Deleterious effects of aggressive rapid crystalloid resuscitation on treatment of hyperinflammatory response and lung injury induced by hemorrhage in aging rats

Background

Large-volume, rapid crystalloid infusion may increase endothelial cell damage and induce shear stress, potentially leading to multiple-organ dysfunction syndrome. Limited guideline data for fluid administration are currently available, especially for the aging population. The aim of the present study was to compare the degree of organ damage in conscious aging rats when different resuscitation speeds were used during the treatment of hemorrhagic shock (HS).

Methods

Eighteen aging male Wistar-Kyoto rats were randomly divided into the following three groups: the control group, 30-min rapid resuscitation group, and 12-h slow resuscitation group. To mimic HS, 40% of the total blood volume was withdrawn. Fluid resuscitation (1:3) was given at 30 min after the blood withdrawal. Blood biochemical parameters including glucose, lactic acid, and lactate dehydrogenase (LDH) were measured along with the levels of serum and bronchoalveolar lavage fluid, tumor necrosis factor alpha (TNF-α), and interleukin 10 by enzyme-linked immunosorbent assay. The lungs were examined for pathologic changes, and the injury score at 24 h after HS was calculated.

Results

Compared with slow-rate resuscitation, initially rapid and immediate resuscitation significantly increased the serum levels of glucose, LDH, and proinflammatory cytokines (TNF-α and interleukin 10), and bronchoalveolar lavage fluid levels of white blood cells, TNF-α, and LDH as well as produced pathologic changes in the organ. The lung injury scores were higher after induced HS in aging rats.

Conclusions

The slow and continuous (12 h) fluid resuscitation rate ameliorated HS-induced organ damage in conscious aging rats.     

埃博拉病毒病研究的现状和思考

埃博拉病毒病（ Ebola virus disease）是一种急性出血性传染病,主要通过接触传播,临床表现为突起发热、肌肉酸痛、腹泻、出血和多脏器损害,伴随外周血白细胞、血小板计数降低等。埃博拉病毒是人类历史上最致命的病毒之一,人感染后病死率在50％～90％,被世界卫生组织（ WHO）列为生物安全第四级（ Biosafety level 4, BSL-4）病毒,同时也被视为生物恐怖工具之一。     

Ruptured splenic peliosis in a patient with no comorbidity: A case report

BACKGROUND Splenic peliosis is a disease characterized by widespread blood-filled cystic cavities within the parenchyma. Patients with this disease are usually asymptomatic;therefore, spontaneous or trauma-related rupture of the hemorrhagic cysts can occasionally cause life-threatening hemorrhagic shock.CASE SUMMARY A 51-year-old male patient with abdominal pain visited our emergency medical center two times with an interval of 2 mo. The patient was discharged from the hospital without treatment at his first visit;however, at the time of second admission, the hemoperitoneum with multiple cystic lesions of the spleen was found incidentally on the abdomen computed tomography scan. Since the patient was stable hemodynamically, a scheduled surgery was performed. The operative findings were consistent with splenic peliosis, and laparoscopic splenectomy was performed to prevent recurrent rupture of the hemorrhagic cysts.CONCLUSION Splenic peliosis is extremely rare, and we suggest splenectomy is necessarily required as a definite treatment for ruptured splenic peliosis to rescue patients with hemodynamic instability and to prevent recurrent rupture of hemorrhagic cysts in patients with stable hemodynamics.     

Novel triple therapy for hemorrhagic ascites caused by endometriosis: A case report

BACKGROUNDMassive hemorrhagic ascites caused by endometriosis is exceedingly rare, and the treatment strategy remains controversial. Here, we report a case of endometriosis with massive hemorrhagic ascites treated with a novel triple therapy including conservative surgery, gonadotropin-releasing hormone agonist, and then dienogest.CASE SUMMARYA 28-year-old nulliparous patient was admitted to Shengjing Hospital of China Medical University, and exploratory laparoscopy was performed. A total of 9500 mL of brown ascites was aspirated from the pelvic cavity, the bilateral ovaries strongly adhered to the posterior of the uterus and were fixed to the pelvic floor, and endometriotic cysts were not observed in either ovary. The pelvic and abdominal peritonea were covered with patchy red, white, and brown endometriotic lesions and defects. Partial surgical resection of endometriotic lesions on the peritoneum was performed while we simultaneously collected multiple peritoneal biopsies. The final pathological diagnosis was endometriosis coupled with hemorrhagic necrotic tissue.CONCLUSIONPostoperative injection of gonadotropin-releasing hormone agonist was provided three times, followed by dienogest administration, and we will continue to follow up with this ongoing treatment.     

急慢性出血性脑卒中患者受损皮质脊髓束磁共振弥散张量成像特点分析

目的:探究急慢性出血性脑卒中患者受损皮质脊髓束磁共振成像(MRI)的弥散张量成像(DTI)特点分析.方法:选取60例出血性脑卒中患者,依据诊断结果将其分为急性出血性脑卒中组(急性组,21例)和慢性出血性脑卒中组(慢性组,39例).对两组患者进行DTI扫描,测量病变侧皮质脊髓束、病变对侧分数各向异性(FA)值及平均弥散率...     

1990～2006年广西肾综合征出血热流行特征与趋势

目的分析17年广西肾综合征出血热(HFRS)的流行特征与发病趋势。方法收集17年来广西HFRS的发病、死亡数据,对疫区分布及其流行强度进行分析。结果17年间广西肾综合征出血热累计报告病例数为271例,处于低发病水平,并于1994年和2002年分别出现两个流行高峰;除柳州、崇左、贺州和防城港市外,全区其他地市均有病例报告,尤其以桂北地区多见;近年来城市发病例数有增多趋势。结论广西HFRS的流行处于低发病水平,但桂北地区较高,城市发病有上升趋势,应加强监测,采取综合措施预防控制HFRS的流行和传播。     

浙江省肾综合征出血热(HFRS)-Ⅰ型鼠脑纯化疫苗安全性、血清学、防病效果和免疫策略研究

目的　现场观察、考核兰州生物制品研究所生产的HFRS -Ⅰ型鼠脑纯化疫苗的安全性、血清免疫学与防病效果 ,并确定其免疫程序和免疫策略。方法　试验组和对照组按随机整群分组法进行分组 ;采用 0、7、2 8d及免后 1年加强 1针的免疫程序 ;分别采集免前、全程接种后 2周、加强前、加强后两周、加强后 1、2、3、4、5年的部分接种者全血和微量耳垂血 ,分别测定其中和抗体和IFA抗体 ,观察疫苗的血清免疫学效果和现场流行病学防病效果。结果　在 1995年 8月～ 2 0 0 1年 12月的 6年时间里从疫苗开始接种到加强后 5年 ,观察了HFRS -Ⅰ型鼠脑灭活纯化疫苗的安全性、血清免疫学效果和流行病学防病效果等。纵观结果 :证明该疫苗除了因疫苗中残留蔗糖导致较重较普遍的局部反应外 ,未发现其他严重的副反应 ,证明疫苗有较好安全性。从血清免疫效果看 ,86例全程接种后两周的免疫者血清 ,IFA抗体阳转率达 10 0 % ,中和抗体阳转率为4 4 4 4 % (8/ 18)。 1年后 ,IFA抗体和中和抗体阳性率分别下降到 2 8 5 7%和 14 80 %。但加强后 2周的血清IFA抗体和中和抗体阳性率分别反弹至 83 33%和 5 5 5 6 % ,其抗体几何平均滴度也随之回升 ,但不十分明显。此外 ,在加强后 2年IFA和中和抗体阳性率再次下降到较低水平 ,分别为     

CT微血管表面通透性参数在检测缺血性脑卒中出血性转化中的应用

目的探讨CT灌注(CT perfusion,CTP)成像获得的脑组织局部微血管表面通透性(permeability surface,PS)参数在预测急性缺血性脑卒中后出血性转化中的应用价值。方法回顾性分析发病3~8h内急性缺血性脑卒中患者的影像学资料,所有患者均进行CTP检查。根据随访CT或MRI影像判断有无发生出血性转化(hemorrhagic transforma-tion,HT),分为出血组(PSHT)及未出血组(PSNo-HT)。采用Mann-Whitney U检验比较PSHT及PSNo-HT两者相应临床及影像学参数之间的差异。采用受试者工作曲线(receiver operating characteristic,ROC)分析相对表面通透性(rPS)值预测HT的敏感度及特异性。结果 26例患者进行入院CTP检查的患者中11例发生HT。PSHT组与PSNo-HT组患者的rPS值之间差异有统计学意义(P<0.05),两组患者的年龄、发病时间、rCBV及rCBF的差异无统计学意义(P值均>0.05)。ROC分析显示:rPS阈值为5.81时,预测HT的敏感性及特异性分别为90.91%、87.50%。结论动态CTP成像获得的PS参数图能够判断哪些患者易发生HT,在指导急性缺血性脑卒中患者的临床治疗方面有较高的应用价值。     

产科失血性休克51例临床分析

目的:探讨产科失血性休克发生的原因和防治方法。方法:对3年来产科失血性休克51例进行回顾性分析。结果:产科失血性休克的发生率为0.65%,胎盘因素是失血性休克的主要原因;主要的危险因素是多次妊娠和流产、院外分娩及重度子痫前期。产科失血性休克导致的子宫切除率为17.6%。结论:减少妊娠和刮宫次数,杜绝院外分娩,加强孕期保健对于预防产科失血性休克不容忽视,对于无法控制的产后出血,子宫全切或次全切除是挽救孕产妇生命的重要措施。