Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial.

BACKGROUND: A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome. METHODS: We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)-free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay. RESULTS: The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, -1.63 days [95% confidence interval (CI), -4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51-2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66-14.02 days], p = 0.01). CONCLUSION: Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.

Estrogenic effect of dietary 4-tert-octylphenol in rainbow trout (Oncorhynchus mykiss).

The estrogenic effect of dietary 4-tert-octylphenol (octylphenol) in rainbow trout Oncorhynchus mykiss was investigated. Octylphenol was administered orally to sexually immature rainbow trout every second day for 11 days in doses between 0.4 and 50 mgkg(-1)2 d(-1). Plasma vitellogenin was measured at day 0, 6 and 11 and at the end of the experiments, the amounts of octylphenol retained in liver and muscle were determined. Increases in average plasma vitellogenin levels were seen at exposure to 40 mg octylphenol kg(-1) every second day; the most sensitive fish responded to 30 mgkg(-1). Doses below 20 mg octylphenol kg(-1)2 d(-1) had no effect. The ED(50) value for induction of vitellogenin synthesis was 35 mg octylphenol kg(-1)2 d(-1). Only 1 to 2 per thousand of the total amount of octylphenol administered orally over the 11 days experimental period was retained in muscle and liver at the end of the experiment. A clear dose-related increase was observed for concentrations of octylphenol in both liver and muscle of fish exposed to doses between 0.4 and 50 mgkg(-1)2 d(-1). A significant correlation was found between the concentrations of octylphenol in the liver and vitellogenin level in plasma.