岛状皮瓣静脉淤血再通后对大鼠全身情况的影响

目的：探讨岛状皮瓣静脉淤血再通后对全身多脏器的影响。方法：按静脉淤血时间的不同将大鼠分为4组。观察耳部微循环的改变，测量术后肿瘤坏死因子α(TNFα），白细胞介素10（IL－10）的动态变化，观察心，肺，肝，肾，小肠及耳部血管等组织结构及中性粒细胞浸润数目。结果：皮瓣原位缝合组及静脉淤血2h组，耳部微循环、TNFα、IL-10浓度基本保持不变，各脏器结构改变较轻，中性粒细胞浸润数目少。静脉淤血6、10h组，微循环，肺，小肠，血管则有明显组织学改变，大量中性粒细胞浸润其中，但心，肝，肾组织学改变较轻。TNFα浓度再灌注1h达到高峰，其后逐渐下降，IL－10浓度3h达到最低，然后逐渐上升。结论：皮瓣静脉淤血再通后可造成肺、小肠及血管器官损伤，静脉淤血时间越长，再通后则损伤程度越重。全身微循环的改变，中性粒细胞在肺、小肠中的浸润，与血管内皮细胞的粘附及细胞因子TNFα与IL－10的浓度失衡是重要的操作原因。     

暴发性重症急性胰腺炎临床特点及治疗方法的探讨

目的 认识暴发性重症急性胰腺炎(fulminant severe acute pancreatitis，FSAP)的特点，探讨其治疗方法。方法 统计出现症状72h内住院的重症胰腺炎(severe acute pancreatitis，SAP)病人209人，回顾性的整理、分析暴发性重症胰腺炎发生、发展的特点。暴发性重症急性胰腺炎定义为，出现症状72h内发生器官衰竭的重症胰腺炎。56例病人为暴发性重症胰腺炎组(FSAP组)。153例72h内末发生器官衰竭的病人组成重症胰腺炎组(SAP组)。结果 FSAP死亡率、低氧血症和多器官系统衰竭发生率明显高于SAP组(53．6％vs2．6％，85．71％vs22．88％和78．6％vs41．2％)。Logistic回归分析FSAP高危因素为：高APACHE—Ⅱ评分，低氧血症。结论 我们提出FSAP的特征为：多器官系统衰竭、胰腺病变重、早期发生低氧血症、早期腹腔高压征(intro-abdominal hypertension,LAH)和高APACHE—Ⅱ评分。FSAP的预后差。积极纠正低氧血症、微创治疗等手段可能对FSAP治疗有益。     

Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review

In recent years, humanity has been confronted with a global pandemic due to coronavirus disease 2019 (COVID-19), which has caused an unprecedented health and economic crisis worldwide. Apart from the respiratory symptoms, which are considered the principal manifestations of COVID-19, it has been recognized that COVID-19 constitutes a systemic inflammatory process affecting multiple organ systems. Across the spectrum of organ involvement in COVID-19, acute liver injury (ALI) has been gradually gaining increasing attention by the international scientific community. COVID-19 associated liver impairment can affect a considerable proportion of COVID-19 patients and seems to correlate with the severity of the disease course. Indeed, COVID-19 patients hospitalized in the intensive care unit (ICU) run a greater risk of developing ALI due to the severity of their clinical condition and in the context of multi-organ failure. The putative pathophysiological mechanisms of COVID-19 induced ALI in ICU patients remain poorly understood and appear to be multifactorial in nature. Several theories have been proposed to explain the occurrence of ALI in the ICU setting, such as hypoperfusion and ischemia due to hemodynamic instability, passive liver congestion as a result of congestive heart failure, ischemia-reperfusion injury, hypoxia due to respiratory failure, mechanical ventilation itself, sepsis and septic shock, cytokine storm, endotheliitis with concomitant coagulopathy, drug-induced liver injury, parenteral nutrition and direct cytopathic viral effect. It should be noted that no specific therapy for COVID-19 induced ALI exists. Therefore, the therapeutic approach lies in preventive measures and is exclusively supportive once ALI ensues. The aim of the current review is to scrutinize the existing evidence on COVID-19 associated ALI in ICU patients, explore its clinical implications, shed light on the underlying pathophysiological mechanisms and propose potential therapeutic approaches. Ongoing research on the particular scientific field will further elucidate the pathophysiology behind ALI and address unresolved issues, in the hope of mitigating the tremendous health consequences imposed by COVID-19 on ICU patients.     

Impact of emerging hepatitis C virus treatments on future needs for liver transplantation in France: A modelling approach

BackgroundIn light of the impact of emerging hepatitis C virus treatments on morbidity and mortality, we sought to determine whether candidates for liver transplantation for hepatocellular carcinoma and decompensated cirrhosis will decrease sufficiently to match liver grafts for hepatitis C virus-infected patients.AimsUsing a Markov model, we quantified future liver graft needs for hepatitis C virus-induced diseases and estimated the impact of current and emerging treatments.MethodsWe simulated progression of yearly-hepatitis-C-virus-infected cohorts from the beginning of the epidemic and calculated 2013–2022 candidates for liver transplantation up until 2022 without and with therapies. We compared these estimated numbers to projected trends in liver grafts for hepatitis C virus.ResultsOverall, current treatment would avoid transplantation of 4425 (4183–4684) potential candidates during the period 2013–2022. It would enable an 88% and 42% reduction in the gap between liver transplantation activity and candidates for hepatocellular carcinoma and decompensated cirrhosis, respectively. Emerging hepatitis C virus treatments would allow adequacy in transplant activities for hepatocellular carcinoma. However, they would not lead to adequacy in decompensated cirrhosis from 2013 to 2022. Results were robust to sensitivity analysis.ConclusionOur study indicates that patients will benefit from public health policies regarding hepatitis C virus screening and therapeutic access to new emerging treatments.     

Lactobacillus fermentum,a pathogen in documented cholecystitis

INTRODUCTIONLactobacillus species are probiotics proven to exhibit various preventative as well as therapeutic properties. While lactobacillus species have been implicated in the formation of dental caries, endocarditis and bacteremia, their role as pathogens in cholecystitis has not been reported. We present a rare case of Lactobacillus fermentum working as a pathogen in cholecystitis.PRESENTATION OF CASEAn 81-year old male was admitted with right upper quadrant abdominal pain. His signs, symptoms, laboratory values and imaging were consistent with a diagnosis of cholecystitis with ascending cholangitis. In view of his co-morbidity and severe sepsis, the patient was treated non-operatively with antibiotics and cholecystostomy. L. fermentum, which was vancomycin resistant, was identified from the cholecystostomy aspirate and from anaerobic blood culture. The patient went into septic shock, developed multi-organ dysfunction syndrome and eventually died.DISCUSSIONCommensal bacteria such as L. fermentum are known to modulate immunity, reduce the pathogenicity of gastrointestinal organisms and play a therapeutic role in various disease processes. We isolated L. fermentum as a pathogen in a documented case of cholecystitis with ascending cholangitis.CONCLUSIONWhile the routine use lactobacillus species as a probiotic is supported in the literature, understanding its potential role as a pathogen may allow more judicious use of these bacteria and encourage research to elucidate the pathogenicity of lactobacillus species.     

Comparative toxicity of low dose tributyltin chloride on serum,liver, lung and kidney following subchronic exposure

Tributyltin (TBT) pollution is rampant worldwide and is a growing threat due to its bio-accumulative property. Isolated studies of TBT toxicity on different organs are available but consolidated information is greatly lacking. We planned this study to delineate the effect of subchronic (1 month) exposure to low dose TBT-chloride (TBTC) (1 and 5 mg/kg) in male Wistar rats. Total tin concentration was found to be significantly increased in liver, kidney and blood, and marginally in lungs. Organo-somatic indices were seen to be altered with little effect on serum biochemical markers (liver and kidney function, and general parameters). Reactive oxygen species but not lipid peroxidation content was observed to be significantly elevated both in the tissues and serum. TBTC was found to act as a hyperlipidemic agent and it also affected heme biosynthetic pathway. Hematological analysis showed that TBTC exposure resulted in minor alterations in RBC parameters. Histological studies demonstrated marked tissue damage in all the 3 organs. Calcium inhibitors (BAPTA-AM, EGTA) and antioxidants (NAC, C-PC) significantly restored TBTC induced loss in cell viability, under ex-vivo conditions. Antioxidants were evidently more efficient in comparison to the calcium inhibitors, implying major role of oxidative stress pathways in TBTC toxicity.     

Correlation between Medium-term Multi-organ Carcinogenesis Bioassay Data and Long-term Observation Results in Rats

The effects of four test chemicals [2-acetylaminofluorene (2-AAF), D, L-ethionine (ethionine), butylated hydroxyanisole (BHA), and catechol] were compared in medium- and long-term in vivo systems. In the medium-term assay, animals were sequentially treated with N-diethylnitrosamine (100 mg/kg body weight, i.p., single injection), N-methylnitrosourea (20 mg/kg body weight, i.p., 4 times during weeks 1 and 2), N-butyl-N-(4-hydroxybutyl)nitrosamine (0.05% in the drinking water during weeks 1 and 2), 1,2-dimethylhydrazine (40 mg/kg body weight, s.c., 4 times during weeks 3 and 4) and dihydroxy-di-N-propylnitrosamine (0.1% in the drinking water during weeks 3 and 4) for multi-organ initiation, and then treated with one of the four test chemicals for 24 weeks, and killed at week 28 (group 1). In the long-term assay, animals were treated in the same manner and then given hasal diet and tap water (group 3) or test chemical continuously (group 4) for the remainder of the lifespan. Animals receiving multi-organ initiation and then maintained on hasal diet for 24 weeks (group 2) or their lifespan (group 5) served as controls. Detailed histopathological examinations were performed on all rats. Hepatocellular carcinoma incidences in the long-term assay were found to reflect closely the respective medium-term results. Induction of proliferative forestomach or glandular stomach lesions by BHA and/or catechol, and bladder lesions by 2-AAF and BHA in the mediumterm assay also correlated with tumor development in the long-term. Furthermore, inhibition of thyroid proliferative lesions by all test chemicals corresponded with low thyroid tumor incidences in the long-term assay. The observed strong correlation between medium- and long-term results confirms the applicability of our medium-term multi-organ carcinogenesis bioassay system for detection of modifying effects of test chemicals in different organs.     

Transient polycythemia and multi-organ failure due to acute alcohol ingestion

 Relative polycythemia is characterized by elevated hematocrit with normal red cell mass and results from decreased plasma volume. We present a case of a 39-year-old man who had at least two episodes of severe relative polycythemia and multi-organ failure following acute alcohol ingestion. Although the acute dehydrating effects of alcohol are well known, they usually result in an indolent course. This is the first report of recurrent severe polycythemia and multi-organ failure following acute alcohol consumption. Received: 17 December 1999 / Accepted: 24 March 2000     

Natural Killer Activity in a Medium-term Multi-organ Bioassay for Carcinogenesis

Natural killer (NK) cell activity was evaluated after the initiation and promotion steps in a medium-term multi-organ bioassay for carcinogenesis. NK cell activity was assessed in vitro by Cr⁵¹ release assay at the 4th and 30th weeks of the experiment. Male Wistar rats were sequentially initiated with N-diethylnitrosamine (DEN i.p.), N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN drinking water), N-methyl-N-nitrosourea (MNU i.p.), dihydroxy-di-N-propylnitrosamine (DHPN drinking water) and N, N'-dimethylhydrazine (DMH s.c.) at subcarcinogenic doses for 4 weeks (DMBDD initiation). One group was evaluated at the 4th week and the other was maintained without any further treatment until the 30th week. Two initiated groups were exposed through the diet to 2-acetylaminofluorene (2-AAF) or phenobarbital (PB), from the 6th until the 30th week. Five additional groups were studied to evaluate the effects of each initiator on NK activity. All groups submitted to initiation only, initiation plus promotion, or promotion only, developed significantly more preneoplastic lesions than the untreated control group. The main target organs for tumor development in the initiated animals were the liver and the colon, irrespective of treatment with 2-AAF or PB. NK cell activity was not affected by exposure to genotoxic carcinogens after initiation, at the 4th week. Treatments only with PB or 2-AAF did not change NK cell activity. However, decreased NK cell activity was registered in the group only initiated with DMBDD and in the group given DMBDD+2-AAF. This late depression of NK cell activity at the 30th week could be related to the production of suppressing molecules by the tumor cells.     

急性砷化氢中毒的多器官损害

总结２７例砷化氢中毒患者引起全身多脏器（包括外周血、肾、心、肝、胆、肺、胃肠道、系统、电解质、酸碱平衡紊乱等）损害的临床表现及救治体会，认为多器官损害使病情复杂化，容易误诊。治疗上应根据各器官受累情况，综合考虑，分清轻重缓急，从而提高该类病人的成功率。