Tasks of COVID-19 prevention and control management teams at primary health care facilities in mainland China: a nationwide online cross-sectional survey.

BACKGROUND: This research aimed to investigate the tasks performed by Coronavirus Disease 2019(COVID-19) prevention and control management teams at primary healthcare (PHC) facilities during COVID-19 pandemic across the mainland China. METHODS: An online survey was performed and COVID-19 prevention and control management teams at PHC facilities were invited to participate in this research. The top 7 most important tasks in the three different periods of COVID-19 containment were selected and ranked. Participations of tasks were surveyed. RESULTS: A total of 998 valid responses (an effective rate of 99.11%) were collected. The respondents were divided into Group A (≤5 respondents within each PHC facility, n1 = 718) and Group B (> 5 respondents within each PHC facility, n2 = 280). The consensus was selected from top 7 most important tasks including screening at travel centers/intervals and screening at entry centers, at-home/centralized quarantine management, transferring, pre-examination/triage and fever sentinel surveillance clinic/fever clinic. Pre-examination/triage and fever sentinel surveillance clinic/fever clinic works became more significant in the regular prevention and control period. Adjusted analysis found that team members of Group A with a college, undergraduate college and graduate school educational background were less involved in pre-examination/triage works (aOR: 0.28; 95%CI: 0.09-0.86, P = 0.026; aOR: 0.30; 95%CI: 0.10-0.90, P = 0.031; aOR: 0.21; 95%CI: 0.05-0.82, P = 0.024). Those who were over the median age were twice more likely to be engaged in managing fever sentinel surveillance of clinic/fever clinic visitors (aOR: 2.18; 95%CI: 1.16-4.08, P = 0.015). Those being specialized in nursing and other specialties were less likely to participate in fever sentinel surveillance of clinic/fever clinic works (aOR: 0.44; 95%CI: 0.24-0.81, P = 0.009; aOR: 0.30; 95%CI: 0.16-0.58, P < 0.001). Those came from central and western China were less likely to participate in centralized quarantine management (aOR: 0.61; 95%CI: 0.38-0.98, P = 0.042; aOR: 0.64; 95%CI: 0.42-0.97, P = 0.037). Team members came from central and western China were twice less likely to participate in screening at travel centers/intervals (aOR: 1.75; 95%CI: 1.14-2.70, P = 0.011; aOR: 1.63; 95%CI: 1.07-2.48, P = 0.024). CONCLUSION: In mainland China, team members of COVID-19 prevention and control at PHC facilities are mainly responsible for screening, quarantine, transferring and monitoring during the COVID-19 pandemic. Pre-examination/triage and the fever sentinel surveillance clinic/fever clinic were gradually valued. Team members with lower educational background are competent in pre-examination/triage works, but more experienced general practitioners are more likely to be in charge of fever sentinel surveillance clinic/fever clinics work. The necessity of COVID-19 prevention and control management teams to participate in screening at travel centers/intervals is subjected to further discussions.

Vaccination coverage among COVID-19 prevention and control management teams at primary healthcare facilities in China and their attitudes towards COVID-19 vaccine: a cross-sectional online survey.

OBJECTIVE: To investigate the COVID-19 vaccination coverage rate and differences among various COVID-19 prevention primary healthcare (PHC) facilities in China and understand their attitudes towards COVID-19 vaccine. These findings are helpful to provide important suggestions to further improve national COVID-19 vaccination rate. DESIGN: A nationwide cross-sectional online survey was designed and conducted among COVID-19 prevention and control management teams at PHC facilities in mainland China. In the self-designed questionnaires, each subject was asked to evaluate on a 1-10 scale (10=extremely important/acceptable/influential) the COVID-19 vaccination importance, acceptance and factors related to vaccine hesitancy. SETTING: Subjects from 31 provinces and autonomous regions including minorities across mainland China were invited to complete the questionnaire between 22 February 2021 and 2 March 2021. PARTICIPANTS: Were selected by multistage stratified sampling, 998 valid questionnaires (valid rate 99.11%) were collected. The respondents were divided into group A (≤5 respondents within each PHC facility, n1=718) and group B (>5 respondents within each PHC facility, n2=280). OUTCOME MEASURES: Survey on vaccination rate and attitude towards COVID-19 vaccine included the following: (1) if the subjects think the vaccination is important in containment of COVID-19 pandemic (1-10 scale, 10=extremely important), (2) if they would accept COVID-19 vaccine (1-10 scale, 10=extremely acceptable) and (3) their opinions on 7 factors possibly related to vaccine hesitancy (1-10 scale, 10=extremely influential). All the items were designed based on the previous expert interviews. RESULTS: Our results showed vaccination rate was greater in group A (85.93%) than in group B (66.43%) (p<0.001). Detailed analyses revealed that in group A, male members were twice as likely to get vaccinated as compared with female members (adjusted OR (aOR): 2.07; 95% CI: 1.26 to 3.43, p=0.004). In group B, those who were at or under the median age had twice the odds of vaccination coverage compared with those who were over the median age (aOR: 2.29; 95% CI: 1.22 to 4.33, p=0.010). In addition, those who were specialised in traditional Chinese medicine were less likely to get vaccinated against COVID-19 compared with those who were specialised in general medicine, with the aOR: 0.10 (95% CI: 0.01 to 0.83, p=0.033). By analysing the factors that influenced the vaccination attitudes among the 998 respondents, we found no significant difference between the vaccinated and unvaccinated participants. However, further detailed analyses found that team members with undergraduate college education were less likely to score higher in COVID-19 vaccination importance than those with technical secondary school education (aOR: 0.35; 95% CI: 0.13 to 0.93, p=0.035); Furthermore, those with non-medical job titles had nearly twice the odds of giving a higher score for the uncertainty of vaccine efficacy compared with those with junior medical titles (aOR: 1.70; 95% CI: 1.02 to 2.85, p=0.016). Team members with a non-medical title were more likely to give a higher score for advice on social sources compared with those with a junior medical title (aOR: 1.70; 95% CI: 1.02 to 2.85, p=0.042). CONCLUSION: In PHC facilities, although there was a higher COVID-19 vaccination rate among COVID-19 prevention and control teams, some subgroups with different descriptive characters showed negative attitudes towards COVID-19 vaccination. Because primary care workers in China are highly expected to receive the vaccination, and support and educate the public for COVID-19 vaccination. Thus, it is important and necessary to continue to educate them about their vaccination concerns and change their attitudes towards vaccination. Our findings are highly beneficial for designing public vaccination education strategies.

Prevention and control of COVID-19 by primary health care facilities in China: a field-survey-based qualitative study in three typical cities.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) containment, primary health care (PHC) facilities inChina played an important role in providing both healthcare and public care services to community populations. The tasks of COVID-19 containment facilitated by PHC facilities were different among different regions and during different periods of COVID-19 pandemic. We sought to investigate the gaps on task participation, explore existing problems and provide corresponding solutions. METHODS: Semi-structured face-to-face interviews with COVID-19 prevention and control management teams of PHC facilities were conducted. Purposive stratified sampling was used and 32 team members of 22 PHC facilities were selected from Wuhan (as high-risk city), Shanghai (as medium-risk city) and Zunyi (as low-risk city). Framework analysis was employed to analyze the transcribed recordings. RESULTS: The main tasks of PHC facilities during the early period of the pandemic included assisting in contact tracing and epidemiological investigation, screening of populations at high-risk at travel centers/internals, house-by-house, or pre-examination/triage within PHC facilities; at-home/ centralized quarantine management; the work of fever sentinel clinics. Further analyses revealed the existing problems and suggestions for improvement or resolutions. Regular medical supply reserves were recommended because of the medical supply shortage during the pre-outbreak period. Temporarily converted quarantine wards and centralized quarantine centers could be used to deal with pressures on patients' treatment and management of the febrile patients. Only after strict evaluation of nucleic acid testing (NAT) results and housing conditions, decision on quarantine at-home or centralized quarantine centers could be made. Settings of fever sentinel clinics at PHC facilities allowed fever patients with no COVID-19 infection risks for treatment without being transferred to fever clinics of the designed secondary hospitals. Psychological intervention was sometimes in need and really helped in addressing individuals' mental pressures. CONCLUSIONS: During the COVID-19 containment, PHC facilities in China were responsible for different tasks and several problems were encountered in the working process. Accordingly, specific and feasible suggestions were put forward for different problems. Our findings are highly beneficial for healthcare teams and governments in handling similar situations.

Study of the radiotherapy sensitizea-tion of retroperitoneal lymph node metastasis in patients by sodium glycididazole.

To observe the radiotherapy sensitization effect of retroperitoneal lymph node metastasis in patients by sodium glycididazole in recent clinical efficacy and toxicity. A total of 42 patients admitted with metastasis and recurrence of retroperitoneal lymph node from September 2006 to December 2009 were classified with the method of case-control. After three dimensional conformal radiation therapy with or without sodium glycididazole (800 mg/m²) for sensitization, the results of recent clinical efficacy, relief of pain, and Karnofsky score were obtained. Tumor remission rate of patients in sensitization group (with sodium glycididazole) at post-radiotherapy 3 months was significant higher than that in control group (without sodium glycididazole) (52% vs. 24%; P<0.05). Oral dose of morphine daily, and Karnofsky score in anterior-posterior radiotherapy of patients in the sensitization group were significant different with those in the control group (93 ± 12 and 42 ± 6 mg vs. 94 ± 12 and 20 ± 5 mg and (65 ± 4) and (90 ± 9) vs. (64 ± 5) and (80 ± 10), respectively; P<0.01). Sodium glycididazole has positive radiotherapy sensitization to the metastasis or recurrence of retroperitoneal lymph node for digestive tract cancer, which could obviously improve the life quality or release the pain for patients.

Extensive variability in vasoactive agent therapy: a nationwide survey in Chinese intensive care units.

BACKGROUND: Inconsistencies in the use of the vasoactive agent therapy to treat shock are found in previous studies. A descriptive study was proposed to investigate current use of vasoactive agents for patients with shock in Chinese intensive care settings. METHODS: A nationwide survey of physicians was conducted from August 17 to December 30, 2012. Physicians were asked to complete a questionnaire which focused on the selection of vasoactive agents, management in the use of vasopressor/inotropic therapy, monitoring protocols when using these agents, and demographic characteristics. RESULTS: The response rate was 65.1% with physicians returning 586 valid questionnaires. Norepinephrine was the first choice of a vasopressor used to treat septic shock by 70.8% of respondents; 73.4% of respondents favored dopamine for hypovolemic shock; and 68.3% of respondents preferred dopamine for cardiogenic shock. Dobutamine was selected by 84.1%, 64.5%, and 60.6% of respondents for septic, hypovolemic, and cardiogenic shock, respectively. Vasodilator agents were prescribed by physicians in the management of cardiogenic shock (67.1%) rather than for septic (32.3%) and hypovolemic shock (6.5%). A significant number of physicians working in teaching hospitals were using vasoactive agents in an appropriate manner when compared to physicians in nonteaching hospitals. CONCLUSIONS: Vasoactive agent use for treatment of shock is inconsistent according to self-report by Chinese intensive care physicians; however, the variation in use depends upon the form of shock being treated and the type of hospital; thus, corresponding educational programs about vasoactive agent use for shock management should be considered.

Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research.

BACKGROUND: Central venous pressure (CVP) and intrathoracic blood volume index (ITBVI) were used to assess the fluid status. It has previously been shown that CVP is not as accurate as ITBVI for all the shock patients. We therefore hypothesized that the change of CVP has the ability to predict fluid responsiveness in some clinical cases of shock. METHODS: From September 1st 2009 to September 1st 2011, sixty-three patients with shock from different Intensive Care Unit (ICU) were collected into this retrospective study. All the patients received fluid challenge strategy (infusing 300 ml hydroxyethyl starch in 20 minutes), were monitored with CVP and pulse-indicated continuous cardiac output (PICCO). The correlation between changes in cardiac index (ΔCI), CVP (ΔCVP) and ITBVI (ΔITBVI) were analyzed. Fluid responsiveness was defined as an increase in CI ≥ 10%. Receiver operating characteristic (ROC) curves were generated for ΔCVP and ΔITBVI. RESULTS: For all the patients, there was no correlation between ΔCI and ΔCVP (P = 0.073), but in the subgroup analysis, the correlation between ΔCI and ΔCVP was significant in those younger than 60 years old (P = 0.018) and those with hypovolemic shock (P = 0.001). The difference of areas under the ROC curves of ΔCVP and ΔITBVI were not statistically significant in the group younger than 60 years old or hypovolemic shock group (P > 0.05, respectively). However, no similar results can be found in the group older than 60 years old and the other two shock type groups from ROC curves of ΔCVP and ΔITBVI. CONCLUSIONS: ΔCVP is not suitable for evaluating the volume status of the shock patients with fluid resuscitation regardless of their condition. However, in some ways, ΔCVP have the ability to predict fluid responsiveness in the younger shock patients or in the hypovolemic shock patients.

[Effects of postoperative restrictive fluid management on recovery of gastrointestinal function after elective colonic resection].

OBJECTIVE: To investigate the effect of postoperative restrictive fluid management by ensuring adequate tissue perfusion on the recovery of gastrointestinal function after elective colonic resection. METHODS: Thirty patients suffered with elective colonic resection, after 6 hours of anesthesia recovery, were randomly divided into restrictive fluid management group (restrictive group, n=15) and traditional fluid management group (control group, n=15). From the surgery day to the 4th postoperative day, patients in restrictive group and control group received the total fluids of 25-35 ml×kg(-1)×d(-1) or 40-50 ml×kg(-1)×d(-1) respectively. Fluid balance, tissue perfusion, gastrointestinal function recovery time and the imbalance of fluid and electrolyte were recorded. RESULTS: The total fluid input and net fluid balance in restrictive group were significantly fewer than those in control group (total fluid input: 1782.56±258.38 ml/d vs. 2707.50±294.64 ml/d, net fluid balance: 316.67±202.86 ml/d vs. 623.33±244.38 ml/d, both P<0.05), and central venous pressure (CVP) was significantly lower than that in control group (4.03±1.81 mm Hg vs. 6.47±3.09 mm Hg, P<0.05). There were no differences in heart rate (HR) and mean arterial pressure (MAP) between two groups (HR: 85.03±13.49 bpm vs. 81.44±12.49 bpm, MAP: 80.65±11.39 mm Hg vs. 82.38±8.28 mm Hg, both P>0.05). The lactate clearance rate of the first postoperative 24 hours in restrictive group was higher than that in control group [35 (17, 53)% vs. 17 (-6, 33)%, P<0.05]. The times of bowel sounds recovery, the first flatus and stool passed in restrictive group were shorter than those in control group (bowel sounds: 37.43±24.97 hours vs. 46.36±19.34 hours, flatus: 53.63±12.78 hours vs. 75.43±20.07 hours, stool: 78.73±46.48 hours vs. 93.40±41.08 hours, all P<0.05). Vomiting was reduced in the restrictive group compared with control group (2 vs. 7, P<0.05). There were no differences in the occurrences of electrolyte imbalance (5 vs. 3), fluid insufficient (2 vs. 0) and fluid overload (0 vs. 1) between the two groups. CONCLUSION: The postoperative restrictive fluid management by ensuring tissue perfusion can shorten the gastrointestinal function recovery time after elective colonic resection, and may not increase the incidence of water and electrolyte disorders.

The effects of stimulation at acupoint ST36 points against hemorrhagic shock in dogs.

The aim of this study is to investigate the effects of electroacupuncturing (EA) zusanli points on levels of basic hemodynamics, lactate, and cytokines in dogs with hemorrhagic shock. Thirty healthy dogs were randomly divided into 5 groups: sham hemorrhagic shocked group, hemorrhagic shocked group, EA group, nonacupuncturing group, and EA after vagotomy group. Zusanli points were electroacupunctured with constant voltage (10-15 V, 30 Hz) for 30 minutes immediately after the shock models were established. Before the stimulation, a blood pressure transducer was implanted into the right femoral artery for continuous recording of mean arterial pressure (MAP), and a 5F Swan-Ganz pediatric catheter was implanted into the pulmonary artery. The levels of serum tumor necrosis factor α (TNF-α) in the femoral artery were detected at 0, 120, and 180 minutes after hemorrhage. The levels of serum lactate in the femoral artery were detected before hemorrhage (-45 minutes), at 0 minute, and at 180 minutes. In the hemorrhagic shocked group, the levels of MAP, cardiac output, cardiac index, central venous pressure, and pulmonary arterial wedge pressure decreased significantly; at the same time, the levels of serum TNF-α and serum lactate increased significantly. There were no differences between these groups and the hemorrhagic group, but they were different from the sham hemorrhagic shocked group. In the EA group, the levels of MAP, cardiac output, cardiac index, central venous pressure, and pulmonary arterial wedge pressure gradually increased, but the content of serum TNF-α and lactate obviously decreased. The results suggested that EA zusanli points produce a protective effect on hemorrhagic shock in dogs.

The protective effect of the cholinergic anti-inflammatory pathway against septic shock in rats.

To investigate the effects of the cholinergic anti-inflammatory pathway on hemodynamics, blood biochemistry, the plasma TNF-alpha level, and the nuclear factor-kappaB (NF-kappaB) activation during septic shock, male Sprague-Dawley rats were subjected to cecal ligation and puncture (CLP, a model of polymicrobial sepsis) or sham operation. Forty-eight rats were randomly assigned into six equal groups: sham CLP group; CLP group; VGX group was subjected to bilateral cervical vagotomy after CLP; STM group was subjected to bilateral cervical vagotomy after CLP plus the left vagus nerve trunk electrical stimulation; THA group was administered tetrahydroaminoacridine after CLP and bilateral cervical vagotomy; and alpha-BGT group was administered alpha-bungarotoxin before electrical stimulation of the vagus nerve. The right carotid artery was cannulated to monitor MAP. The plasma TNF-alpha level was measured using enzyme-linked immunosorbent assays. The hepatic NF-kappaB activation was determined by Western blotting. Cecal ligation and puncture produced progressive hypotension. Serum aspartate transaminase and alanine transaminase levels significantly increased after CLP challenge. The plasma TNF-alpha level and the hepatic NF-kappaB activation significantly increased after CLP alone or with bilateral cervical vagotomy compared with sham-operated group. Application of constant voltage pulses to the caudal vagus trunk significantly prevented the development of CLP-induced hypotension, alleviated the hepatic damage, and reduced the plasma TNF-alpha production, but electrical stimulation had no effect on the hepatic NF-kappaB activation. Tetrahydroaminoacridine administration after bilateral cervical vagotomy reversed hypotension and attenuated the plasma TNF-alpha response; in addition, it had no effect on the hepatic NF-kappaB activation. alpha-Bungarotoxin pretreatment significantly reversed the inhibitory effect of vagal electrical stimulation, but it had no effect on the hepatic NF-kappaB activation. Our results showed that the cholinergic anti-inflammatory pathway might produce a potential protective effect on polymicrobial sepsis in rats.

Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients.

INTRODUCTION: Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population. METHODS: Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis. RESULTS: A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both gram-positive and gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020). CONCLUSION: IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.

[Protective effects of electric stimulation of vagus nerve on acute lung injury in rat with sepsis].

OBJECTIVE: To investigate the protective effect of stimulation of vagus nerve on acute lung injury in rat with sepsis. METHODS: Sepsis was reproduced by cecal ligation and puncture (CLP). Forty male Sprague-Dawley (SD) rats were randomly divided into 4 groups (each n=10): SHAM group received performed sham surgery. In CLP group, CLP was performed. In vagotomy (VGX) group, rats were subjected to bilateral cervical VGX following CLP. In vagus stimulation (STM) group, rats were subjected to bilateral cervical VGX after CLP and the efferent end of the left vagus nerve was stimulated with electric current. The animals were sacrificed at 18 hours after production. Tumor necrosis factor-alpha (TNF-alpha) level in blood was detected, arterial blood lactic acid concentration,pH, partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), base excess (BE) and lung wet/drying (W/D) ratio were determined. The histopathology and ultra-microstructure of the lung were observed. RESULTS: The TNF-alpha and lactic acid concentrations, PaCO2 and W/D ratio were all increased, and pH, PaO2, BE all lowered in CLP group and VGX group compared with those of SHAM group (P<0.05 or P<0.01). Compared with CLP group, TNF-alpha, lactic acid concentration,PaCO2,W/D ratio in STM group were decreased obviously, and pH, PaO2 and BE were all increased (P<0.05 or P<0.01). The lung tissue pathology and ultra-microstructure changes indicated that lung injury was severe in CLP group than in SHAM group and was ameliorated in STM group compared with that of CLP group and VGX group. CONCLUSION: The results suggest that direct electrical stimulation of the efferent end of vagus nerve can protect lung against injury induced by sepsis in rat.

Effects of ketamine on proinflammatory cytokines and nuclear factor kappaB in polymicrobial sepsis rats.

AIM: To explore the effects of ketamine on hemo-dynamics, plasma proinflammatory cytokine (TNF-alpha and IL-6) levels and nuclear factor kappa B (NF-kappaB) activation during polymicrobial sepsis. METHODS: Male Sprague-Dawley rats were subjected to cecal ligation and puncture (CLP) or sham operation. The rats were randomly assigned into four equal groups: sham CLP group, CLP group, ketamine (KT) I group and KT II group. Thirty minutes before CLP, ketamine (5 mg/kg per hour and 10 mg/kg per hour, respectively) was infused continuously through the left femoral vein cannula in KT I group or KT II group. Sham CLP group and CLP group received 0.9% saline only (5 mL/kg per hour). The right femoral artery was cannulated to monitor mean arterial pressure (MAP) and heart rates (HR),and draw blood samples. The proinflammatory cytokine (TNF-alpha and IL-6) levels of plasma were measured using enzyme-linked immunosorbent assays (ELISA). The hepatic NF-kappaB activation was determined by Western blot and HPIAS 2000 image analysis system. Twenty hours after CLP, the rats were killed by right femoral artery phlebotomization. RESULTS: CLP produced progressive hypotension, and a first increase followed by a decrease in HR. The hypotension was prevented, and the HR was slightly steady in ketamine treated rats. TNF-alpha levels of plasma reached a peak value at 2 h after CLP. Ketamine (KT I group or KT II group) caused a significant decrease compared with CLP group at 2, 5 and 9 h time points after CLP (14.3 +/- 1.9 vs 4.3 +/- 0.9, 9.7 +/- 1.4 vs 4.3 +/- 0.9; 9.3 +/- 1.5 vs 4.3 +/- 0.9, 8.7 +/- 1.4 vs 4.3 +/- 0.9; 6.0 +/- 1.5 vs 5.0 +/- 1.7, 5.3 +/- 0.8 vs 5.0 +/- 1.7; P < 0.01, respectively). The IL-6 levels of plasma firstly ascended and then descended in CLP group, and reached a peak value at 9 h after CLP. Ketamine (KT I group or KT II group) caused a significant decrease compared with CLP group at 5, 9 or 20 h after CLP (135.0 +/- 52.6 vs 60.0 +/- 16.3, 112.5 +/- 52.6 vs 60.0 +/- 16.3; 410.0 +/- 68.7 vs 62.5 +/- 12.5, 250.0 +/- 28.0 vs 62.5 +/- 12.5; 320.0 +/- 25.9 vs 52.5 +/- 10.1, 215.0 +/- 44.6 vs 52.5 +/- 10.1; P < 0.05, respectively). The IL-6 levels of plasma in KT II group were lower than those of KT I group at 9 h after CLP (250.0 +/- 28.0 vs 410.0 +/- 68.7; P < 0.05). In addition, CLP increased hepatic NF-kappaB expression compared with sham CLP. Ketamine suppressed NF-kappaB activation in a dose-dependent manner at 4 h after CLP (237.7 +/- 3.5 vs 246.9 +/- 3.1; P < 0.05). CONCLUSION: Ketamine stabilizes the hemodynamics, attenuates the proinflammatory cytokine responses, and inhibits hepatic NF-kappaB activation. These findings suggest that ketamine has protective effects against polymicrobial sepsis in rats.

[Protective effect of the cholinergic anti-inflammatory pathway against hemorrhagic shock in rats].

OBJECTIVE: To investigate the effect of the cholinergic anti-inflammatory pathway on hemodynamics in hemorrhaged rats. METHODS: Hemorrhagic shock was induced by modified Wiggers method until mean arterial pressure (MAP) was stabilized within the range of 35 to 40 mm Hg (1 mmHg=0.133 kPa). Thirty male Sprague-Dawley rats were randomly divided into six groups: sham group, hemorrhagic shock (Hem) group, vagotomy (VGX) group, vagus stimulation (STM) group, cholinergic inhibitor (THA) group and N receptor inhibitor (alpha-BGT) group. The distal end of the left vagus nerve trunk was placed on bipolar platinum electrode connected to a stimulation module and controlled by an acquisition system. Stimuli with constant voltage (5 V, 2 ms, 1 Hz) were applied to nerve for 12 minutes, starting 5 minutes after MAP stabilized at a level of 35 to 40 mmHg. Before stimulation a blood pressure transducer was implanted in the common carotid artery for continuous registration of MAP. Blood samples and liver samples were collected from animals of all groups after stimulation. Serum levels of tumor necrosis factor-alpha (TNF-alpha) and liver nuclear factor kappa-B (NF-KappaB) were determined. RESULTS: MAP was markedly lowered at the end of bleeding, and the levels of serum TNF-alpha and liver NF-KappaB markedly increased 45 minutes after the bleeding was discontinued. Bilateral cervical vagotomy did not significantly modify the changes in serum TNF-alpha, but slightly increased liver NF-KappaB activation. Application of constant electric current to the distal end of the vagus trunk significantly reduced serum TNF-alpha and blunted liver NF-KappaB activation. Tetrahydroamino-acridine (THA,1.5 mg/kg, intravenous drip administration after bilateral cervical vagotomy reversed hypotension and attenuated serum TNF-alpha and liver NF-KappaB amounts, but alpha-bungarotoxin (1.0 microg/kg intravenous drip) pretreatment reverted the inhibitory effects of vagal stimulation. CONCLUSION: The result suggest that direct electrical stimulation of the vagus nerve and its transmitter can significantly attenuate peak serum TNF-alpha amounts, inhibit the expression of liver NF-KappaB, and prevent the development of hypotension, thus it might produce a potential protective effect on hemorrhaged rats through acetylcholine (Ach) binds NAch receptor alpha 7 subunit which exists in the macrophage.

[Protective effect of ketamine against septic shock in rats].

OBJECTIVE: To investigate the effects and the mechanism of ketamine on hemodynamics and pro-inflammatory cytokine levels of plasma in septic shock rats. METHODS: Cecal ligation and puncture (CLP) was used to reproduce septic shock model. Twenty healthy and male Sprague-Dawlay (SD) rats weighing (225+/-25) g were randomly divided into four equal groups: Sham CLP group, CLP group, ketamine I (KT I) and ketamine II (KT II) group. Thirty minutes before CLP, normal saline (0.9 %) was infused continuously at a rate of 5 ml.kg(-1).h(-1) through the left femoral vein cannula in sham CLP and CLP group, and ketamine (5 mg.kg(-1).h(-1) and 10 mg.kg(-1).h(-1), respectively) was infused continuously in KT I or KT II group. The right femoral artery was cannulated to monitor mean arterial pressure. The plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured using enzyme-linked immunosorbent assays (ELISA). RESULTS: CLP produced progressive hypotension, and a large increase in the plasma TNF-alpha and IL-6 concentrations. The hemodynamic responses were reversed and the cytokine responses were suppressed in ketamine treated animals. CONCLUSION: Ketamine administration has protective effect against septic shock in CLP rats.