Tumor necrosis factor-alpha during continuous high-flux hemodialysis in sepsis with acute renal failure

Suppressed ex vivo endotoxin (ET)-induced production of the proinflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha), in isolated mononuclear cells (PBMCs) is associated with fatal outcome in severe sepsis. PBMCs from surviving patients, but not those from nonsurviving patients, recover their capacity to produce normal amounts of TNF-alpha. We tested the influence of two modalities of continuous renal replacement therapy (CRRT) on ex vivo-induced whole-blood production of TNF-alpha and inhibitory TNF-soluble receptor type I (TNFsRI) in 12 patients with acute renal failure and sepsis (APACHE II score 22 to 30). METHODS: Standard continuous venovenous hemofiltration (CVVH; 36 liters of bicarbonate substitution fluid per day) was performed in 7 patients using polyamid hemofilters (FH66; Gambro). In an additional five patients, we performed daily 18 hours of high-flux hemodialysis (CHFD) using polysulfon F60S dialyzers (Fresenius) and 75 liters of bicarbonate dialysate using the GENIUS single-pass batch dialysis system. Samples were separated from the blood circuit as well as from the ultrafiltrate/spent dialysate lines at the start, during, and end of treatment. Whole-blood samples were incubated with 1 ng/ml of ET for three hours at 37 degrees C. Ultrafiltrate or dialysate samples were incubated with donor whole blood in the presence of ET to measure suppressing activity in ultrafiltrate and spent dialysate. RESULTS: At the start of CRRT, ET-induced whole-blood TNF-alpha production was suppressed to approximately 10% of that in normal controls. During CVVH, median ET-induced TNF-alpha production increased from 0.35 ng/ml at the start to 1.2 ng/ml at three hours, but decreased to pre-CVVH levels at the end of a 24-hour period. In contrast, in patients on CHFD, the median ET-induced TNF-alpha production was 0.5 ng/ml at the start, 1.1 ng/ml at 3 hours, 1.6 ng/ml at six hours, and 1.5 ng/ml at the end of 18 hours of treatment. The ultrafiltrate obtained after three hours of CVVH did not contain suppressing activity. In CHFD, the spent dialysate as compared with fresh dialysate suppressed ET-induced TNF-alpha production in donor blood by 33% throughout the 18 hours of treatment. Whole-blood production of TNFsRI did not change significantly at any time point during CVVH or CHFD. CONCLUSION: These data suggest that high-volume CHFD is superior to standard CVVH in removing a suppressing factor of proinflammatory cytokine production. As CVVH only transiently improves TNF-alpha production, it is most likely that the putative suppressing factor is removed because of saturable membrane adsorption in CVVH. In CHFD, there is a combination of adsorption and detectable diffusion into the dialysate. It remains to be shown whether a further increase in the volume of dialysate per day is able to not only improve but normalize the cytokine response and improve outcome in septic patients with acute renal failure.     

参麦注射液对内皮细胞增殖和迁移的影响

目的：探讨参麦注射液对血管生成的影响。方法：采用MTT法检测参麦注射液对牛血清和肿瘤细胞条件培养液促进的牛主动脉内皮细胞增殖的影响，采用琼脂糖刮除法检测参麦对牛血清和肿瘤条件培养液促进的牛内皮细胞迁移的影响。结果：在含10％新生小牛血清培养液中和在肿瘤细胞条件培养液中，参麦都能明显抑制牛主动脉内皮细胞增殖，且呈量效关系，对肿瘤细胞条件培养液诱导的内皮细胞迁移抑制作用显著。方法：参麦能抑制牛内细胞增殖和迁移，具有抑制血管生成的作用。     

血清白细胞介素2检测在恶性腹水白细胞介素2治疗中的应用

目的 对恶性腹水患者血清白细胞介素2(IL-2)水平进行测定,了解血清IL-2水平与腹腔灌注IL-2治疗疗效之间的关系,以期获得判定恶性腹水IL-2治疗疗效的指标。方法 54例恶性非肝癌性腹水患者均接受IL-2腹腔灌注治疗,治疗前应用ELISA法检测血清IL-2水平,将IL-2测定值较高的27例患者分为A组,IL-2测定值较低的27例患者分为B组。比较两组患者的治疗效果。结果 血清IL-2测定值较低组IL-2腹腔灌注治疗的有效率为77.8％(21/27),明显高于IL-2测定值较高组的51.9％(14/27,P<0.05)。结论 恶性腹水患者IL-2腹腔灌注治疗前血清IL-2水平高低与IL-2治疗的疗效明显相关,原有IL-2水平较低的患者IL-2腹腔灌注治疗的疗效较好。血清IL-2水平可作为判定IL-2腹腔灌注治疗疗效的指标。     

人膀胱癌细胞nm23蛋白表达量与丝裂霉素抗药指数之间的相关性研究

目的探讨膀胱癌细胞nm23蛋白表达量与丝裂霉素药物敏感性之间的相关性.为临床膀胱移行细胞癌治疗方案选择提供理论依据.方法对32例临床病理诊断为膀胱移行细胞癌标本采用S-P免疫组化和图像分析技术检测细胞的nm23蛋白表达量;同时采用MTT法测定膀胱癌细胞对丝裂霉素的药物敏感性.结果膀胱癌nm23表达量与MMC抗药指数相关,相关指数为0.890(P＜0.001).结论膀胱癌nm23蛋白表达量与MMC抗药指数呈正相关.     

Administration of prostacyclin after liver transplantation: a placebo controlled randomized trial

The shortage of suitable organs for liver grafts is responsible for the use of marginal donors for liver transplantation (OLT). If these liver grafts function poorly initially after OLT, a supportive therapy is necessary. The purpose of this study was to evaluate the effects of prostacyclin (PGI2) on postoperative liver graft function after OLT. A total of 30 adult recipients of primary OLT were randomized to either receive PGI2 (4 ng/kg per min body weight, n = 15) or a placebo for 6 d. To evaluate regional splanchnic oxygenation a fiberoptic pulmonary-artery catheter was inserted into a hepatic vein and the difference between mixed venous oxygen content and hepatic venous oxygen content was determined (deltaO2). Measurements were performed directly after transplantation and at 6, 12, 24 and 48 h postoperatively. A significant correlation between deltaO2 and the level of transaminases (ALT/AST) was observed 24 and 48 h after transplantation (p < 0.05). PGI2 treatment induced a significant decrease in deltaO2 after 24 and 48 h after reperfusion (p < 0.05). Peak AST levels tended to be lower in the PGI2 treatment group (418 +/- 99 vs. 638 +/- 156 U/L, p < 0.1). These results suggest that administration of PGI2 after OLT improves hepatic-splanchnic oxygenation and may thereby reduce reperfusion injury after OLT.