Beneficial effects of iloprost during experimentally induced hemorrhagic shock

BACKGROUND: The aim of the study was to evaluate the efficacy of iloprost on myocardial insufficiency associated with hypovolemic shock in dogs. We designed the study as a controlled randomized study. METHODS: Sixteen mixed-breed dogs were included into the study and divided into two equal groups as the control and iloprost groups. Mean arterial pressure was reduced to 45 mmHg by withdrawing the arterial blood into citrated bags. The control group did not receive any drug but the other group received iloprost at a rate of 20 ng/kg/min by an infusion pump. Iloprost infusion was started 30 min after the blood pressure was reduced to 45 mmHg. All measurements were made before removal of blood, 45 min after exsanguination and at 1 hour intervals for 3 hours. Left ventricular stroke work index was measured 72 hours after the study. The hemodynamic and biochemical parameters and blood gas analysis were obtained. RESULTS: After hemorrhage, cardiac index (CI) decreased significantly from 132 +/- 14 to 51 +/- 8 ml/kg/min in the control group and from 128 +/- 11 ml/kg/min to 47 +/- 13 ml/kg/min in the iloprost group, respectively but at the end of the third hour it was 81 +/- 8 ml/kg/min in the control group and 105 +/- 6 ml/kg/min in the iloprost group (p < 0.05). Tumor necrosis factor-alpha (TNF alpha) was 41 +/- 8 pg/ml in the control group and 18 +/- 6 in the iloprost group 3 hours after bleeding (p < 0.05). Tumor necrosis factor-alpha concentration was significantly higher in the control group than in the iloprost group. There was no significant difference in pH between the groups but actual bicarbonate concentrations were different between the groups (p < 0.05). At the end of the third hour total body oxygen consumption was 105 +/- 11 ml/min in the control group and 132 +/- 12 ml/min in the iloprost group (p < 0.05). Oxygen delivery 3 hours after hemorrhage was 201 +/- 19 ml/min in the control group and 252 +/- 24 ml/min in the iloprost group (p > 0.05). Left ventricular stroke work index was higher in the iloprost group (p < 0.05). CONCLUSIONS: Hemorrhagic shock causes tumor necrosis factor-alpha release which may lead to multiple organ failure. Organ dysfunction still persists even after the appropriate treatment. Iloprost attenuates the release of tumor necrosis factor-alpha which may improve the adverse effects of hemorrhagic shock.     

ATP-MgCl2 treatment after experimental acute myocardial ischemia and reperfusion

BACKGROUND: The effect of ATP-MgCl2 on myocardial metabolism and hemodynamics was investigated in this study. METHODS: Twelve dogs were entered in this research. Six dogs received ATP-MgCl2 and the remaining dogs were considered as controls. The amount of ATP and MgCl2 concentration of this solution is 100 mumol/ml each. The volume administered to the animals during the aortic occlusion is 0.25 ml/kg/hour; in the solution are 100 mumol/ml dose each. The volume administered to the animals during reperfusion is 0.25 ml/kg/hour. The left anterior descending artery was occluded for a period of one hour and the drug was administered during reperfusion. RESULTS: Three hours after reperfusion, cardiac output was 1524 +/- 26 ml/min in the control group and 1638 +/- 47 ml/min in the ATP-MgCl2 group (p < 0.05), pulmonary capillary wedge pressure was 14 +/- 3 in the control group and 8 +/- 2 in the ATP-MgCl2 group. At the same time interval tissue ATP and lactate level was 7 +/- 3, 1.3 +/- 0.4 in the control group and 14 +/- 2, 0.0 +/- 0.2 in the ATP-MgCl2 group respectively (p < 0.05). CONCLUSIONS: In this study we demonstrated that ATP-MgCl2 usage after one hour of arterial occlusion protects the heart from the adverse effects of ischemia/reperfusion.     

Alcohol inhibition of suckling-induced prolactin release in lactating rats: threshold evaluation

Prolactin release in response to suckling was examined in primiparous lactating rats two hours after alcohol administration. Litters were adjusted to eight pups on lactation day 2 and dams were implanted with an atrial catheter on day 6. On day 10, pups were separated from the mother at 0800 h. An extension was attached to the catheter at 1100 h. Following removal of a baseline blood sample an hour later, rats were infused with alcohol doses of 0, 0.5, 1.0, 2.0 or 2.5 g/kg body weight. Two hours later, pups were returned to dams. Subsequent blood samples were obtained 10, 30, 60, 120 and 180 min after the onset of suckling. Following 10 min of suckling, plasma prolactin for groups of rats infused with alcohol at 2.0 and 2.5 g/kg body weight were lower than control, 0.5 and 1.0 g/kg groups. The blood alcohol level (BAL) for the 2.0 g/kg group was 94 +/- 8 mg% and for the 2.5 g/kg group was 162 +/- 4 mg%. After 30 min, the BAL for the 2.5 g/kg group was 134 +/- 5 mg% and plasma prolactin was suppressed in this group compared to control, 0.5 and 1.0 g/kg groups. The BAL for the 2.0 g/kg group after 30 min of suckling was 74 +/- 9 mg% but prolactin was not significantly lower than controls. We conclude that in rats, alcohol inhibition of suckling-induced prolactin release is directly correlated to the BAL. The threshold BAL which effectively inhibits this prolactin release is lower than the human legal intoxication level.     

高渗氯化钠羟乙基淀粉40应用于失血性休克的研究

目的探讨高渗氯化钠羟乙基淀粉40(HSH)对失血性休克的扩容效果。方法外伤致失血性休克患者70例,随机分成两组:高渗氯化钠羟乙基淀粉40组(H组),复方乳酸钠组(R组),每组各35例。H组患者30分钟内输注HSH10ml/kg,R组患者相同时间内输注Ringer’s10ml/kg。分别于输注前、输注结束和输注后30min三个时间点监测中心静脉压(CVP)、收缩压(SBP)、舒张压(DBP)、心率(HR)和血氧饱和度(SpO2),检测血浆Na+、Cl-、K+浓度。结果经快速扩容后,两组CVP、SBP、DBP、HR和SpO2较输注前均有改善,H组较R组改善更明显,差异有统计学意义(p<0.05)。H组钾离子轻度降低,钠离子和氯离子略有升高,但与R组比较无统计学差异。结论HSH(10ml/kg)应用于失血性休克患者,扩容效果较复方乳酸钠好。     

Mg++SO4 treatment improves the hemodynamics following the acute myocardial ischemia and reperfusion

BACKGROUND: The effect of Mg++SO4 on myocardial hemodynamics was investigated in this study. METHODS: Twelve dogs were entered in this research. Six dogs received Mg++SO4 and the remaining dogs were considered as controls. The amount of Mg++SO4 that was administered to the animals was 0.15 mmol/kg/hr each. The left anterior descending artery was occluded for a period of 1 hour and the drug was administered during reperfusion. RESULTS: Two hours after reperfusion, cardiac output was 1275+/-50 ml/min in the control group and 1475+/-25 ml/min in the Mg++SO4 group (p<0.05), pulmonary capillary wedge pressure was 18+/-3 mmHg in the control group and 12+/-2 mmHg in the Mg++SO4 group. CONCLUSIONS: In this study it was shown that Mg++SO4 usage after 1 hour arterial occlusion and 2 hours reperfusion protects the heart from the adverse effects of ischemia/reperfusion and had a better central hemodynamics.     

三磷酸腺苷-氯化镁对新生大鼠高氧肺损伤的影响

目的:探讨三磷酸腺苷-氯化镁(ATP-MgCl2)对高氧诱发新生鼠肺损伤的影响。方法:选用生后2天体重5～10 g的Wistar大鼠120只,随机分为空气对照组、高氧模型组、ATP-MgCl2治疗组,每组40只。新生鼠制备成高氧模型后第2天始治疗组新生鼠腹腔内注射ATP-MgCl2(45 mg/kg),空气对照组和高氧模型组腹腔内注射等量生理盐水,以上3组实验开始第3、7及14天每组处死10只动物,取肺组织,光镜下观察肺组织的病理变化,采用免疫组化染色观察肺组织中肿瘤坏死因子-a(TNF-a),转化生长因子(TGF-β1)和波形蛋白(Vimentin)的表达。结果:高氧模型组TNF-a、TGF-β1及Vim-entin表达强度明显高于空气对照组,差异有统计学意义(P<0.01)。ATP-MgCl2组TNF-a、TGF-β1及Vimentin表达强度低于高氧模型组,差异有统计学意义(P<0.05)。结论:三磷酸腺苷-氯化镁对新生大鼠高氧肺损伤有保护作用,对支气管肺发育不良有一定的预防作用。     

Greater appetite control associated with an increased frequency of eating in lean males

Eight healthy males of age 22.9+/-4.2 years (mean+/-SD) and body weight 73.26+/-11.50 kg, with BMI of 23.11+/-2.84 kg/m(2)underwent two different eating meal frequency patterns on 2 separate days. On both days they were fed approximately 33.3% of their average daily energy requirements as a breakfast pre-load meal: served either as a single meal (SINGLE) or divided into five equal portions (served hourly) (MULTI). Five and a half hours after the initial meal, an ad libitum meal was served. Venous blood was tested to determine plasma glucose and serum insulin concentrations every hour until the ad libitum lunch, and at 15-, 45- and 75-min after lunch. Visual analogue scales (VAS) were completed every hour until the ad libitum lunch, and at 15-, 45- and 75-min after lunch as a measure to determine hunger, appetite and satiety indices. Although both groups were fed isocaloric and identical macronutrient "breakfast pre-loads" (3450+/-466 kJ), the SINGLE group consumed 26.6% more (p<0.02) energy in the ad libitum lunch (5111+/-1502 kJ vs. 3752+/-893 kJ) than the MULTI group did. The pre-load feeding pattern had no effect on blood glucose responses throughout the trial. Following the larger SINGLE pre-load, serum insulin concentration rose to a higher (p<0.01) level compared to the first of the MULTI pre-load meals (123.04+/-61.51 microIU/ml vs. 37. 30+/-26.65 microIU/ml SINGLE vs. MULTI, respectively). Serum insulin rose to a higher (p<0.01) level following the fifth and final of the MULTI pre-load meals compared to the serum insulin levels in the SINGLE group at the same time into the trial (74. 21+/-51.64 microIU/ml vs. 24.98+/-13.46 microIU/ml MULTI vs. SINGLE, respectively). Despite consuming more energy in the ad libitum lunch, the SINGLE group showed no difference in serum insulin concentration following the ad libitum lunch compared to the insulin response of the MULTI group. These data suggest that when the nutrient load was spread into equal amounts and consumed evenly through the day in lean healthy males, there was an enhanced control of appetite. This greater control of satiety when consuming smaller multiple meals may possibly be linked to an attenuation in insulin response although clearly both other physical (gastric stretch) and physiological (release of gastric hormones) factors may also be affected by the periodicity of eating.     

口服布洛芬治疗早产儿静脉导管未闭效果研究

目的 检验口服布洛芬治疗早产儿静脉导管未闭(PDV)的可行性。方法 选择2016年3月-2017年7月因“早产儿/新生儿黄疸”入院,生后24 h内经心脏彩超确诊为PDV的90例患儿为研究对象,随机分为治疗组和对照组,每组45例。治疗组出生后24 h内口服布洛芬混悬液,首剂为10 mg/kg,24 h、48 h后再分别给予5 mg/kg;对照组出生后2 h内口服生理盐水,首剂为1 ml/kg,24 h、48 h后再分别给予0.5 mg/kg。治疗前后分别检测两组患儿的总胆红素(TB)、直接胆红素(DBIL)、间接胆红素(IBIL)及血氨水平,治疗结束后复查两组患儿心脏彩超,观察两组患儿的治疗效果,以及治疗后的不良反应。结果 1)治疗组患儿静脉导管关闭率高于对照组(78.8% vs. 22.2%),差异有统计学意义(P＜0.01);2)治疗后治疗组的TB、IBIL及血氨低于对照组,差异有统计学意义(P＜0.01),两组的DBIL水平比较差异无统计学意义(P＞0.05);3)两组患儿大便隐血阳性率、颅内出血、坏死性小肠结肠炎、少尿、喂养不耐受等发生率差异均无统计学意义(P均＞0.05),血小板及肌酐水平比较差异均无统计学意义(P均＞0.05)。结论 口服布洛芬可有效促进PDV早产儿静脉导管闭合,且临床应用相对安全。     

Effect of growth hormone on the glomerular filtration response to a protein meal

The role of dietary protein intake in the pathogenesis of progressive renal disease has been recently reexamined. Studies of both animal and humans with chronic renal disease have shown that restriction of dietary protein may slow the progression of the decline in renal function. This occurs because of a decrease in intraglomerular blood flow and pressure. The mechanism of this phenomenon is not known. The effect of protein intake on renal function is thought to be hormonally mediated. Since growth hormone can increase renal blood flow as well as GFR, we tested the hypothesis that the presence of growth hormone is necessary for the increase in glomerular filtration rate (GFR) seen after the ingestion of a protein meal. We evaluated the change in GFR after a standardized mixed protein meal in 13 patients with growth hormone deficiency. Neither basal creatinine clearance after an overnight fast (76 +/- 17 ml/min/m2; mean +/- SD) nor maximum increment after a 50 g/m2 protein meal (33 +/- 11 ml/min/m2) differed in these growth hormone-deficient patients from 16 normals controls (76 +/- 18 and 30 +/- 15 ml/min/m2, respectively). Twelve hours after an injection of exogenous growth hormone, 0.06 mg/kg up to a maximum of 5 mg, the GFR response to a protein meal did not differ from the pretreatment response (77 +/- 19 and 32 +/- 17 ml/min/m2, respectively). We conclude that the presence of physiologic amounts of growth hormone is not necessary for the GFR response to a standard protein meal.     

Increased prostacyclin production after percutaneous transluminal angioplasty of the iliac artery for atherosclerosis obliterans

BACKGROUND: Endothelial prostacyclin production is modulated by blood flow (wall shear stress). Local plasma prostacyclin concentrations and hemodynamic parameters have therefore been investigated in patients with atherosclerosis obliterans before and after angioplasty. METHODS. DESIGN: Prospective study. SETTING: Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. PATIENTS: Nine lower limbs in eight patients with significant stenoses of the iliac artery were studied. Interventions: blood samples were obtained from the femoral artery and femoral vein of nine lower limbs undergoing percutaneous balloon angioplasty of the iliac artery. MEASURES: Prostacyclin concentrations, radioimmunoassayed as 6-keto-prostaglandin F1 alpha, were measured before and after balloon dilatation. Femoral blood flow and the ankle-brachial pressure index (ABI) were measured using a Doppler velocimeter before and after the procedure. The femoral blood flow waveform was used to calculate the mean blood flow and shear stress variation. RESULTS: Before angioplasty, the mean (+/- SEM) plasma prostacyclin concentration was 21.6 +/- 1.5 pg/ml in the femoral artery and 25.4 +/- 1.1 pg/ml in the femoral vein. After angioplasty, these values increased to 25.6 +/- 2.2 pg/ml (p < 0.05) and 32.8 +/- 1.8 pg/ml (p < 0.01), respectively. The pre-procedural ABI, mean flow rate, and shear stress variation were 0.596 +/- 0.071, 354.1 +/- 63.3 ml/min, and 69.1 +/- 9.9 dyne/cm2, respectively. Both ABI and shear stress variation increased after angioplasty to 0.738 +/- 0.076 (p < 0.05) and 111.1 +/- 24.2 (p = 0.0775) dyne/cm2, but the mean flow rate (287.1 +/- 61.1 ml/min after angioplasty) did not increase (p = 0.2002). CONCLUSIONS: These results suggest that prostacyclin production increases after angioplasty, possibly due to increases in the intraluminal pressure and shear stress variation. This enhanced prostacyclin production may help to maintain arterial or bypass graft patency.     

Protein metabolism assessed by 1-13C leucine infusions in patients undergoing bone marrow transplantation

Patients receiving cytoreductive therapy and bone marrow transplantation (BMT) are known to develop marked protein catabolism. To assess the contribution of whole body protein breakdown, amino acid oxidation and incorporation into proteins, plasma leucine kinetics (1-13C-leucine infusion technique) were determined in six patients five times within 14 days before and after cytoreductive therapy (Cyclophosphamide and total body irradiation) and marrow transplantation. Nitrogen balance became negative (-0.20 +/- 0.04 g/Kg/24 hr) after cyclophosphamide (p less than 0.01) and was -0.25 +/- 0.05 g/Kg/24 hr 7 days after BMT in spite of total parenteral nutrition. Plasma leucine concentration increased after BMT by 67% (p less than 0.0015). Leucine plasma appearance was 1.20 +/- 0.15 mumol/kg/min before treatment, it increased slightly and transiently after cyclophosphamide, and increased again from day 5 to day 7 after BMT (p less than 0.01), suggesting increased protein break-down. Leucine oxidation increased from 0.27 +/- 0.07 before therapy to 0.97 +/- 0.16 mumol/kg/min (p less than 0.02) after cyclophosphamide and BMT. Nonoxidative leucine disappearance rate decreased slightly from 0.92 +/- 0.08 to 0.75 +/- 0.16 mumol/kg/min after BMT (ns). Leucine metabolic clearance rate decreased from 11.8 +/- 1.65 before therapy to 6.9 +/- 0.70 ml/kg/min (p less than 0.02) after cytoreductive therapy. After BMT it increased again to 9.9 +/- 1.5 ml/kg/min (p less than 0.02). The results demonstrate that patients undergoing cytoreductive therapy and bone marrow transplantation develop negative nitrogen balance due to increased protein breakdown associated with increased leucine oxidation and increased metabolic clearance rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma homocysteine levels in hyperinsulinemic patients

In order to evaluate the clinical characteristics of metabolic syndrome, a screening procedure was performed and in a cohort of middle-aged (40-60 years) hyperinsulinaemic (fasting plasma insulin > 15 microU/ml) and/or postprandial [120 min after 75 g glucose load] insulin > 45 microU/ml) subjects (n = 91; men/women: 38/53; age mean +/- SD 47.6 +/- 4.3 years; body mass index: 34.6 +/- 4.9 kg/m2; waist-hip ratio: 0.92 +/- 0.07; actual blood pressure 146 +/- 16/87 +/- 9 mmHg; fasting insulin: 24.2 +/- 11.3 microU/ml; postprandial insulin 125.5 +/- 103.8 microU/ml; serum LDL-cholesterol: 3.73 +/- 1.09 mmol/l; HDL-cholesterol: 1.12 +/- 0.30 mmol/l; triglycerides: 2.97 +/- 2.38 mmol/l; uric acid 279 +/- 79 mumol/l) plasma fasting homocysteine, vitamin B12 and folic acid levels were simultaneously determined. The values were separately evaluated according to the stages of glucose tolerance (normal glucose tolerance [n = 47]; impaired glucose tolerance [n = 24] and diabetes mellitus [n = 20]). Laboratory normal values were determined in 47 healthy subjects (control group, age: 45.0 +/- 7.8 years, men/women: 19/28). There was no significant difference between hyperinsulinaemic and control subjects regarding plasma homocysteine (9.28 +/- 3.81 mumol/l vs. 9.63 +/- 2.70 mumol/l), folic acid (8.5 +/- 5.9 ng/ml vs. 7.5 +/- 2.1 ng/ml) and vitamin B12 levels (423 +/- 141 pg/ml vs. 356 +/- 121 pg/ml). Plasma homocysteine levels were significantly (p < 0.001) higher in hyperinsulinaemic men than women (11.34 +/- 4.72 mumol/l [n = 38] vs. 7.86 +/- 2.13 mumol/l [n = 53]). There was no significant difference between subgroups classified according to the stages of glucose tolerance in hyperinsulinaemic groups. Plasma homocysteine values exceeding the upper limit of normal range (> 12.45 mumol/l) were detected at a similar prevalence rate in control (4/47 = 8.5%) and in hyperinsulinaemic subjects (10/91 = 10.9%). A weak but statistically significant correlation was found between plasma homocysteine values and age of subjects (r = 0.222; p < 0.05) whereas a stronger correlation was documented between plasma homocysteine and serum creatinine values (r = 0.658; p < 0.001) in hyperinsulinaemic groups (n = 91). Plasma homocysteine values independently from the stages of glucose tolerance are not elevated in hyperinsulinaemic subjects. Hyperhomocysteinaemia is not a characteristic feature of hyperinsulinism suggesting that plasma homocysteine levels are of no considerable importance in the complex pathomechanism of atherosclerosis at early stages of metabolic syndrome.     

山莨菪碱对大鼠热应激的影响

目的　探讨预先静脉注射山莨菪碱有无预防大鼠中暑性内毒素血症的作用。方法　实验动物随机分为两组 ,置于 38℃～ 40℃、5 0 %～ 6 0 %相对湿度的热环境中 ,用四道生理记录仪、半导体温度计测平均动脉压和直肠温度 ,并测热应激的生存时间和生存率 ,在严格无菌和去热源的条件下 ,采集门静脉血和颈动脉血 ,用显示基质偶氮法测血浆内毒素含量。结果　热应激过程中 ,实验组和对照组动物肛温持续增加 ,2h后分别达 (4 2 .7± 0 .6 )℃和 (4 3.1± 0 .5 )℃ ,两组比较 ,差异无显著性(P >0 .0 5 ) ,死亡前肛温高达 (4 4.6± 0 .2 )℃和 (4 4.2± 0 .3)℃ ,差异有显著性 (P <0 .0 1)。实验前门静脉血内毒素含量分别为 (4 5 .7± 5 .2 ) pg/ml和 (4 2 .6± 5 .4) pg/ml,外周血内毒素含量分别为 (14.8± 4.5 ) pg/ml和 (13.9± 7.2 )pg/ml,差异均无显著性 (P >0 .0 5 ) ;2h后门静脉血分别增至 (12 2 .2±16 .7)pg/ml和 (15 0 .4± 2 2 .1) pg/ml,而外周血增至 (32 .3± 7.8) pg/ml和 (4 9.7± 10 .2 )pg/ml,明显高于实验前 ,差异有显著性 (P <0 .0 1) ,而且两组之间比较 ,差异也有显著性 (P <0 .0 1)。两组动物心率变化趋势基本相同 ,都是先升后降 ,但实验前后心率变化的差异无显著性 (P >0 .0 5 ) ;实验前两组动     

Peripheral insulin sensitivity is decreased by elevated non-esterified fatty acid level in dexamethasone-treated rats

The pathogenesis of glucocorticoid-induced insulin resistance in the peripheral tissue was studied by perfusion experiments of the isolated rat hindquarter and insulin tolerance tests in the rat with the cutting off operation of blood supplies to the liver, kidneys, intestines and pancreas. The rat was injected with 0.5 mg/kg dexamethasone for 7 days. Just after the multiple functional organectomies, insulin was loaded in doses of 0.1 and 0.5 U/kg. Plasma insulin levels during 0-10 min were approximately 100-20 and 500-100 microU/ml, respectively. The decreasing rates in plasma glucose level after injections of saline and 0.1 U/kg insulin were much smaller in dexamethasone-treated than control rats (0.0+/-7.2 vs 13.3+/-3.4%/10 min, p<0.05, and 8.0+/-5.8 vs 39.4+/-3.7%/10 min, p<0.01 respectively). The decreasing rate after 0.5 U/kg insulin loads was similar between both groups (40.2+/-10.0 in dexamethasone-treated and 52.3+/-7.3%/10 min in control rats). Plasma non-esterified fatty acids were raised in dexamethasone-treated compared to control rats (1.23+/-0.23 vs 0.73+/-0.08 mM, p<0.01). In the hindquarter perfusion study, glucose uptake in the dexamethasone-treated rat leg was no less than in the normal rat leg under a palmitate-free condition, and was decreased by the addition of 1.0 mM palmitate without and together with 100 and 500 microU/ml insulin. These results suggest that the glucocorticoid-induced peripheral insulin resistance is characterised by the decreased sensitivity and the preserved responsiveness to insulin, and is caused mainly by an elevated non-esterified fatty acid level.     

Enhanced rate of ethanol elimination from blood after intravenous administration of amino acids compared with equicaloric glucose

AIMS: To investigate the effect of an amino acid mixture given intravenously (i.v.) on the rate of ethanol elimination from blood compared with equicaloric glucose and Ringer's acetate as control treatments. METHODS: In a randomized cross-over study, six healthy men (mean age 23 years) fasted overnight before receiving either Ringer's acetate, glucose or the amino acid mixture (Vamin 18 g N/l) by constant rate i.v. infusion over 4.5 h. Ethanol (0.4 g/kg) was given by an i.v. infusion lasting 60 min during the time each of the treatments was administered. At various times post-infusion, blood samples were taken for determination of ethanol by headspace gas chromatography. Blood glucose and heart rate were monitored at regular intervals. Concentration-time profiles of ethanol were plotted for each subject and the rate of ethanol disappearance from blood as well as other pharmacokinetic parameters were compared by repeated measures analysis of variance. RESULTS: The rate of ethanol elimination from blood was increased significantly (P < 0.001) after treatment with amino acids (mean +/- SD, 0.174 +/- 0.011 g/l/h) compared with equicaloric glucose (0.121 +/- 0.016 g/l/h) or Ringer's acetate (0.110 +/- 0.013 g/l/h). Heart rate was also slightly higher during infusion of the amino acid mixture (P < 0.05). CONCLUSIONS: When the rate of ethanol elimination from blood is relatively slow, such as after an overnight fast, it can be increased by approximately 60% after treatment with i.v. amino acids. The efficacy of amino acid treatment was not related to the supply of calories because glucose was no more effective than Ringer's acetate. We suggest that amino acids might increase hepatic oxygen consumption, resulting in a more effective conversion of NADH to NAD+ in mitochondria. An important feature of the experimental design was ensuring hepatic availability of amino acids during much of the time that ethanol was being metabolized.     

微米及纳米SiO2粉体的急性肺毒性比较

目的 比较纳米级SiO2与微米级SiO2粉体对呼吸道染尘大鼠的急性肺毒性.方法 雄性Wistar大鼠125只,按体重分为25组.呼吸道染尘剂量μm-SiO2分别为100(A组)、300 mg/m3(B组);nm-SiO2分别为100(A'组)、300 mg/m3(B'组).1次染尘2 h后,比较6、12、24、48、72 h支气管肺泡灌洗液(bronehoalveolar lavage fluid,BALF)中细胞总数(total cellular score,TCS)及分类、总蛋白(total protein,TPr)含量、碱性磷酸酶(alkaline phosphatase,AKP)和乳酸脱氢酶(lactate dehydrogenase,LDH)活性,血清和肺组织羟脯氨酸(hydroxyproline,HyP)含量.结果 染尘后6 h A'组BALF中TCS[(55.00±8.30)×104个/ml]、B'组BALF中TCS[(52.50±9.02)×104个/ml]均高于对照组[(34.88±12.53)×104个/ml];染尘后6、24 h A'组BALF中TCS[(55.00±8.30)×104个/ml、(39.75±12.08)×104个/ml]均高于等剂量微米SiO2染尘组[(32.38±13.07)×104个/ml、(24.13±10.97)×104个/ml].48 h A'组BALF中TPr[(0.34±0.09)g/L]、B'组BALF中TPr[(0.38±0.16)g/L]含量均高于等剂量微米SiO2染尘组[(0.20±0.07)g/L、(0.21±0.05)g/L].72 h A'组BALF中LDH活力[(1.66±0.22)×103 U/L]高于等剂量微米SiO2染尘组[(1.38±0.17)×103 U/L].6、24 h B'组BALF中AKP活力[(5.14±1.47)U/100 ml、(5.86±2.41)U/100 ml]均高于等剂量微米SiO2染尘组[(3.64±0.36)U/100 ml、(3.30±2.19)U/100 m1].6、12、48、72 h A'组肺组织HyP含量[(0.532±0.053)、(0.484±0.046)、(0.591±0.096)、(0.551±0.084)μg/mg肺湿重]以及12、72 h B'组肺组织HyP含量[(0.508±0.081)、(0.565±0.053)μg/mg肺湿重]均高于等剂量微米SiO2染尘组[(0.345±0.074)、(0.368±0.095)、(0.431±0.036)、(0.399±0.080)、(0.396±0.039)、(0.465±0.062)μg/mg肺湿重].结论 本实验条件下,与微米级SiO2粉尘相比,纳米级SiO2粉尘可导致较严重的急性肺毒性.     

Influence on gallbladder volume of early postoperative gastric supply of nutrients

BACKGROUND & AIM: The gallbladder volume is a predictor of biliary stasis and the formation of biliary sludge. Biliary stasis and sludge have been recently recognized as the precursors of acute acalculous cholecystitis, as well as 'idiopathic' postoperative pancreatitis, rare but very serious complications after surgery. The aim of the study was to establish how early postoperative gastric supply of nutrients affects the gallbladder volume in patients after noncardiac and cardiac surgery. METHODS: In the two prospective, randomized studies 40 patients (study I-noncardiac surgery) treated at surgical ICU after major elective extrahepatobiliary and extragastrointestinal surgeries (7 thoracic, 19 vascular, 14 urological) and 40 patients (study II-cardiac surgery) treated at cardiosurgical ICU after CABG surgery were analyzed. In both studies the patients were divided into two groups: control group C (study I: 20 patients, age 45+/-18 yrs, male 65%; study II: 20 patients age 58+/-7 yrs, male 60%) and group E (group of early postoperative gastric supply of nutrients) (study I: 20 patients, age 52+/-17 yrs, male 50%; study II: 20 patients; age 59+/-8 yrs, male 65%). For the first 24 hours the patients in group C received only crystalloid solutions and the gallbladder volume was verified 24 hours after the surgery. In group E, postoperative gastric supply of nutrients began 18 hours after surgery (Osmolite, Ross; first 3 hours 30 ml/h and second 3 hours 50 ml/h; total 240 ml after 6 hours). In all patients sonographic measurement of gallbladder volume was performed immediately before surgery and 6 hours after the start of feeding (24 hours after surgery). The measurement was done with ultrasonographic scanner Hitachi 405 EUB (convex probe 3.5-5MHz) by the same specialist, and the volume was calculated using the ellipsoid method. RESULTS: The gallbladder volume measured by ultrasonography 24 hours after surgery in study I (noncardiac surgery) in group E amounted to 43+/-25 ml while in control group C it was significantly higher, i.e. 67+/-30 ml (P<0.05). In study II (cardiac surgery) in group E gallbladder volume amounted to 59+/-15 ml while in control group C it was also significantly higher, i.e. 71+/-11 ml (P<0.05). CONCLUSION: An early postoperative gastric supply of nutrients after both noncardiac and cardiac adult surgery diminishes the volume and probably stimulates the motility of the gallbladder, thus preventing biliary stasis and the formation of biliary sludge.