Benefits of anti­inflammatory therapy in the treatment of ischemia/reperfusion injury in the renal microvascular endothelium of rats with return of spontaneous circulation.

The aim of the present study was to investigate whether prostaglandin E1 (PGE1), target temperature management (TTM) and a combined intervention involving the two would be beneficial as anti­inflammatory therapies for ischemia/reperfusion (I/R) injury to the renal microvascular endothelium of rats with return of spontaneous circulation (ROSC). In each group of rats with different interventions, following successful cardiopulmonary resuscitation, the levels of thrombomodulin (TM), interleukin­6 (IL­6) and tumor necrosis factor­α (TNF­α) in the plasma were evaluated. The expression of vascular endothelial (VE)­cadherin and vascular cell adhesion molecule­1 (VCAM­1) mRNA was analyzed in the kidney. Hematoxylin and eosin staining and VE­cadherin/vascular endothelial growth factor receptor double fluorescent immunohistochemistry staining were also performed. PGE1 improved tubular cell swelling and inflammatory cell infiltration. PGE1 also alleviated VE­cadherin protein loss in renal microvascular endothelium cells (RMECs), lowered the tubular injury score, decreased VE­cadherin and VCAM­1 mRNA expression, and markedly inhibited the release of TM (at 3 time points) and TNF­α (4 and 8 h; P<0.05). In addition to improving the renal tubular injury score and altering the concentration of TNF­α at 8 h, the effect of TTM was the same as PGE1 for the other indicators (P>0.05). The PGE1/TTM combined intervention significantly reduced IL­6 concentration at 8 h (P<0.05). The correlation analysis demonstrated that the peak TM and TNF­α levels (P<0.001, r=0.809), and IL­6 levels (P<0.001, r=0.792) were positively associated. PGE1 and TTM had a protective effect against I/R injury to the RMEC, while the PGE1/TTM combined intervention exhibited an increased synergistic effect as an anti­inflammatory treatment when compared with either of the single interventions.

[The Protective Effect of Target Temperature Management Combined with Prostaglandin E1 on Ischemia/Reperfusion Injury of Cerebral Micro-vascular Endothelium of ROSC Rat].

OBJECTIVE: To investigate the protective effect of target temperature management (TTM) combined with prostaglandin E1 (PGE1) on ischemia/reperfusion (I/R) injury of cerebral micro-vascular endothelium cell (CMEC) in the return of spontaneous circulation (ROSC) rats with successful cardiopulmonary resuscitation. METHODS: Transoesophageal cardiac pacing with alternating current was used to induce ventricular fibrillation in rats. Five groups were set: Sham group (S group), ROSC group (R group), PGE1 group (P group), TTM group (T group) and PGE1/TTM group (PT group). Cell edema and micro-thrombus formation in cerebral tissue were evaluated through HE staining. I/R injury of CMEC was evaluated through CD34/TUNEL and vascular endothelial (VE)-cadherin/VE growth factor receptor double fluorescent immunohistochemistry staining. VE-cadherin mRNA and vascular cell adhesion molecule-1 (VCAM-1) mRNA expression in cerebral tissue lysate was analyzed by fluorescence quantitative PCR. RESULTS: TTM, PGE1 and PGE1/TTM could significantly improve cerebral interstitial edema, micro-thrombus, and inflammatory cells infiltration in the brain tissue, and reduce the apoptosis and VE-cadherin protein loss of CMEC. PGE1/TTM showed better protective effect. These 3 interventions also inhibited the rapid elevation of VE-cadherin mRNA (0. 5 h) and VCAM-1 mRNA (4 h and 8 h) expression (P < 0.05), which might indicate the less I/R injury of CMEC of ROSC rat. CONCLUSION: Both PGE1 and TTM could alleviate I/R injury of CMEC from ROSC rat after CPR separately, while PGE1/TTM combined intervention might have synergistic better effect.

[Prognostic significance of serum lactic acid in evaluation of acute paraquat poisoning patients].

OBJECTIVE: To discuss the role of serum lactic acid (Lac) level in evaluation of prognosis of acute paraquat poisoning (APP) patients. METHODS: Clinical data from 168 APP patients were retrospectively analyzed. The serum Lac level and the plasma paraquat concentrations at admission were collected, and the severity index of paraquat poisoning (SIPP) were calculated. The patients were divided into <10, 10-50, ≥50 h×mg×L(-1) groups on the basis of SIPP. The correlation between Lac and SIPP was analyzed, as well as the role in evaluating prognosis. RESULTS: The higher the SIPP level, the higher the Lac level [2.00 (1.50, 2.83) mmol/L, 3.10 (1.73, 5.15) mmol/L, 8.95 (5.90, 13.10) mmol/L, all P<0.05]; Lac was correlated positively with SIPP (r=0.569, P<0.05). The higher the SIPP, the higher the mortality of patients [17.4% (15/86), 61.5% (24/39), 97.7% (42/43), all P<0.05]. The survival days of SIPP≥50 h×mg×L(-1) group was shorter than that in SIPP<10 h×mg×L(-1) group and 10-50 h×mg×L(-1) group [2.0 (1.0, 3.0) days vs. 9.0 (4.0, 11.0) days and 5.0 (3.0, 10.0) days, both P<0.05]. A negative correlation was found between Lac, SIPP and survival days in non-survivors (r1=-0.778, r2=-0.621, both P<0.05). Logistic regression analyses showed either Lac or SIPP was of prognostic significance [odds ratio (OR) of Lac: 1.758, 95% confidence interval (95%CI) 1.278-2.417;OR of SIPP: 1.063,95%CI 1.025-1.103, both P=0.001]. The area under the receiver operating characteristic curve (ROC curve) of Lac, SIPP and prognosis were 0.885 and 0.897 respectively (both P<0.05), Lac≥3.35 mmol/L was the best cut-off value, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy for predicting the death were 74.07%, 90.80%, 88.24%, 79.00%, 8.056, 0.286 and 82.74% respectively; the evaluation value was closed to SIPP≥13.83 h×mg×L(-1) (77.78%, 91.95%, 90.00%, 81.63%, 9.677, 0.242 and 85.12%, respectively). CONCLUSIONS: The change in serum Lac level has evaluation value of the severity and prognosis for APP patients, and Lac≥3.35 mmol/L can be made as a simple and easy indicator for prognosis of APP patients.