[Change in number of circulating endothelial progenitor cells and its significance in septic rats].

OBJECTIVE: To observe the change in number of circulating endothelial progenitor cells (cEPCs) and analyze its significance in septic rat. METHODS: Septic model of male Sprague-Dawley (SD) rats was reproduced by cecum ligation and puncture (n=80), and the normal control group (n=16) and sham operation group (n=80) were established. Nine rats in each group were used, and the cEPCs numbers in peripheral blood mononuclear cells (PBMCs, by flow cytometry), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), D-dimer (by enzyme linked immunosorbent assay, ELISA), antithrombase-III ( AT-III , by immunonephelometry), wet/dry (W/D) ratio of liver, kidney and lung were determined at 0, 6, 12, 18 hours and 1, 2, 3, 7 days after reproduction of model. Eight rats in each group were used, and the pathologic changes in liver, kidney and lung at 1 day were observed, and the injury scores were evaluated. RESULTS: The cEPCs number was markedly increased, reaching the peak [(7 161.9±689.8)/10(6) PBMCs]at 18 hours. Circulating TNF-α, IL-10, D-dimer, AT-III were found to be increased, and the levels reached the peak at 12 hours, 12 hours, 3 days, 18 hours, respectively[(51.3±6.8) ng/L, (77.9±8.6) ng/L, (93.5±11.5) mg/L, (193.8±43.0) mg/L]. W/D ratio was elevated and signs of injury to the liver,kidney, lung became more obvious (18-hour W/D of liver: 3.79±0.09, kidney: 4.25±0.08, lung: 4.91±0.09; 1-day tissue evaluation of liver:1.86±0.26, kidney: 5.14±0.34, lung: 6.57±0.37). The levels of all parameters in model group were significantly higher than those in sham operation group[18-hour cEPCs numbers: (2 235.5±472.7)/10(6) PBMCs, 12-hour TNF-α: (14.3±5.8) ng/L, 12-hour IL-10: (35.0±5.8) ng/L, 3-day D-dimer: (14.2±4.4) mg/L, 18-hour AT-III: (100.1±12.8) mg/L; 18-hour liver W/D ratio: 3.50±0.07, kidney: 3.96±0.04, lung: 4.54±0.14; 1-day tissue evaluation of liver:0.29±0.18,kidney: 0.57±0.20, lung: 1.14±0.51, P<0.05 or P<0.01]. There was positive correlation between cEPCs numbers and TNF-α (r=0.587), IL-10 (r=0.497), D-dimer (r=0.294), AT-III (r=0.690), and W/D ratio of liver, kidney, lung (r(1)=0.532, r(2)=0.532, r(3)=0.679, all P<0.01). CONCLUSION: The cEPCs number markedly increases in septic rats, and it shows positive correlation with the degree of inflammatory reaction, blood clotting activation, capillary leakage and tissue damage. The increase of number of cEPCs is the result of reaction to sepsis, and its change in number might be valuable in evaluating the pathogenesis of sepsis.

Intravenous colistin sulfate: a rarely used form of polymyxin E for the treatment of severe multidrug-resistant Gram-negative bacterial infections.

In recent reports polymyxins have been considered an effective and safe treatment option for the management of multidrug-resistant (MDR) Gram-negative bacterial infections. Here we report our clinical experience with the use of intravenous colistin sulfate in critically ill patients hospitalized from January 2006 to October 2008, as a last treatment resort in China, and assess its effectiveness and adverse effects. Fifteen patients who suffered from severe infections caused by MDR or pandrug-resistant (PDR) Gram-negative bacteria (13 isolates of Acinetobacter baumannii, 4 isolates of Pseudomonas aeruginosa and 2 isolates of Klebsiella pneumoniae), unresponsive to the initial empirical regimens, were treated with colistin sulfate (daily dose of 1.28 +/- 0.25 million IU and duration of 22.3 +/- 6.2 days), based on sensitivity results. The treatment resulted in a good clinical response in 73.3%, microbiological clearance in 60% and mortality in 20%. Possible nephrotoxicity occurred in 1 patient and no patients developed neurotoxicity. In conclusion, intravenous colistin sulfate is a safe and viable alternative for the treatment of severe infections due to sensitive MDR Gram-negative bacteria.

[Investigation of distribution of bacteria and fungi in severe acute pancreatitis].

OBJECTIVE: To investigate the spectrum of bacteria and fungi in different sites in severe acute pancreatitis (SAP). METHODS: The prospective study was performed in 205 patients with SAP treated from January 2000 to December 2008. The Infection rate of bacteria and fungi was observed prospectively in pancreatic necrosis and(or) pus form abdomen, body fluids and deep vein catheter in SAP. Body fluids and pancreatic necrosis were cultured twice a week. Central venous catheter was cultured when it had been placed for two weeks. Blood was cultured for bacteria and fungi when body temperature was more than 39 degrees C. Constituent ratio of bacteria and fungi was observed in different sites and in all sites within 28 days after onset of SAP. RESULTS: There were 937 pathogens, among which infection rates of gram-negative bacteria was higher than gram-positive bacteria and fungi (P < 0.05), the infection rates of gam-positive bacteria and fungi were similar. Infection rates of gram-negative bacteria in pancreatic necrosis (55.2%), bile (55.4%), blood (68.1%) and central venous catheter (44.4%) were increased significantly (P < 0.05) compared with gram-positive bacteria and (30.2%, 33.9%, 23.4%, 38.9%) and fungi (14.6%, 10.7%, 8.5%, 16.7%); however, infection rate of fungi (59.6%) was increased significantly (P < 0.05) compared with gram-negative bacteria (24.0%) and gram-positive bacteria (16.3%) in urine; infection rate of gram-negative bacteria (53.2%) was significantly higher (P < 0.05) than that of fungi (27.1%) and gram-positive bacteria (19.7%) in sputum. Infection rate of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia) in gram-negative bacteria in pancreatic necrosis, bile, blood, central venous catheter and sputum was significantly higher than that of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae) (P < 0.01); infection rate of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli) was higher significantly (P < 0.01) than that of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii). Infection rate of staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus was significantly higher (P < 0.05) than that of Enterococcus faecalis and Enterococcus faecium in pancreatic necrosis and sputum;but infection rate of Enterococcus faecium in bile and urine was significantly higher than other gram-positive bacteria (P < 0.05). There was not difference among gram-positive bacteria;however, infection rate of Staphylococcus epidermidis in central venous catheter was increased significantly (P < 0.05). Infection rate of candida mycoderma in pancreatic necrosis, bile, urine and sputum was significantly higher than that of tricho bacteria (P < 0.05). The peak of infection rate of microbes in body fluid was within 2 to 3 weeks. CONCLUSIONS: Constituent ratio in gram-negative, gram-positive bacteria and fungi as well as their species in different sites is diverse. The peak of infection rate of microbes is 2 to 3 weeks after onset of the disease.

Time of dissociation between microcirculation, macrocirculation, and lactate levels in a rabbit model of early endotoxemic shock.

BACKGROUND: The relationship between macrocirculation and microcirculation remains controversial. The loss of coherence between microcirculation and macrocirculation has already been found in late-stage sepsis shock. The objective of this study was to determine the earliest possible time of detecting the loss of coherence between microcirculation and macrocirculation in early-stage endotoxemic shock. METHODS: We randomized 24 female New Zealand white rabbits into two groups: endotoxemic shock group (n = 14) and control group (n = 10). Rabbits in the endotoxemic shock group were equipped with arterial and venous catheters and received an intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg over 10 min). Rabbits in the control group received the same dose of saline infusion. Microcirculatory perfusion parameters were assessed in the sublingual mucosa using sidestream dark-field video microscopy. Systemic hemodynamics and blood lactate levels were measured at baseline and over a 120-min period. RESULTS: Ninety minutes after completing LPS infusion, all animals in the endotoxemic shock group developed a hypodynamic septic condition, characterized by low cardiac output and increased systemic vascular resistance; 120 min after completing LPS infusion, the mean arterial pressure decreased by 25% (P = 0.01), confirming ongoing endotoxemic shock. However, significant decreases in sublingual microcirculatory parameters of small vessels (microvascular flow index, perfused vessel density, and proportion of small perfused vessels) were observed 30 min after completing LPS infusion (P = 0.01, for all), and threshold decreases of 30% were found 60 min after completing LPS infusion (P = 0.001, for all) in the endotoxemic shock group. Lactate levels significantly increased to more than 2 mm/L at 90 min and more than 4 mm/L at 120 min in the endotoxemic shock group (P = 0.02 and P = 0.01, respectively). CONCLUSIONS: Changes in microcirculatory perfusion precede changes in macrocirculation and lactate levels in a rabbit model of endotoxemia shock. Microcirculation, macrocirculation, and oxygen metabolism are distinct in early-stage endotoxic shock.

Effect of biliary tract external drainage on cytokine expression and histomorphology of intestine, liver, and lung in rats with hemorrhagic shock.

OBJECTIVE: To investigate the protective effect of biliary tract external drainage on cytokine expression and pathomorphism of intestine, liver, and lung in rats with hemorrhagic shock. DESIGN: Randomized, control animal study. SETTING: This study was conducted at The Institution Digestive Surgery Research Laboratory of Shanghai Jiao Tong University. SUBJECTS: Sprague-Dawley rats. INTERVENTIONS: Biliary tract external drainage was performed by inserting a cannula into the bile duct. Hemorrhagic shock was induced by drawing blood from the carotid artery. MEASUREMENTS AND MAIN RESULTS: Twenty-four Sprague-Dawley rats were randomized to three equal groups of eight: sham shock; hemorrhagic shock; and hemorrhagic shock plus bile duct drainage. The messenger RNA expression of tumor necrosis factor-alpha, interleukin-6 in the intestine, liver, and lung tissue from the three groups were analyzed by reverse transcription-polymerase chain reaction. Tumor necrosis factor-alpha was analyzed in the bile of the rats by enzyme-linked immunosorbent assay. Histology of intestine, liver, and lung was performed in all groups by hematoxylin and eosin staining. The messenger RNA expression of tumor necrosis factor-alpha was significantly increased in the hemorrhagic shock group compared with the sham shock group (intestine 0.54 +/- 0.07 vs. 0.37 +/- 0.05, liver 1.01 +/- 0.06 vs. 0.56 +/- 0.07, lung 0.94 +/- 0.07 vs. 0.62 +/- 0.06). The messenger RNA expression of interleukin-6 was also significantly increased in the hemorrhagic shock group compared with the sham shock group (intestine 0.89 +/- 0.12 vs. 0.50 +/- 0.09, liver 1.07 +/- 0.10 vs. 0.57 +/- 0.12, lung 1.09 +/- 0.09 vs. 0.67 +/- 0.06). Biliary tract external drainage reduced significantly the messenger RNA expression of tumor necrosis factor-alpha (intestine 0.43 +/- 0.06 vs. 0.54 +/- 0.07, liver 0.74 +/- 0.18 vs. 1.01 +/- 0.06, lung 0.87 +/- 0.15 vs. 0.94 +/- 0.07) and interleukin-6 (intestine 0.60 +/- 0.11 vs. 0.89 +/- 0.12, liver 0.71 +/- 0.16 vs. 1.07 +/- 0.10, lung 0.88 +/- 0.25 vs. 1.09 +/- 0.09). The concentration of tumor necrosis factor-alpha in bile was significantly higher in the hemorrhagic shock group compared with the sham shock group (31.22 +/- 6.44 ng/mL vs. 15.49 +/- 3.64 ng/mL, p < .01). The histologic observation of the intestine, liver, and lung showed that the biliary tract external drainage significantly attenuate the putrescence and exfoliation of intestinal villi, denaturation and putrescence of hepatocytes, edema, and inflammatory cells infiltration of lung. CONCLUSIONS: Biliary tract external drainage decreases the messenger RNA expression of tumor necrosis factor-alpha, interleukin-6 and attenuate the tissue injury of the intestine, liver, and lung in rats model of hemorrhagic shock. The gut-liver axis was implicated to play a crucial role in hemorrhagic shock-induced multiple organ dysfunction syndrome.

[Studies on the cell markers of endothelial function in sepsis].

OBJECTIVE: To study the phasic changes of the number of circulating endothelial cells (CEC) and endothelial microparticles (EMP) during the process of sepsis. METHODS: Thirty-one patients with sepsis were divided into mild group (<9), moderate group (9-15) and severe group (>15) according to the acute physiology and chronic health evaluation II (APACHE II) scores after onset, and each group was further divided into survivors and non-survivors.The level of CEC, EMP and pro-inflammatory cytokines were determined on 1, 2, 3, 7, 14 days after onset. RESULTS: (1)The level of EMP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) in the severe group were significantly higher than the mild group and moderate group (P<0.05 or P<0.01). The number of CEC in the severe group was significantly lower than the mild group and moderate group (P<0.05 or P<0.01). (2)The levels of CEC, EMP in the non-survivor and the survivor group were significantly higher with sepsis increased significantly; and the levels of EMP, pro-inflammatory in the non-survivor group were significantly higher than those of the survivor group (P<0.05 or P<0.01), but the levels of CEC, IL-4 and IL-10 in non-survivors were significantly lower than the survivors (P<0.05 or P<0.01). CONCLUSION: The levels of CEC and EMP in patients with sepsis increased significantly. They can not only serve as an index to reflect the severity of sepsis, but also have a prognostic value in patients with sepsis.

[Characteristics of hemoglobin changes and its significance in critically ill patients].

OBJECTIVES: To investigate characteristics of hemoglobin changes in surgical critically ill patients. METHODS: One hundred and ten consecutive critically ill patients admitted to the surgical ICU of Shanghai Ruijin Hospital were prospectively included in the clinical trial from January 2004 to December 2006. And changes of hemoglobin and prognosis were retrospectively analyzed. The inclusion criteria were surgical critical illness, APACHE II > or = 8 points, and admission to ICU within 48 hours after onset of critical illness, except for patients with bleeding. According to hemoglobin level before transfusion, 110 patients divide into the low level hemoglobin group (< or = 100 g/L) and the high level hemoglobin group (> 100 g/L). Time interval for valley value of hemoglobin within 28 days and incidence of hypo-hemoglobin (< or = 100 g/L) were investigated; the mean hemoglobin level, mean APACHE II scores, amount of concentrated red blood cells and rate of mechanical ventilation as well as duration of ventilation within 28 days were calculated. ICU survival rate was observed. RESULTS: Level of hemoglobin in low level group was decreased significantly compared to high level group [(86.3 +/- 23.8) g/L vs. (112.9 +/- 20.4) g/L, P < 0.01]; and time of its valley values was shorter than that of high level group [(3 +/- 1) d vs. (5 +/- 2) d, P < 0.01]; the responding level of hemoglobin was (89.3 +/- 11.3) g/L and (110.0 +/- 12.5) g/L (P = 0.001), respectively. Incidence of hypo-hemoglobin was 92.9% in low level group and 0 in high level group within 28 days (P < 0.01). Hemoglobin level of high level group was significantly higher than that of low level group within 28 days [(120.2 +/- 12.5) g/L vs. (89.3 +/- 11.3) g/L, P < 0.05], and the total amount of blood transfusion in high level group was less significantly than that of low level group [(12.4 +/- 10.1) U vs. (24.0 +/- 15.6) U, P = 0.042]; mean APACHE II score in high level group was significantly lower than that of low level group [(8.7 +/- 2.4) vs. (13.2 +/- 4.3), P < 0.001]; rate of mechanical ventilation was no difference (56.4% vs. 52.7%, P = 0.765); but duration of mechanical ventilation was shorter than that of low level group [(12 +/- 5) d vs. (25 +/- 7) d, P < 0.001]. Survival rate in high level group in ICU was significantly higher than that of low level group (80.0% vs. 61.8%, P = 0.036). CONCLUSION: Prolonged hypo-hemoglobin level (< or = 100 g/L) and valley value in advance suggest bad prognosis.

[Protecting effect of mesenteric lymph duct ligation on vital organs of rats with hemorrhagic shock].

OBJECTIVE: To investigate the protecting effect of mesenteric lymph duct ligation on cytokine expression and pathological changes in intestine, liver and lung in rats with hemorrhagic shock. METHODS: Twenty-four Sprague-Dawley (SD) rats were randomly divided into three groups: control, hemorrhagic shock and hemorrhagic shock plus mesenteric lymph duct ligation, with 8 rats in each group. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expressions of tumor necrosis factor-alpha (TNF-alpha) mRNA and interleukin-6 (IL-6) mRNA in intestine, liver and lung tissue in three groups. Hematoxylin-eosin (HE) staining was used for the observation of pathological changes in intestine, liver, lung in all groups. RESULTS: The TNF-alpha mRNA and IL-6 mRNA in intestinal, liver, and lung tissues of rats in the hemorrhagic shock group were markedly higher than those in control group (TNF-alpha mRNA: intestine 0.54+/-0.07 vs. 0.37+/-0.05, liver 1.01+/-0.06 vs. 0.56+/-0.07, lung 0.94+/-0.07 vs. 0.62+/-0.06; IL-6 mRNA: intestine 0.89+/-0.12 vs. 0.50+/-0.09, liver 1.07+/-0.10 vs. 0.57+/-0.12, lung 1.09+/-0.09 vs. 0.67+/-0.06, all P<0.01). Mesenteric lymph duct ligation could obviously reduce the expressions of TNF-alpha mRNA and IL-6 mRNA (TNF-alpha mRNA: intestine 0.47+/-0.05 vs. 0.54+/-0.07, liver 0.81+/-0.07 vs. 1.01+/-0.06, lung 0.80+/-0.05 vs. 0.94+/-0.07; IL-6 mRNA: intestine 0.66+/-0.07 vs. 0.89+/-0.12, liver 0.83+/-0.13 vs. 1.07+/-0.10, lung 0.73+/-0.11 vs. 1.09+/-0.09, P<0.05 or P<0.01). Mesenteric lymph duct ligation could markedly attenuate necrosis and exfoliation of the intestinal villi, and it also ameliorated degeneration of liver cells, lung edema and infiltration of inflammatory cells. CONCLUSION: Mesenteric lymph duct ligation can decrease the expressions of TNF-alpha mRNA and IL-6 mRNA in intestine, liver and lung tissue and attenuate the damage to these organs in rats with hemorrhagic shock. It plays a vital role in protecting the organ functions.

[Strategy of treatment with high-volume hemofiltration on severe acute pancreatitis and fulminant acute pancreatitis.].

OBJECTIVE: To investigate strategy of treatment of hemofiltration on severe acute pancreatitis (SAP) and fulminant acute pancreatitis (FAP). METHODS: One hundred and thirty patients with SAP and eighty-one patients with FAP treated with hemofiltration (HF) were prospectively observed from March 1997 to December 2008. Indications for HF, variables (time interval for hemofiltration), mode, therapeutic dosage, blood rate, heparin dosage and components of hemofiltration, therapeutic efficacy (time of disapearance of abdominal pain, intra-abdominal pressure and survival rate) and complications (incidence of bleeding and blood infection). RESULTS: All patients underwent high volume hemofiltration (HVHF) or hemodialysis-filtration (HDF) within 72 hours after onset of the disease. Dose of SAP and FAP was (53 +/- 6) mlxkg(-1)xh(-1) and (59 +/- 10) mlxkg(-1)xh(-1) (P < 0.05), respectively. Rate of short veno-venous hemofiltration in SAP (76.9%) was higher than that of FAP (38.3%) (P < 0.05); however, rate of continuous veno-venous hemofiltration (23.1%) was lower than that of FAP (37.0%) (P < 0.05). Rate of HDF was much higher in FAP than that of SAP. Low molecular weight heparin and heparin were both available to anticoagualte;but dosage required in patients with FAP was much higher than that of SAP (P < 0.05). Time intervals for amelioration of abdominal pain in SAP and FAP were (9 +/- 6) h and (15 +/- 10) h, respectively. Itra-abdominal pressure was decreased significantly at the end of hemofiltration compared to prior to hemofiltration in SAP and FAP (P < 0.05). Level of serum triglyceride decreased abruptly after adsorption (P < 0.05). Rate of operation within 28 days in SAP (73.8%) was lower than FAP (87.7%). The in-hospital survival rates in SAP and FAP were 88.5% and 67.9%, respectively. Amount of platelet decreased in patients with blood flow rate less than 240 ml/min was higher than that of more than 240 ml/min (P < 0.05). And incidence of blood stream infection and bleeding increased significantly (P < 0.05). CONCLUSIONS: HVHF and HDF used in SAP and FAP patients underwent conservative treatment within 72 hours, respectively, can increase survival rate significantly.

[A study on increased permeability and morphological changes in actin cytoskeleton and tight junction of vascular endothelial cells induced by tumor necrosis factor-alpha].

OBJECTIVE: To study the effect of human tumor necrosis factor-alpha (TNF-alpha) on permeability of human vascular endothelial cell (EA.hy926) monolayer and its mechanism. METHODS: 5, 10, 20 microg/L TNF-alpha was respectively added to the cultured endothelial cell monolayer for 24 hours, or 10 microg/L TNF-alpha for 6, 12, 24 hours. Human vascular endothelial cell (EA.hy926) monolayer permeability was measured by detecting fluorescence intensity of fluorescein isothiocyanate (FITC) labeled dextran. Immunofluorescence and laser confocal microscopy were used to assess vascular endothelial actin cytoskeleton (F-actin) and tight junction protein (ZO-1) distribution. Western blotting was used to assess ZO-1 expression. RESULTS: Compared with control group, TNF-alpha significantly increased endothelial permeability and induced F-actin redistribution and stress fiber formation with ZO-1 derangement. Gaps increased obviously between endothelial cells. Furthermore, Western blotting showed that TNF-alpha reduced ZO-1 expression in a dose- and time-dependent manner. CONCLUSION: TNF-alpha increased endothelial cell permeability by damaging integrity of endothelial barrier function.

[Detection of early organ dysfunction for the selection of treatment strategy on severe acute pancreatitis.].

OBJECTIVE: To investigate the severity related influencing factor and treatment strategy of severe acute pancreatitis with early organ dysfunction. METHODS: From July 2007 to December 2008, 167 patients with severe acute pancreatitis were treated in the Surgical Department of Ruijin Hospital. The relationships between the happening of early organ dysfunction and outcome of the patients were observed, with operative or nonoperative treatment strategy. RESULTS: Among 167 patients, 68 patients have early organ dysfunction, in which 39 with single organ dysfunction and 29 with multiple organ dysfunction. The early organ dysfunction were involved in 47.1% in cardiovascular system, 35.3% in lung and 29.4% in kidney. Aging (P < 0.05) and higher APACHE II score (P < 0.05) predicted a poor prognosis, which were benefit from early operation. CONCLUSIONS: The mortality of the patients with SAP is related to age, and the degree of organ dysfunction as well. In the first phase of the disease, the selection of operation depends on the trends and the degree of early organ dysfunction before infected necrosis happens, with the aid of SOFA score as a scale.

[Studies on the temporal profile of expression and release of major pro-inflammatory cytokines in vital organs following hemorrhagic shock].

OBJECTIVE: To study the kinetics of expression and release of major pro-inflammatory cytokines in the vital organs after hemorrhagic shock. METHODS: Eighty Sprague-Dawley (SD) rats were randomly divided into hemorrhagic shock group (n=40) and control group (n=40). Eight rats were sacrificed at 30, 60 and 90 minutes respectively after shock and 30 and 90 minutes respectively after resuscitation. The expressions of mRNA of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and IL-6 in intestine, liver, lung tissues were assessed by reverse transcription-polymerase chain reaction (RT-PCR), and the release of TNF-alpha and IL-6 in blood serum were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: (1)The pro-inflammatory cytokines were not increased in intestine, liver and lung tissues at 30 minutes after shock. The TNF-alpha mRNA expression was first up-regulated in the intestine at 60 minutes after shock (P<0.05), followed by the liver at 90 minutes after shock (P<0.01) and then the lung at 30 minutes after resuscitation (P<0.05). The TNF-alpha mRNA expressions in intestine, liver and lung tissues were higher at 90 minutes after resuscitation compared with those of control group (all P<0.01). The expressions of mRNA of TNF-alpha, IL-1 beta, IL-6 in the vital organs could be successively increased after hemorrhagic shock and resuscitation, with the TNF-alpha mRNA expression being the earliest, followed by the IL-1 beta mRNA and IL-6 mRNA. (2)The levels of TNF-alpha were increased in portal bloodstream prior to peripheral blood, and TNF-alpha preceded IL-6 at 60 minutes after shock (P<0.05), while there were no significant differences in the levels of TNF-alpha and IL-6 in portal bloodstream and peripheral blood at 30 minutes after shock, but they were higher than those of control group at 90 minutes after shock and at 30 and 90 minutes after resuscitation (all P<0.01). CONCLUSION: There is gut-liver-lung axis in the kinetics of expression and release of major pro-inflammatory cytokines after hemorrhagic shock.

[Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase].

OBJECTIVE: To investigate the strategy of controlling fluid resuscitation for severe acute pancreatitis (SAP) in acute phase. METHODS: From March 2001 to January 2006, 83 patients meeting for experimental criteria were included in this clinical trial. They were divided into early fluid expansion group (Group I, within 24 h after admission, 21 patients), middle fluid expansion group (Group II, within 25 - 48 h, 35 patients) and late fluid expansion group (Group III, within 49 - 72 h, 27 patients). Parameters of treatment of fluid therapy within 4 d after admission were observed. Serum lactic level was measured on admission and on meeting for criteria of fluid expansion. APACHEII scores, operation rate within 2 weeks, rate of mechanical ventilation, rate of ACS and survival rate were observed. RESULTS: Time interval for meeting fluid expansion criteria in Group I, Group II, Group III was (13 +/- 6) h, (38 +/- 5) h and (61 +/- 8) h, respectively. And there was statistical significance among them (P < 0.05). HCT (%) in Group I (33 +/- 6)% was lower than that of Group II (40 +/- 6)% and Group III (42 +/- 11)% significantly (P < 0.01) at the first day after admission; and there was no statistical significance between Group II and Group III. The amount of crystal and colloid infused in Group I (4014 +/- 2887) ml and (1220 +/- 705) ml at the day of admission was more than those of Group II (2366 +/- 1959) ml and (821 +/- 600) ml and Group III (2615 +/- 1574) ml and (701 +/- 585) ml (P < 0.01); but there was not different between Group II and Group III (P > 0.05). The ratio of colloid and crystal in Group III at the day of admission was lower than those of Group I and Group II (P < 0.05). The total amount of fluid infused was not different among 3 groups for the 4 d (P > 0.05). And infusion rate at the day of admission in Group I was more rapid than those of Group II and Group III (P < 0.05); and there was no difference between Group II and Group III (P > 0.05). The total amount of fluid sequestration in Group II for the 4 d was lower than those of Group I and Group III (P < 0.05); and there was no statistical significance between Group I and Group III (P > 0.05). At the first to the third day after admission APACHEII scores in Group I were higher than those of Group II and Group III (P < 0.05); and at the second and third day, APACHEII scores in Group III were higher than those of Group II (P < 0.05). Rate of mechanical ventilation in Group I (85.7%) was higher than those of Group II (37.1%) and group III (63.0%) (P < 0.05); and rate of ACS was most lowest in Group II (37.1%) (P < 0.05). Survival rate in Group I (38.1%) was lower than those of Group II (85.7%) and Group III (66.7%) (P < 0.05); and Group III was lower than that of Group II (P = 0.075). CONCLUSIONS: Within 72 h after onset of the disease, survival rate is improved significantly through controlling fluid resuscitation and prevention of body fluid sequestration.

[Long-term outcome and health-related quality of life in survivors of severe acute pancreatitis].

OBJECTIVE: To evaluate the health-related quality of life and postdischarge long-term outcome after severe acute pancreatitis. METHODS: The hospital records of patients with SAP discharged healthy from January 2003 to December 2003 were reviewed. The Rand 36-item Health Survey with accessory question was mailed to each patient. The means and deviations for each of eight scales scores of SF-36 were calculated, the study population scores were compared with general Chinese population; Univariate analysis was applied to determining the effects of variables such as age, sex, causes of disease, mode of treatment, frequency of surgery, financial burden, length of stay, chronic complications. Accessory questions were analyzed separately. RESULTS: The means and deviations for each of eight scales (PF, RP, RE, BP, VT, MH, SF, GH) scores of SF-36 in SAP patients were 83 +/- 15, 62 +/- 42, 69 +/- 36, 80 +/- 15, 69 +/- 19, 72 +/- 15, 75 +/- 18, 65 +/- 18, compared with general people. Except RP and SF, the others were similar. In the ANOVA of Physical Component Summary, the three variables mode of treatment, financial burden and length of stay were included (P < 0.05), while in that of Mental Component Summary, the two variables of gender and financial burden were included (P < 0.05). CONCLUSIONS: The health-related quality of life in SAP patients is similar to that of general people. Greater attention should be given to mode of treatment, length of stay and financial burden to improve quality of life.