Postoperative hyper-inflammation as a predictor of poor outcomes in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair.

BACKGROUND: Postoperative hyper-inflammation is a frequent event in patients with acute Stanford type A aortic dissection (ATAAD) after surgical repair. This study's objective was to determine which inflammatory biomarkers could be used to make a better formula for identifying postoperative hyper-inflammation, and which risk factors were associated with hyper-inflammation. METHODS: A total of 405 patients were enrolled in this study from October 1, 2020 to April 1, 2023. Of these patients, 124 exhibited poor outcomes. In order to investigate the optimal cut-off values for poor outcomes, logistic and receiver operating characteristic analyses were performed on the following parameters on the first postoperative day: procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and systemic immune-inflammation index (SII). These cut-off points were used to separate the patients into hyper-inflammatory (n = 52) and control (n = 353) groups. Finally, the logistic were used to find the risk factors of hyper-inflammatory. RESULTS: PCT, CRP, IL-6, and SII were independent risk factors of poor outcomes in the multivariate logistic model. Cut-off points of these biomarkers were 2.18 ng/ml, 49.76 mg/L, 301.88 pg/ml, 2509.96 × 109/L respectively. These points were used to define postoperative hyper-inflammation (OR 2.97, 95% CI 1.35-6.53, P < 0.01). Cardiopulmonary bypass (CPB) > 180 min, and deep hypothermia circulatory arrest (DHCA) > 40 min were the independent risk factors for hyper-inflammation. CONCLUSIONS: PCT > 2.18, CRP > 49.76, IL-6 > 301.88, and SII < 2509.96 could be used to define postoperative hyper-inflammation which increased mortality and morbidity in patients after ATAAD surgery. Based on these findings, we found that CPB > 180 min and DHCA > 40 min were separate risk factors for postoperative hyper-inflammation.

Sivelestat in Patients at a High Risk of Postoperative Acute Lung Injury After Scheduled Cardiac Surgery: A Prospective Cohort Study.

Background: Sivelestat, a neutrophil elastase inhibitor, is specifically developed to mitigate the occurrence of acute lung injury (ALI) in individuals who are undergoing cardiovascular surgery. However, its impact on patients who are at a heightened risk of developing ALI after scheduled cardiac surgery has yet to be determined. In order to address this knowledge gap, we undertook a study to assess the efficacy of sivelestat in protecting the lungs of these patients. Methods: We conducted a prospective cohort study involving 718 patients who were at high risk of developing postoperative acute lung injury (ALI) and underwent scheduled cardiac surgery between April 25th, 2022, and September 7th, 2023. Among them, 52 patients received sivelestat (administered at a dosage of 0.2mg/kg/h for 3 days), while 666 patients served as controls, not receiving sivelestat. The control conditions were the same for all patients, including ventilation strategy, extubating time, and fluid management. Subsequently, a propensity-score matched cohort was established, consisting of 40 patients in both the sivelestat and control groups. The primary outcome measure encompassed a composite of adverse outcomes, including 30-day mortality, ALI, acute respiratory distress syndrome (ARDS), and others. Secondary outcomes assessed included pneumonia, ventricular arrhythmias, mechanical ventilation (MV) time, and more. Results: After conducting propensity matching in our study, we observed that there were no significant differences in 30-day mortality between the sivelestat and control groups (0% vs 2.5%, P=0.32). However, the use of sivelestat exhibited a significant reduction in the incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) compared to the control group (0% vs 55%, P<0.01), pneumonia (0 vs 37.5%, P<0.01), MV time (median:8 hours, IQR:4-14.8 hours vs median: 15.2 hours, IQR:14-16.3 hours, P<0.01). Compared to the control group, the sivelestat could significantly decrease white cell count (P<0.01), neutrophile percentage (P<0.01) and C-reactive protein (P<0.01) in the period of postoperative 5 days. Conclusion: The prophylactic administration of sivelestat has shown promising results in reducing the occurrence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in patients with a heightened risk of developing these conditions after elective cardiac surgery. Our study findings indicate that sivelestat may provide protective effects by suppressing inflammation triggered by neutrophil activation, thereby safeguarding pulmonary function. Registration: ChiCTR2200059102, https://www.chictr.org.cn/showproj.html?proj=166643.

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and cardiac intensive care unit length of stay after heart valve surgery.

BACKGROUND: We sought to explore the relationship between dexmedetomidine as an anesthetic adjuvant in cardiac surgery and postoperative complications and length of stay (LOS) in the cardiac intensive care unit (CICU). METHODS: We conducted a retrospective study of patients aged 18 years and older who underwent heart valve surgery between October 2020 and June 2022. The primary endpoint of the study was major postoperative complications (cardiac arrest, atrial fibrillation, myocardial injury/infarction, heart failure) and the secondary endpoint was prolonged CICU LOS (defined as LOS > 90th percentile). Multivariate logistic regression analysis was performed for variables that were significant in the univariate analysis. RESULTS: A total of 856 patients entered our study. The 283 patients who experienced the primary and secondary endpoints were included in the adverse outcomes group, and the remaining 573 were included in the prognostic control group. Multivariate logistic regression analysis revealed that age > 60 years (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.23-2.31; p < 0.01), cardiopulmonary bypass (CPB) > 180 min (OR, 1.62; 95% CI, 1.03-2.55; p = 0.04) and postoperative mechanical ventilation time > 10 h (OR, 1.84; 95% CI, 1.35-2.52; p < 0.01) were independent risk factors for major postoperative complications; Age > 60 years (OR, 3.20; 95% CI, 1.65-6.20; p < 0.01), preoperative NYHA class 4 (OR, 4.03; 95% CI, 1.74-9.33; p < 0.01), diabetes mellitus (OR, 2.57; 95% CI, 1.22-5.41; p = 0.01), Intraoperative red blood cell (RBC) transfusion > 650 ml (OR, 2.04; 95% CI, 1.13-3.66; p = 0.02), Intraoperative bleeding > 1200 ml (OR, 2.69; 95% CI, 1.42-5.12; p < 0.01) were independent risk factors for prolonged CICU length of stay. Intraoperative use of dexmedetomidine as an anesthetic adjunct was a protective factor for major complications (odds ratio, 0.51; 95% confidence interval, 0.35-0.74; p < 0.01) and prolonged CICU stay. (odds ratio, 0.37; 95% confidence interval, 0.19-0.73; p < 0.01). CONCLUSIONS: In patients undergoing heart valve surgery, age, duration of cardiopulmonary bypass, and duration of mechanical ventilation are associated with major postoperative complication. Age, preoperative NYHA classification 4, diabetes mellitus, intraoperative bleeding, and RBC transfusion are associated with increased CICU length of stay. Intraoperative use of dexmedetomidine may improve such clinical outcomes.

Downregulation of EphB2 by RNA interference attenuates glial/fibrotic scar formation and promotes axon growth.

The rapid formation of a glial/fibrotic scar is one of the main factors hampering axon growth after spinal cord injury. The bidirectional EphB2/ephrin-B2 signaling of the fibroblast-astrocyte contact-dependent interaction is a trigger for glial/fibrotic scar formation. In the present study, a new in vitro model was produced by coculture of fibroblasts and astrocytes wounded by scratching to mimic glial/fibrotic scar-like structures using an improved slide system. After treatment with RNAi to downregulate EphB2, changes in glial/fibrotic scar formation and the growth of VSC4.1 motoneuron axons were examined. Following RNAi treatment, fibroblasts and astrocytes dispersed without forming a glial/fibrotic scar-like structure. Furthermore, the expression levels of neurocan, NG2 and collagen I in the coculture were reduced, and the growth of VSC4.1 motoneuron axons was enhanced. These findings suggest that suppression of EphB2 expression by RNAi attenuates the formation of a glial/fibrotic scar and promotes axon growth. This study was approved by the Laboratory Animal Ethics Committee of Jiangsu Province, China (approval No. 2019-0506-002) on May 6, 2019.

Prognostic Role of Nodal Skip Metastasis in Thoracic Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study.

BACKGROUND: Nodal-skip metastasis (NSM) is found in esophageal squamous cell carcinoma (ESCC), but its prognostic role is controversial. This study aimed to investigate the prognostic value of NSM for thoracic ESCC patients. METHODS: Categorization of NSM was according to the N groupings of Japan Esophagus Society (JES) staging system, which is dependent on tumor location. Using the Kaplan-Meier method and Cox-regression analysis, this study retrospectively analyzed the overall survival (OS) for 2325 ESCC patients after radical esophagectomy at three high-volume esophageal cancer centers. Predictive models also were constructed. RESULTS: The overall NSM rate was 20% (229/1141): 37.4% in the in upper, 12.9% in the middle, and 22.2% in the lower thoracic ESCC. The patients with NSM always had a better prognosis than those without NSM. Furthermore, NSM was an independent prognostic factor for thoracic ESCC patients (hazard ratio [HR], 0.633; 95% confidence interval [CI], 0.499-0.803; P < 0.001). By integrating the prognostic values of NSM and N stage, the authors proposed the new N staging system. The categories defined by the new N staging system were more homogeneous in terms of OS than those defined by the current N system. Moreover, the new N system was shown to be an independent prognostic factor also for thoracic ESCC patients (HR, 1.607; 95% CI, 1.520-1.700; P < 0.001). Overall, the new N system had slightly better homogeneity, discriminatory ability, and monotonicity of gradient than the current N system. CONCLUSIONS: This study emphasized the prognostic power of NSM and developed a modified node-staging system to improve the efficiency of the current International Union for Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) N staging system.

Petrocodon luteoflorus (Gesneriaceae), a new species from karst region in Guizhou, China.

A new species of Gesneriaceae, Petrocodon luteoflorus Lei Cai & F.Wen was first described and illustrated from Maolan National Nature Reserve, Libo County, Guizhou Province, China. The diagnostic characters and notes of this species between its most morphologically similar species, P. dealbatus Hance, a detailed description, colour photographs, etymology, as well as distribution and habitat, are also provided in this paper.

Circulating miRNAs as biomarkers for severe acute pancreatitis associated with acute lung injury.

AIM: To identify circulating micro (mi)RNAs as biological markers for prediction of severe acute pancreatitis (SAP) with acute lung injury (ALI). METHODS: Twenty-four serum samples were respectively collected and classified as SAP associated with ALI and SAP without ALI, and the miRNA expression profiles were determined by microarray analysis. These miRNAs were validated by quantitative reverse transcription-polymerase chain reaction, and their putative targets were predicted by the online software TargetScan, miRanda and PicTar database. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (commonly known as KEGG) were used to predict their possible functions and pathways involved. RESULTS: We investigated 287 miRNAs based on microarray data analysis. Twelve miRNAs were differentially expressed in the patients with SAP with ALI and those with SAP without ALI. Hsa-miR-1260b, 762, 22-3p, 23b and 23a were differently up-regulated and hsa-miR-550a*, 324-5p, 484, 331-3p, 140-3p, 342-3p and 150 were differently down-regulated in patients with SAP with ALI compared to those with SAP without ALI. In addition, 85 putative target genes of the significantly dysregulated miRNAs were found by TargetScan, miRanda and PicTar. Finally, GO and pathway network analysis showed that they were mainly enriched in signal transduction, metabolic processes, cytoplasm and cell membranes. CONCLUSION: This is the first study to identify 12 circulating miRNAs in patients with SAP with ALI, which may be biomarkers for prediction of ALI after SAP.

[Change and Influencing Factors of Dissolved Carbon and Dissolved Nitrogen in Water of the Three Gorges Reservoir].

In order to understand the changes of dissolved carbon and dissolved nitrogen in the water of Three Gorges Reservoir,this research was carried out once a week by the bank of Yangtze River in Fuling beach from March 2011 to August 2012,and the variation characteristics of dissolved C,N composition and their source were analyzed.The results showed that the concentration of DOC ranged from 0.64 mg·L-1 to 9.07 mg·L-1,and had obvious seasonal change:summer >spring and autumn >winter.Annual total input of DOC was 1.78×109 kg,the seasonal change trend of the total input of DOC was similar to that of the concentration of DOC;The concentration of DTN ranged from 2.59 mg·L-1 to 4.35 mg·L-1:spring >winter >summer >autumn,annual total input was 1.32×109 kg,the seasonal input changed in the order of summer >autumn >spring >winter,among them DON,NO3--N accounted for 30.35%-63.45% and 35.87%-67.72%,respectively.DOC was affected by precipitation and air temperature,and mainly came from the exogenous input,in the spring and summer its exogenous input increased with the increase of rainfall runoff,but in the autumn and winter the endogenous contribution increased;DTN was relatively affected by human emissions and water dilution.Correlation analysis showed that there was a significant negative correlation between DOC and DON (P<0.05),DOC/DON ratio usually reflects the source of the DOM,the DOC/DON in the water of three gorges reservoir ranged from 0.35 to 7.28,the source of DOM had obvious seasonal characteristics.DOC/DON was the highest in summer,and the DOM mainly came from watershed erosion;DOC/DON was the lowest in winter,and the DOM mainly came from living sewage and endogenous field;the DOC/DON ratios in spring and autumn were higher than those in winter and lower than those in summer,and the DOM sources included watershed erosion,living sewage and endogenous field.

[Characteristics and Influencing Factors of CH4 Emissions from the Drawdown Area of the Three Gorges Reservoir].

Five levels (180 m, 175 m, 165 m, 155 m, and 140 m) in a typical drawdown area in Wangjiagou in the Three Gorges Reservoir were selected to study CH4 emissions from subtropical reservoirs. The experimental period lasted two years from September 2010 to August 2012. The methods of static opaque chambers during the drainage period and floating chambers during flooding period were used in this study. The elevations of 175 m, 165 m, and 155 m were all located in the drawdown area, whereas the 180 m elevation was located in the land and never flooded. The 140 m elevation was permanently flooded and used as a control area. The results showed that the CH4 fluxes showed no significant trends at 175 m and 165 m in the first year of the experiment, while the fluxes showed a single peak pattern with the climax in the summer at 155 m and 140 m. At 175 m, the CH4 emissions showed a single peak pattern with the climax during its flooding period, and then showed not regular CH4 emission sources or sinks alternately in the second year, whereas the CH4 fluxes at 165 m, 155 m, and 140 m presented a single-peak shape with winter climax. During the entire observation period, the CH4 emission fluxes at 180 m were stable and showed no obvious peaks. In addition, CH4 fluxes were higher during the flooding period than in the drainage period at 175 m, 165 m, and 155 m.The order of the annual CH4 cumulative emissions at the five elevations was 140 m (99.58 kg·hm-2) > 155 m (82.98 kg·hm-2) > 165 m (65.38 kg·hm-2) > 180 m (6.32 kg·hm-2) > 175 m (4.27kg·hm-2), suggesting that the soil was more conducive to CH4 production when the flooding period was longer. Correlation analysis indicated that there were no significant correlations between CH4 fluxes and the soil carbon component and pH on land and during the drainage period but CH4 fluxes increased with the increase in soil water content. There was a significant linear negative correlation between CH4 emissions from the gas-water interface at 140 m and in water. The soil moisture content was one of the key factors affecting the CH4 fluxes during the drainage period, while during flooding period, the CH4 fluxes were regulated by flooding depth.

The effect of Chinese herbal medicine on hemorrhagic shock: A systematic review and meta-analysis.

BACKGROUND: Chinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy. OBJECTIVE: To evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients. METHODS: We screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias. RESULTS: Fifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR=0.24, 95%CI:0.13-0.46, P<0.0001), reduce the incidence of MODS (RR=0.47, 95%CI: 0.34-0.66,P<0.00001), symptomatic improvement: increase blood pressure (BP) (MD=8.83, 95%CI:6.82-10.84,P<0.00001), regulate heart rate (MD=-7.6,95%CI:-9.17 to -6.02,P<0.00001), increase urine volume (MD=7.26, 95%CI:5.00-9.53, P<0.00001), compared with conventional therapy alone. No serious adverse events were reported. CONCLUSIONS: CHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.

[Features and Influencing Factors of N2O Emissions from Drawdown Area in the Three Gorges Reservoir].

Three heights (180 m, 175 m and 155 m) located in a typical drawdown area in Wangjiagou of the Three Gorges Reservoir were selected for studying the N2O emissions from subtropical reservoirs. The experimental period lasted two years from August 2010 to August 2012. The methods of static opaque chambers during the drainage period and floating chambers during flooding period were adopted in this study. The heights of 175 m and 155 m were both located in the drawdown area, whereas the 180 m height was located in the land as a control to 175 m and 155 m. N2O fluxes showed clear seasonal trends at each height and remarkable differences were observed between the two years at the 180 m height. N2O fluxes were lowest in spring at the 180 m height. N2O fluxes showed a single-peak pattern with climax in summer in the first year, whereas a double-peak pattern with climax in summer and after dry-wet alternating in the next year after the highest water level of 175 m was succeeded in the Three Gorges Reservoir. N2O fluxes presented a single-peak shape with summer climax at the 155 m height. Additionally, N2O fluxes were higher during the drainage period than in the flooding period at both the 175 m and 155 m heights. The order of the annual N2O cumulative emissions at the three heights was 175 m (853.92 mg·m-2) > 180 m (336.69 mg·m-2) > 155 m (324.69 mg·m-2), and there was a notable difference between 175 m and 155 m, indicating that short-term flooding could increase N2O emissions but long-term flooding could restrain N2O emissions. Correlation analysis showed that there were no obvious relativities between N2O fluxes and environmental factors in the land and during the drainage period. However, N2O fluxes were significantly negatively correlated with water temperature and wind speed during the flooding period. Principal component analysis found that soil nutrient conditions and physicochemical properties were the most important factors for N2O emissions in the land, the nitrogen distribution in water was a main determinant for N2O emissions during the flooding period, and soil physicochemical properties and microbial activity importantly affected N2O emissions during the drainage period in the drawdown area.

[Characteristics and Influencing Factors of Soil Microbial Biomass Carbon and Nitrogen in Drawdown Area in the Three Gorges Reservoir].

Taking a typical drawdown area located in Wangjiagou of the Three Gorges Reservoir as the study object, four elevations 180,175,165 and 155 m were selected to explore the effect of water level change on soil microbial biomass carbon (SMBC) and microbial biomass nitrogen (SMBN). Wherein, 175,165 and 155 m elevations located in the fluctuating zone, manifested as short, medium and long-term flooding, respectively; 180 m was used as the control, located on the land and never flooded. Sampling depth in soil samples was 0-20 cm, collected once a week. The results indicated that, soil organic carbon (SOC) and total nitrogen (TN) contents at 180 m had no obvious seasonal changes, while they showed remarkable seasonal trends at 175m, which in spring and summer were significantly higher than in autumn and winter; SMBC and SMBN contents and their allocation ratio at four elevations were similar and had significant seasonal fluctuation, which were highest in autumn and lowest in summer at each elevation, indicating that in drawdown area the microbial activity and turnover rate of soil organic carbon and nitrogen were limited by the high-temperature and low-humidity soil environment in summer. Data analysis showed that, compared with the 180 m elevation, contents of SOC, TN, SMBC and microbial quotient, SMBN and its allocation proportion showed varying degrees of increase, while contents of these indexes were significantly lower than control except SMBN and its allocation proportion, meaning that compared with 180 m short and medium-term flooding was conducive to improve soil carbon, nitrogen and their turnover rate and microbial biomass, however, contents of soil carbon and nitrogen and microbial biomass carbon were significantly restricted at 155 m as soil was subjected to flooding stress, meanwhile the turnover rate of SOC was reduced. Correlation analysis implied that SMBC and SMBN had very significant negative correlation with temperature at 5 cm soil depth and pH, meaning that the two environmental factors had a strong effect on soil microbial biomass.

[Effect of Raw Materials and Preparing Process on the Composition of Lime-Ash].

As the saying goes that "no ash, no glaze", lime-ash has been the core material widely used to prepare glaze in ancient China. Among all the lime-ashes, those made in Jingdezhen are the most influential and representative ones. Not only did lime-ash contribute greatly to the prosperity of porcelain making of Jingdezhen in Song, Yuan, Ming and Qing Dynasty, but also it has a complicated, rigorous and a touch of "mysterious" in its preparation process, technical principle and glaze mechanism. Therefore, the research of the lime-ash has been an important subject in exploring the "secret" of ancient Chinese porcelain production by Chinese and foreign researchers. In this paper, four representative firewood and two lime stones as the raw materials were collected for the comparative studies, and three kinds of lime-ash with different smolder times were collected from one of the only two traditional lime-ash workshops in Shou'an town nearby Jingdezhen urban area. The chemical composition and phase composition of the raw materials and lime-ash with different smolder times made in Jingdezhen were discussed by testing with the Energy Dispersive X Ray Fluorescence (EDXRF) and X-Ray Diffraction (XRD). The results showed that Fe(2)O(3), MnO contents reaches 1.41% and 1.52% respectively, but the P(2)O(5) content is just 0.54% of Langqi grass which is lower than other firewood that is not only benefited to form the characteristic of "Green in the white" in Jingdezhen traditional glaze, but also is favor to enhance the transparency of glaze and promote the coloration of traditional under-glazed color painted porcelain, such as the blue and white porcelain. The CaO content of grey lime stone is lower than that of the black lime stone with MgO content of 35.79%.This could be the main reason why the craftsmen prefer to use black lime stone to prepare lime-ash. In addition, the EDXRF results show that the K(2)O, P(2)O(5), MnO and Fe(2)O(3) contents have increased as the time of smoldering increases. In the meanwhile, the calcium carbonate (CaCO(3)) phase has also increased, but the calcium hydroxide (Ca(OH)(2)) phase has decreased. The study helps Jingdezhen porcelain "look like jade" and is also good to avoid the "thickness" of glaze when there is a certain amount of Ca(OH)(2) in glaze. So it could be concluded that the unique raw materials and smolder technology of the lime-ash which have provided the technical support for the development of lime-ash glaze are the unique features of ancient Jingdezhen ash glaze.

Effects of pyruvate-enriched peritoneal dialysis solution on intestinal barrier in peritoneal resuscitation from hemorrhagic shock in rats.

BACKGROUND: To investigate protective effects of pyruvate-enriched peritoneal dialysis solution (P-PDS), compared with lactate-PDS (L-PDS), on the intestinal mucosal barrier in peritoneal resuscitation (PR) from severe hemorrhagic shock (HS) in rats. MATERIALS AND METHODS: Fifty male SD rats were randomly divided into five groups (n = 10): group sham, group control (HS without fluid resuscitation), group intravenous resuscitation (IVR) (HS with IVR only), group L-PDS (HS with i.v. infusion plus PR with L-PDS), and group P-PDS (HS with i.v. infusion plus PR with P-PDS). HS was induced by hemorrhage with mean arterial pressure 40 mm Hg for 60 min. In three groups with fluid rehydration, IVR included shed blood and dl-lactate Ringer solution equal to two times the volume of shed blood during 60 min; in two groups with PR, 20 mL of L-PDS, or P-PDS were infused when i.v. infusion started after HS into the peritoneal cavity in 20 min, respectively. Blood samples were taken for determinations of pH, base excess, PaCO2, PaO2, and D-LA 60 min post fluid resuscitation. After rats were sacrificed, a segment of intestine was harvested for the detection of expressions of intestinal barrier proteins: zonula occludens-1 (ZO-1) and phosphorylated vasodilator-stimulated phosphoprotein (p-VASP) by Western blot and immunohistochemistry. Intestinal morphologic alterations were also observed. RESULTS: Blood pH, base excess, and PaO2 were higher, whereas PaCO2 and D-LA were lower in group P-PDS than in other three HS groups (P < 0.05 and P < 0.01, respectively). Severe acidosis was nearly corrected in group P-PDS. Intestinal barrier proteins ZO-1 and p-VASP were significantly preserved in group P-PDS than in group L-PDS (P < 0.05) although they were improved in group L-PDS in comparison with other two HS groups (P < 0.05 or P < 0.01). Expressions of barrier proteins by Western blotting in group P-PDS were reversed to normal. The score of intestinal epithelial damage index was reduced in group L-PDS, compared with other two HS groups (P < 0.05), however, it was significantly lower in group P-PDS than in group L-PDS (P < 0.05). CONCLUSIONS: Pyruvate was superior to lactate in PDS in the correction of severe acidosis with PR. P-PDS was more preservative of expressions of intestinal ZO-1 and p-VASP and mucosal barrier function, compared with L-PDS in PR from severe HS in rats.

[Clinical research of Dahuang Fuzi decoction in auxiliary treatment of severe acute pancreatitis: a multi-center observation in 206 patients].

OBJECTIVE: To observe the efficacy of Dahuang Fuzi decoction in patients with severe acute pancreatitis (SAP), and to provide valuable medical evidences for a treatment of SAP with combined traditional Chinese and western medicine. METHODS: A prospective, multi-center, randomized, controlled clinical trial was designed. Two hundred and six adult patients with SAP admitted to intensive care unit (ICU) in three tertiary university teaching hospitals in Dalian from January 2007 to February 2010 were randomly divided into two groups: soapsuds enema control group (control group, n=101) and Dahuang Fuzi decoction enema study group (study group, n=105). The levels of serum amylase, albumin (Alb), D-lactic acid, endotoxin and diamine oxidase (DAO), high-sensitive C-reactive protein (hs-CRP), immunoglobulin (IgG, IgA, IgM), complements (C3, C4), tumour necrosis factor-α (TNF-α), interleukins (IL-6, IL-8) were determined before and after treatment for 2, 4, 7 days. The bowel sound, gastrointestinal function score, the acute physiology and chronic health evaluation II (APACHEII) score and the length of mechanical ventilation (MV), the length of stay in ICU, the mortality rate and average hospital expenses within 28 days were compared. RESULTS: Compared with control group, in the study group the levels of serum amylase, DAO, D-lactic acid and endotoxin were lowered, the Alb was increased, the levels of TNF-α, IL-6, IL-8, hs-CRP were decreased, the function of body immunity was enhanced, intestinal peristalsis was enhanced, gastrointestinal function score and APACHEII score were improved, the length of MV was reduced, the length of stay in ICU was diminished, the 28-day mortality and average hospital expenses were lowered [4 days amylase (U/L): 357.35±137.54 vs. 492.95±189.42, 2 days DAO (kU/L) : 5.20±0.59 vs. 5.45±0.72, 4 days D-lactic acid (mmol/L): 3.31±0.48 vs. 4.15±0.55, 2 days endotoxin (kEU/L): 0.29±0.11 vs. 0.34±0.14, 4 days Alb (g/L): 34.75±3.56 vs. 32.53±3.44, 2 days TNF-α (ng/L): 3.08±0.45 vs. 3.36±1.11, 2 days IL-6 (ng/L): 298.54±67.82 vs. 313.56±73.91, 4 days IL-8 (ng/L): 30.48±8.56 vs. 45.16±10.81, 2 days hs-CRP (mg/L): 32.56±11.83 vs. 40.42±15.10, 4 days IgG (g/L): 7.05±2.56 vs. 9.53±2.94, 2 days IgA (mg/L): 1 600±170 vs. 1 400±140, 4 days IgM (mg/L): 1 310±280 vs. 1 650±290, 4 days C3 (g/L): 1.11±0.09 vs. 1.50±0.15, 4 days C4 (g/L) : 0.32±0.11 vs. 0.41±0.10, 2 days bowel sound (times/min): 1.26±0.45 vs. 1.15±0.41, 2 days gastrointestinal function score: 2.24±0.98 vs. 2.42±1.05, 4 days APACHEII score: 16.4±6.8 vs. 20.1±7.1, the length of MV (days): 6.5±3.1 vs. 10.1±4.6, the length of stay in ICU (days): 11.3±6.3 vs. 13.8±7.5, mortality: 8.6% vs. 16.8%, average hospital expenses (yuan): 72 thousands vs. 86 thousands, P<0.05 or P<0.01]. CONCLUSION: Dahuang Fuzi decoction may enhance the intestinal peristalsis, protect the gastrointestinal barrier function, reduce the bacteria and endotoxin translocation and the releasing of inflammation mediators, protect the function of body immunity, reduce the length of MV, the length of stay in ICU, and lower the 28-day mortality and average hospital expenses, and it can improve the prognosis of patients with SAP.

[Expression and significance of phosphatidylinositol 3-kinase/protein kinase B signal transduction pathway in severe acute pancreatitis-associated lung injury].

OBJECTIVE: To investigate the expression and significance of phosphatidylinositol 3-kinase/protein kinase B (PI3K/PKB) signal transduction pathway in severe acute pancreatitis-associated lung injury. METHODS: Twenty-four healthy male Changbai pigs were randomized into four groups: sham operation group (n = 6), ALI group (n = 6), ALI plus LPS (lipopolysaccharide) group (n = 6) and ALI plus Wortmannin group (n = 6). The expression levels of PI3K and PKB were determined by both RT-PCR and Western blot. Activity changes of NF-kappaB were detected by electrophoretic mobility shift assay (EMSA). Contents of TNF-alpha and IL-1beta in bronchoalveolar lavage fluid (BALF) were examined by ELISA. The histopathological changes of lung were observed. RESULTS: The expressions of mRNA and protein PI3K and PKB, NF-kappaB activity and TNF-alpha, IL-1beta in BALF in ALI group were higher than those in sham operation group (P < 0.05 or P < 0.01). In ALI plus LPS group, they increased significantly in comparison with ALI group and sham operation group after injection of LPS (P < 0.05 or P < 0.01). In ALI plus Wortmannin group, these parameters were significantly inhibited by Wortmannin in comparisons with ALI group and ALI plus LPS group (P < 0.05 or P < 0.01). CONCLUSION: The phosphatidylinositol 3-kinase/protein kinase B signal transduction pathway is found to participate in the pathological process of severe acute pancreatitis-associated lung injury through the up-regulations of NF-kappaB activity, TNF-alpha and IL-1beta.