainbow. Some scholars have raised the cultural security model as a possible framework for formulating policies and regulations to protect the health rights of disadvantaged groups (Coffin, 2007). Using knowledge and values to emphasize cultural safety in the health field and cultural awareness holds the potential of reversing the role of traditional wisdom and knowledge transmitters to gain a deep understanding of the health needs of ethnic groups and of implementing related strategies in acute, chronic, and long-term medical care. This issue is rooted in the current, inequitable deployment of long-term care resources and provision of policy recommendations. In this paper, we discuss strategies for considering and actualizing the main concerns and priorities of ethnic groups, cultivating long-term care 2.0 cultural safety seed tutors, and employing ethnically indigenous nurses in their hometowns / communities. Furthermore, in terms of caring for minorities, we also discuss the long-term care needs of disadvantaged groups such as individuals with mental health needs to achieve the goal of holistic care. We look forward to seeing the bright and colorful rainbow once again. From systemic, educational, and practice perspectives, we will jointly promote public health for all and work to let the beauty of the rainbow surpass the traces of sorrow.

[Health of Indigenous People and Cultural Sovereignty: Developing the Competence of Culture Safety Instructors Under the Long-Term Care 2.0 Program].

Taiwan`s various ethnic groups, including 16 indigenous groups, represent disparate distinct cultures and backgrounds. In long-term care, culturally safe services that reflect cultural expectations and practices must be provided to older-adult recipients of care. As frontline healthcare workers face practical challenges in providing these services appropriately, "cultural safety instructors" may be used to help facilitate indigenous cultural care. Therefore, it is vital to develop the role function and cultural competence of these instructors. In this article, related instructor qualifications, course contents, and expected results of an indigenous cultural safety instruction program are presented based on the theory of cultural competence and cultural safety. In addition, relevant perspectives on cultural safety instructors and their cross-cultural competence specific to indigenous peoples, including Dimitrov and Haque (2016) and Leininiger (1996), are integrated. It is hoped that this study promotes reflection and provides a reference on practice and policies related to long-term care for indigenous people.

[Early Warning Systems: Introduction and Application].

Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.

Serum osteoprotegerin is an independent marker of central arterial stiffness as assessed using carotid-femoral pulse wave velocity in hemodialysis patients: a cross sectional study.

BACKGROUND: Cardiovascular morbidity and mortality are highly prevalent in patients with end-stage renal disease, and osteoprotegerin (OPG) may be an important link between bone loss and vascular calcification. This study was conducted to evaluate the relationship between central arterial stiffness and serum OPG levels in hemodialysis (HD) patients. METHODS: Blood samples were collected from 120 HD patients, and the carotid-femoral pulse wave velocity (cfPWV) value was measured using a validated tonometry system. The cfPWV value of > 10 m/s was used to define the high artery stiffness group. Serum OPG levels were analyzed categorically into tertiles. RESULTS: Of the 120 HD patients, 53 (44.2%) were defined as the high arterial stiffness group, who had higher values of systolic blood pressure (p = 0.038), serum calcium (p = 0.007), and OPG (p <  0.001) levels and a higher prevalence of diabetes mellitus (DM, p = 0.001). Increasing tertiles of serum OPG levels were significantly associated with greater height (p = 0.011), male gender (p = 0.008), higher cfPWV values (p = 0.020), and lower intact parathyroid hormone (iPTH, p = 0.049) levels. Multivariable linear regression analysis showed that cfPWV value was independently associated with DM (ß = 1.83, p = 0.008) and increasing tertiles of serum OPG levels (ß = 0.89 and 1.63 for tertile 2 and tertile 3, respectively, p for trend = 0.035) in HD patients. Multivariable logistic regression analysis revealed that, in addition to age, DM, low iPTH levels, and high serum calcium levels, increasing tertiles of serum OPG levels (OR = 5.34 for tertile 2; OR = 7.06 for tertile 3; p for trend = 0.002) were an independent predictor of high arterial stiffness in HD patients. Serum calcium levels positively correlated with cfPWV value only in the highest OPG tertile group (r = 0.408, p = 0.009). CONCLUSION: A positive association was detected between serum OPG levels and central arterial stiffness in HD patients, and patients with high serum OPG levels may have greater influence of calcium load on central arterial stiffening.

[The Importance of Cross-disciplinary Technology Creativity in the Field of Healthcare].

"Technology - Born from Human Nature" is a familiar Taiwan advertising slogan. Healthcare is a profession that is intimately entwined with human nature. In order to keep up with today's fast-changing healthcare environment and the broadly diverse needs of different healthcare settings, how to best use technology to creatively and efficiently develop patient-friendly care services and interdisciplinary teaching and learning strategies is a topic that is now receiving significant and growing attention in this field. The increasing utilization of big data worldwide is allowing us to better understand public needs and to more-accurately predict changing trends. Related technologies apply knowledge from the field of AI learning, as this process requires deep understanding of how target populations think and reason. This technology has the capacity to significantly improve the accuracy of healthcare diagnoses and to better anticipate patient safety risks in terms of prescription medicine use, the reporting of critical test results, and other factors, thus generating savings in terms of time and costs (Cheong, 2018). Furthermore, healthcare education is increasingly emphasizing the use of simulated environments in order to improve scenario-based learning and teaching efficacy. Virtual reality (VR), augmented reality (AR), and mixed reality (MR) applications help educators overcome the limitations of traditional models of education (Hsieh & Lin, 2017). Educators are now able to incorporate simulations of situations that would otherwise be difficult or impossible to experience otherwise, such as disaster scenes, in-flight medical emergencies, surgeries, emergency rescue scenarios, and gender-care scenarios, into integrated innovative-technology education strategies. Moreover, related technology applications are assisting healthcare professionals to improve their familiarity with clinical techniques, outreach and communication skills, and training. Moreover, whether applied in healthcare education and training, clinical caregiving, emergency medical units, or chronic care settings, these simulation-related, cross-disciplinary technology applications have much to contribute.

Lipid Emulsion Enriched in Omega-3 PUFA Accelerates Wound Healing: A Placebo-Controlled Animal Study.

BACKGROUND: The Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) generate bioactive lipid mediators that reduce inflammation. The present study evaluated the effect of SMOFlipid containing ω-3 PUFAs on wound healing. METHODS: Rats were divided into a SMOFlipid (SMOF) group and a 0.9% saline (placebo) group, with eight rats in each group. Wound excision was performed on the dorsal surface of each rat. In the SMOF group, 1 gm/kg SMOFlipid was dissolved in 3 mL saline as a treatment; in the placebo group, 3 mL saline was prepared as a treatment. The treatments were administered intravenously at an initial rate of 0.2 mL/kg body weight/h immediately after wounding, for 72 h. Blood samples were collected for white blood cell, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 measurements at the baseline and at 1, 6, 12, 24, 48, and 72 h after intervention. Wound areas were measured over a 2-week period after excision, and a histological examination was performed. RESULTS: Compared with the placebo group, SMOFlipid supplementation engendered significant decreases in the wound area on day 3 (78.28 ± 5.25 vs. 105.86 ± 8.89%), day 5 (72.20 ± 4.31 vs. 96.39 ± 4.72%), day 10 (20.78 ± 1.28 vs. 39.80 ± 10.38%), and day 14 (7.56 ± 0.61 vs. 15.10 ± 2.42%). The placebo group had a higher TNF-α level than the SMOF group at 72 h. The IL-10 level was higher in the SMOF group than in the placebo group at 48 h. Histological analysis revealed a higher rate of fibroblast distribution and collagen fiber organization in the SMOF group (P = 0.01). CONCLUSION: SMOFlipid enriched in ω-3 PUFA accelerates wound healing.

[Introduction of Clinical Practice Guidelines for Emergency Patients].

A hospital emergency department is unique among medical environments, with risks of medical errors often higher than in other medical units. Previous studies have confirmed that establishing comprehensive clinical practice guidelines in the emergency department reduces medical costs and improves patient safety and satisfaction. Furthermore, having these guidelines positively influences and significantly impacts the work of emergency care professionals. This article addresses the current assessment and treatment of common emergency care, including non-invasive temperature measurements, oxygenated monitoring during procedural sedation and analgesia, postural differences and vital signs monitoring, and difficulties in peripheral vein placement. Further, this article introduces the recommendations of the Emergency Nurses Association on the empirical level and in terms of the clinical application of these practices in order to help emergency staffs develop domestic and local emergency clinical care guidelines in order to reduce the incidence of medical malpractice and improve care quality and patient satisfaction.

Acute Alcohol Intoxication Exacerbates Rhabdomyolysis-Induced Acute Renal Failure in Rats.

Traumatic and nontraumatic rhabdomyolysis can lead to acute renal failure (ARF), and acute alcohol intoxication can lead to multiple abnormalities of the renal tubules. We examined the effect of acute alcohol intoxication in a rat model of rhabdomyolysis and ARF. Intravenous injections of 5 g/kg ethanol were given to rats over 3 h, followed by glycerol-induced rhabdomyolysis. Biochemical parameters, including blood urea nitrogen (BUN), creatinine (Cre), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and creatine phosphokinase (CPK), were measured before and after induction of rhabdomyolysis. Renal tissue injury score, renal tubular cell expression of E-cadherin, nuclear factor-κB (NF-κB), and inducible nitric oxide synthase (iNOS) were determined. Relative to rats in the vehicle group, rats in the glycerol-induced rhabdomyolysis group had significantly increased serum levels of BUN, Cre, GOT, GPT, and CPK, elevated renal tissue injury scores, increased expression of NF-κB and iNOS, and decreased expression of E-cadherin. Ethanol exacerbated all of these pathological responses. Our results suggest that acute alcohol intoxication exacerbates rhabdomyolysis-induced ARF through its pro-oxidant and inflammatory effects.

Heat adaptation from regular hot water immersion decreases proinflammatory responses, HSP70 expression, and physical heat stress.

Hot-water immersion (HWI) is a type of thermal therapy for treating various diseases. In our study, the physiological responses to occasional and regular HWI have been explored. The rats were divided into a control group, occasional group (1D), and regular group (7D). The 1D and 7D groups received 42°C during 15mins HWI for 1 and 7 days, respectively. The blood samples were collected for proinflammatory cytokines examinations, the heart, liver and kidney were excised for subsequent IHC analysis to measure the level of heat shock protein 70 (HSP70). The results revealed that the body temperature increased significantly during HWI on Day 3 and significantly declined on Days 6 and 7. For the 7D group, body weight, heart rate, hematocrit, platelet, osmolarity, and lactate level were lower than those in the 1D group. Furthermore, the levels of granulocyte counts, tumor necrosis factor-α, and interleukin-6 were lower in the 7D group than in the 1D group. The induction of HSP70 in the 1D group was higher than in the other groups. Physiological responses to occasional HWI are disadvantageous because of heat stress. However, adaptation to heat from regular HWI resulted in decreased proinflammatory responses and physical heat stress.

Freshwater clam extract supplementation improves wound healing by decreasing the tumor necrosis factor α level in blood.

BACKGROUND: The freshwater clam (Corbicula fluminea) is a widely consumed functional food in Asia and is traditionally used to improve health and either prevent or treat inflammation-related diseases. Numerous studies have proposed that freshwater clams act to prevent and attenuate inflammatory responses, and also serve as a possible inhibitor to systemic inflammation. However, there is limited information available about the effects of freshwater clams on wound healing. RESULTS: The present study investigated the influence of freshwater clam extract (FCE) on wound healing and inflammatory responses in a cutaneous incision model. Sixteen rats were used and divided into two groups: the FCE group and the normal saline (NS) group. The rats underwent dorsal full-thickness skin excisional wounds (diameter 20 × 10 mm). FCE or NS was administered for oral feeding twice daily for 14 days after wounding. Blood samples were taken and analyzed, and wound areas were measured at several time points during the 2 weeks after excision. On day 14 after wounding, skin biopsies from the wound sites were sent for histological examination. Treatment with FCE (71.63 ± 9.51 pg mL-1 ) decreased tumor necrosis factor-α levels compared to the NS group (109.86 ± 12.55 pg mL-1 ) after wounding at 3 h (P < 0.05). There were no significant differences in the levels of white blood cells, interleukin (IL)-6, or IL-10. The wound areas of the NS group (23.9%) were larger than those in the FCE group (8.26%) on day 14 (P < 0.05). Numerous fibroblasts and collagen fiber organization were observed in the FCE group. CONCLUSION: FCE supplementation improves the wound healing process. © 2016 Society of Chemical Industry.

Calcitriol decreases pro-inflammatory cytokines and protects against severe hemorrhagic shock induced-organ damage in rats.

INTRODUCTION: Resuscitation after hemorrhagic shock (HS) could result in increased pro-inflammatory cytokines and then multiple organ dysfunctions. Calcitriol exerts pleiotropic effects in a wide variety of target tissues and has a role against anti-inflammation. The present study was aimed to investigate the modulatory effects of calcitriol on the pathophysiological and inflammatory markers following HS in rats. MATERIALS AND METHODS: By withdrawing 60% of the total blood volume over 30min via a femoral artery catheter in rats, HS was induced. Afterwards, 10ng/kg calcitriol was injected intravenously in rats. After performing these procedures, hemodynamic status of mean arterial pressure (MAP) and heart rate (HR) were continuously monitored for 12h. Hemoglobin, lactic dehydrogenase (LDH), creatine phosphokinase (CPK), liver and renal function were measured at 30min before the induction of HS and 0, 1, 3, 6, 9, and 12h after HS, while an equal volume of normal saline as replacement fluid. At 1 and 12h after inducing HS, serum levels of tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were measured, and the livers, kidneys and lungs were taken out and then examined histo-pathologically at 48h after inducing HS. RESULTS: Hemoglobin and MAP were significantly decreased, liver and renal function were significantly impaired, but HR and the levels of LDH, CPK, TNF-α and IL-6 were significantly increased after HS in rats. After being treated with calcitriol following HS resulted in better survival rate, lower serum levels of TNF-α and IL-6, and lesser hepatic, renal, and pulmonary histo-pathologic scores of injury in rats. CONCLUSION: Being treated with calcitriol after HS could ameliorate the pro-inflammatory reactions by modulating the effects of cytokines, which lead to prevention of subsequent major organ damages.

Vitamin D3 Reduces Tissue Damage and Oxidative Stress Caused by Exhaustive Exercise.

Exhaustive exercise results in inflammation and oxidative stress, which can damage tissue. Previous studies have shown that vitamin D has both anti-inflammatory and antiperoxidative activity. Therefore, we aimed to test if vitamin D could reduce the damage caused by exhaustive exercise. Rats were randomized to one of four groups: control, vitamin D, exercise, and vitamin D+exercise. Exercised rats received an intravenous injection of vitamin D (1 ng/mL) or normal saline after exhaustive exercise. Blood pressure, heart rate, and blood samples were collected for biochemical testing. Histological examination and immunohistochemical (IHC) analyses were performed on lungs and kidneys after the animals were sacrificed. In comparison to the exercise group, blood markers of skeletal muscle damage, creatine kinase and lactate dehydrogenase, were significantly (P < 0.05) lower in the vitamin D+exercise group. The exercise group also had more severe tissue injury scores in the lungs (average of 2.4 ± 0.71) and kidneys (average of 3.3 ± 0.6) than the vitamin D-treated exercise group did (1.08 ± 0.57 and 1.16 ± 0.55). IHC staining showed that vitamin D reduced the oxidative product 4-Hydroxynonenal in exercised animals from 20.6% to 13.8% in the lungs and from 29.4% to 16.7% in the kidneys. In summary, postexercise intravenous injection of vitamin D can reduce the peroxidation induced by exhaustive exercise and ameliorate tissue damage, particularly in the kidneys and lungs.

Slow infusion rate of doxorubicin induces higher pro-inflammatory cytokine production.

Different infusion rates of doxorubicin (DOX) have been used for treating human malignancies. Organ toxicity after DOX infusion is a major issue in treatment disruption. However, whether different DOX infusion rates induce different toxicity is still unknown. In this study, we examined the toxicity effects of different DOX infusion rates in the early phase of organ toxicity. Thirty-six rats were randomly divided into 5-, 15-, and 30-min infusion rate groups. A single dose of DOX (8.3 mg/kg, I.V.) was administered at different infusion rates. Blood samples were collected from the femoral artery at 1, 3, 6, 9, 12, 18, 24, 36, and 48 h after DOX administration. The blood cell count and blood biochemistry were analyzed. The liver, kidney, and heart were removed for pathological examinations after the rats were sacrificed. Our findings show that the 30-min group had higher injury markers in the liver (glutamic oxaloacetic transaminase and glutamic pyruvic transaminase), kidneys (blood urea nitrogen and creatinine), and heart (creatine phosphokinase-MB and lactate dehydrogenase), and had higher tumor necrosis factor-alpha and interleukin 6 levels than did the other groups. The 30-min group also had more severe damage according to the pathological examinations. In conclusion, slower infusion of DOX induced a higher inflammatory response and greater organ damage.

[A Reflection on the Policy of Transcultural Long-Term Care for the Indigenous Peoples in Taiwan].

Giving high-profile attention to socio-cultural and traditional beliefs in the promotion of long-term care policies enjoys strong, consensus support in the field of transcultural nursing. To protect the rights of indigenous people in Taiwan, the Ministry of Health and Welfare incorporated the concept of cultural care into the Long-term Care Services Act, which was approved by the Legislature in May 2014. However, the policies, resource strategies, manpower allocations, and staff educations and trainings related to this act are still await implementation in indigenous areas. Beyond the concept of professional healthcare, which considers cultural sensitivity, suitability, and ability, cultural care gives greater priority to crossing cultural barriers, integrating with the lifestyle of clients, and addressing their concerns in order to improve the well-being of target populations. The present article reviews current long-term care policy to highlight the importance of considering the cultural needs of the indigenous peoples of Taiwan in order to enhance the efficiency and impact of long-term care programs. Furthermore, the findings strongly recommend that additional resources be provided in order to meet the long-term care needs of indigenous communities. Finally, cultural-specific, long-term care service strategies should be promulgated in order to upgrade well-being in order to ease and comfort the feelings of indigenous people.

Calcitriol decreases TGF-ß1 and angiotensin II production and protects against chlorhexide digluconate-induced liver peritoneal fibrosis in rats.

Peritoneal fibrosis is a major complication of peritoneal dialysis that can lead to ultrafiltration failure. This study investigates the protective effects of calcitriol on chlorhexidine digluconate-induced peritoneal fibrosis in rats. Peritoneal fibrosis was induced in Sprague-Dawley rats by daily administration of 0.5mL 0.1% chlorhexidine digluconate in normal saline via peritoneal dialysis for 1week. Rats received daily intravenous injections of calcitriol (low-dose, 10ng/kg; or high-dose, 100ng/kg) for 1week. After 7days, conventional 4.25% Dianeal (30mL) was administered via peritoneal dialysis over 4h. Peritoneal solute transport was calculated from the dialysate concentration relative to its concentration in the initial infused dialysis solution (D4/D0 glucose) for glucose, and the dialysate-to-plasma concentration ratio (D4/P4 urea) at 4h for urea. Rats were then sacrificed and the liver peritoneum was harvested for immunohistochemical analysis via microscopy. After dialysis, the D4/P4 Urea level was reduced; increases were observed in the D4/D0 glucose level and the levels of active transforming growth factor-ß1 and angiotensin II in serum and dialysate; the liver peritoneum and muscle peritoneum was markedly thickened, and the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-ß1, and phosphorylated Smad2/3 (P-Smad2/3)-positive cells in the liver peritoneum was elevated in the peritoneal fibrosis group compared with the vehicle group. Calcitriol decreased the serum and dialysate active transforming growth factor-ß1 and angiotensin II level, decreased the thickness of the liver peritoneum and muscle peritoneum, and decreased the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-ß1, and P-Smad2/3-positive cells in liver peritoneum cells. High-dose calcitriol exhibited better protective effects against peritoneal fibrosis than did the lower dose. Calcitriol protected against chlorhexidine digluconate-induced peritoneal fibrosis in rats by decreasing transforming growth factor-ß1 and angiotensin II production.

Deleterious effects of aggressive rapid crystalloid resuscitation on treatment of hyperinflammatory response and lung injury induced by hemorrhage in aging rats.

BACKGROUND: Large-volume, rapid crystalloid infusion may increase endothelial cell damage and induce shear stress, potentially leading to multiple-organ dysfunction syndrome. Limited guideline data for fluid administration are currently available, especially for the aging population. The aim of the present study was to compare the degree of organ damage in conscious aging rats when different resuscitation speeds were used during the treatment of hemorrhagic shock (HS). METHODS: Eighteen aging male Wistar-Kyoto rats were randomly divided into the following three groups: the control group, 30-min rapid resuscitation group, and 12-h slow resuscitation group. To mimic HS, 40% of the total blood volume was withdrawn. Fluid resuscitation (1:3) was given at 30 min after the blood withdrawal. Blood biochemical parameters including glucose, lactic acid, and lactate dehydrogenase (LDH) were measured along with the levels of serum and bronchoalveolar lavage fluid, tumor necrosis factor alpha (TNF-α), and interleukin 10 by enzyme-linked immunosorbent assay. The lungs were examined for pathologic changes, and the injury score at 24 h after HS was calculated. RESULTS: Compared with slow-rate resuscitation, initially rapid and immediate resuscitation significantly increased the serum levels of glucose, LDH, and proinflammatory cytokines (TNF-α and interleukin 10), and bronchoalveolar lavage fluid levels of white blood cells, TNF-α, and LDH as well as produced pathologic changes in the organ. The lung injury scores were higher after induced HS in aging rats. CONCLUSIONS: The slow and continuous (12 h) fluid resuscitation rate ameliorated HS-induced organ damage in conscious aging rats.

Heavy ethanol intoxication increases proinflammatory cytokines and aggravates hemorrhagic shock-induced organ damage in rats.

Hemorrhagic shock (HS) following acute alcohol intoxication can increase proinflammatory cytokine production and induce marked immunosuppression. We investigated the effects of ethanol on physiopathology and cytokine levels following HS in acutely alcohol-intoxicated rats. Rats received an intravenous injection of 5 g/kg ethanol over 3 h followed by HS induced by withdrawal of 40% of total blood volume from a femoral arterial catheter over 30 min. Mean arterial pressure (MAP) and heart rate (HR) were monitored continuously for 48 h after the start of blood withdrawal. Biochemical parameters, including hemoglobin, ethanol, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine (Cre), lactic dehydrogenase (LDH), and creatine phosphokinase (CPK), were measured at 30 min before induction of HS and 0, 1, 3, 6, 9, 12, 18, 24, and 48 h after HS. Serum tumor necrosis factor- α (TNF- α ) and interleukin-6 (IL-6) levels were measured at 1 and 12 h after HS. The liver, kidneys, and lungs were removed for pathology at 48 h later. HS significantly increased HR, blood GOT, GPT, BUN, Cre, LDH, CPK, TNF- α , and IL-6 levels and decreased hemoglobin and MAP in rats. Acute ethanol intoxication further increased serum levels of GOT, GPT, BUN, Cre, LDH, CPK, TNF- α and IL-6 elevation following HS. Acutely intoxicated rats exacerbated the histopathologic changes in the liver, kidneys, and lungs following HS.