Clinical analysis of 156 cases of multiple organ failure caused by fish bile.

OBJECTIVE: To analyze the clinical features and prognosis of patients suffering from fish bile poisoning. METHODS: A total of 156 multiple organ failure (MOF) patients caused by fish bile poisoning were hospitalized in our department over the past 28 years. The patients' symptoms, examination results, treatment and outcomes were collected and analyzed. RESULTS: All patients' first symptom was gastrointestinal discomfort, including unbearable nausea and intractable vomiting. The symptoms that followed were oliguria or anuria, edema, headache, fatigue, jaundice, palpitation, alimentary tract hemorrhage, gross hematuria, dyspnea, shock, tachycardia, bradycardia, arrhythmia, coma, and cardiac arrest. The symptom severity and cohort were different among different patients. Twenty-one cases received gastroscopy, which exhibited diffuse gastric mucosal bleeding. Twelve patients received renal biopsy, which exhibited focal necrosis of tubular epithelial cells. One patient received a liver biopsy, which exhibited extensive hepatocyte necrosis. All patients received blood purification therapy. Of the four patients who died, 4 out of 5 organs had failed. The general mortality rate was 2.6%. CONCLUSIONS: Compared with the MOF caused by trauma and sepsis, the fish bile poisoning MOF has a much lower morality rate. However, patients with higher age, more underlying diseases, and more organ failure tended to have a worse prognosis.

Costimulatory molecule VSIG4 exclusively expressed on macrophages alleviates renal tubulointerstitial injury in VSIG4 KO mice.

BACKGROUND: Activation and infiltration of T cells and macrophages are key features of renal tubulointerstitial injury. The costimulatory molecule V-set and immunoglobulin domain-containing protein-4 (VSIG4), which is exclusively expressed on macrophages, is capable of inhibiting the T cell response. However, it is unclear whether VSIG4 is involved in renal tubulointerstitial injury. This study was designed to investigate the role of VSIG4 in renal tubulointerstitial injury and the related T cell infiltration. METHODS: The unilateral ureteric obstruction (UUO) model of renal inflammation and tubulointerstitial fibrosis was established in VSIG4 transgenic knock-out C57BL/6 mice (VSIG4(-/-)) and wild-type C57BL/6 mice (VSIG4(+/+)). Comparative analysis of renal biological indices were assessed by quantitative real-time PCR and immunofluorescence staining. RESULTS: Both the VSIG4(-/-) and VSIG4(+/+) mice showed UUO-related temporal changes in renal expression of CD3, CD4 and CD8 T cell markers, with the protein levels being significantly lower in the VSIG4(+/+) UUO mice. Moreover, at each time point examined the UUO VSIG4(+/+) mice showed significantly lower renal mRNA levels of the cytokines interleukin (IL)-2, interferon- and tumor necrosis factor-, but significantly higher IL-10, than the UUO VSIG4(-/-) mice. CONCLUSIONS: The macrophage-expressed VSIG4 may act to alleviate renal tubulointerstitial injury via inhibition of T cell infiltration and secretion of inflammation related factors.

[Protective effects of metanephric mesenchymal cells on acute renal tubular damage: experiment with rats].

OBJECTIVE: To study the protective effects of metanephric mesenchymal cells (MMCs) on acute renal tubular damage and explore its possible mechanism. METHODS: MMCs were isolated and cultured from 13-day-old embryonic rats and labeled with 5-bromodeoxyuridine. Seventy-two male SD rats were randomly divided into 3 equal groups: MMC group, receiving MMC injection instantaneously when ischemia/reperfusion (I/R) renal injury was induced, I/R group, undergoing I/R to establish acute renal tubular damage models, and sham operation group. Six rats from each group were killed at different time points: 24 h, 48 h, 72 h, and 96 h later. Blood sample was collected from the vena cava inferior, to examine the serum creatinine (SCr) and blood urea nitrogen (BUN). Specimens of kidney underwent microscopy. Apoptosis was conformed by TUNEL assay. Immunohistochemistry was used to detect the protein expression of Bcl-2 and Bax. The distribution of MMCs labeled with 5-bromodeoxyuridine in kidney was observed by immunofluorescence technique. RESULTS: The SCr and BUN levels in different time points of the MMC group were both significantly lower than those of the I/R group (both P <0.05), HE staining showed that pathological damage of the MMC group was less than that of the I/R group (P <0.05). TUNEL results investigated that the number of apoptosis renal tubular epithelial cells of the MMC group was (13.4 +/- 3.2/HPF), significantly less than that of the I/R group [(25.4 +/- 5.2/HPF)]. In comparison with the I/R group, there were more Bcl-2 positive cells and fewer Bax positive cells in the MMC group. BrdU-labeled MMCs began to occur in the renal tissue (60 +/- 6/HP) In the 72 h subgroup of MMC group, and number of BrdU-labeled MMCs, the 96 h subgroup was (143 +/- 8/HP), significantly higher than that of the 72 h subgroup (P<0.05). CONCLUSION: MMCs have the ability to protect renal function in acute renal tubular damage in rats, migrate and repopulate in the I/R injured renal tubules, and inhibits renal tubular epithelial cell apoptosis. The mechanism may be involved in regulating the expression of Bcl-2 and Bax.

[Video-assisted thoracic surgery: clinical experience among 1264 patients].

OBJECTIVE: To summarize the clinical experience in video-assisted thoracic surgery (VATS). METHODS: From December 1993 to December 2005 1264 patients, 894 males and 370 females, aged 38.9 +/- 12.0, underwent VATS, including bullectomy in 622 cases, resection of mediastinal tumor or cyst in 119 cases, resection of esophageal diseases in 107 cases, lobectomy or wedge-shaped lung resection in 215 cases, lung volume reduction surgery (LVRS) in 17 cases, treatment of thoracic injury in 28 cases, treatment of other thoracic diseases in 72 cases, and biopsy in 84 cases. For the resection of esophageal carcinoma VATS was conducted via the right approach, the esophagus was dissociated, the lymph nodes were resected, upper-abdominal incision was made, the stomach was dissociated and drawn up to the neck region, a cervical incision was made to anastomose the stomach and the residue of esophagus. RESULTS: Operation was completed by VATS successfully in 1230 patients, and 34 cases were converted to traditional thoracotomy because of thoracic adhesion or to radically treat the malignant tumors. Major complications occurred in 45 cases (3.56%), including air-leak lasting more than 7 days in 30 cases, post-operative bleeding in 4 cases (3 of which received VATS once more for hemostasis and the other underwent thoracotomy), hydrothorax or pneumothorax in 3 cases that underwent water-closed drainage, esophageal mucous rupture in 4 cases with achalasia and one case with leiomyoma, all of which underwent repair immediately, infection of pleural cavity in one case after the resection of esophageal diverticulum, and pneumonia in one case after LVRS. One patient with spontaneous pneumothorax and respiratory failure died 5 days after the bullectomy. Spontaneous pneumothorax occurred in 10 patients 2 months to 2 years after VATS 3 of which underwent bullectomy and pleurodesis by VATS once more. CONCLUSION: Spontaneous pneumothorax and some benign thoracic diseases are the major indications of VATS; however, great care should be expended to decide to treat malignant diseases by VATS. It is very important to train the surgeons who are to practice VATS. The practice of VATS should be individualized.