Altered Plasma Concentrations of Trace Elements in Ulcerative Colitis Patients Before and After Surgery

Ileal pouch-anal anastomosis (IPAA) is a classical surgery for ulcerative colitis patients. However, knowledge on trace element alteration in patients who had undergone this surgery is limited. This study was conducted to assess trace element alteration in patients with ulcerative colitis before and after ileal pouch-anal anastomosis. Preoperative (40) and postoperative (35) ulcerative colitis patients were studied. The dietary assessment of trace element intake was undertaken by a semiquantitative food frequency questionnaire. Patients' trace element status of zinc, copper, manganese, selenium, calcium, iron, and vitamin D₃ was assessed by measuring their blood concentrations. We found that with the similar dietary intake, there was no statistical difference in the concentrations of plasma copper, iron, calcium, and vitamin D₃ in the two groups (P?>?0.05). Compared with preoperative patients, postoperative patients had higher concentrations of plasma zinc (14.51?±?4.75 μmol/l) and manganese (0.21?±?0.11 μmol/l) and lower concentrations of plasma selenium (0.86?±?0.58 μmol/l). Both preoperative and postoperative mean concentrations of plasma calcium and vitamin D₃ were below their reference range, respectively. We conclude that IPAA does not seem to alter patients' abnormal trace elements completely. It is important to monitor and supply some specified trace elements even in postoperative patients.     

Sodium Butyrate Protects against Severe Burn-Induced Remote Acute Lung Injury in Rats

High-mobility group box 1 protein (HMGB1), a ubiquitous nuclear protein, drives proinflammatory responses when released extracellularly. It plays a key role as a distal mediator in the development of acute lung injury (ALI). Sodium butyrate, an inhibitor of histone deacetylase, has been demonstrated to inhibit HMGB1 expression. This study investigates the effect of sodium butyrate on burn-induced lung injury. Sprague–Dawley rats were divided into three groups: 1) sham group, sham burn treatment; 2) burn group, third-degree burns over 30% total body surface area (TBSA) with lactated Ringer’s solution for resuscitation; 3) burn plus sodium butyrate group, third-degree burns over 30% TBSA with lactated Ringer’s solution containing sodium butyrate for resuscitation. The burned animals were sacrificed at 12, 24, and 48 h after burn injury. Lung injury was assessed in terms of histologic changes and wet weight to dry weight (W/D) ratio. Tumor necrosis factor (TNF)-α and interleukin (IL)-8 protein concentrations in bronchoalveolar lavage fluid (BALF) and serum were measured by enzyme-linked immunosorbent assay, and HMGB1 expression in the lung was determined by Western blot analysis. Pulmonary myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration were measured to reflect neutrophil infiltration and oxidative stress in the lung, respectively. As a result, sodium butyrate significantly inhibited the HMGB1 expressions in the lungs, reduced the lung W/D ratio, and improved the pulmonary histologic changes induced by burn trauma. Furthermore, sodium butyrate administration decreased the TNF-α and IL-8 concentrations in BALF and serum, suppressed MPO activity, and reduced the MDA content in the lungs after severe burn. These results suggest that sodium butyrate attenuates inflammatory responses, neutrophil infiltration, and oxidative stress in the lungs, and protects against remote ALI induced by severe burn, which is associated with inhibiting HMGB1 expression.     

他克莫司对大鼠重症急性胰腺炎和其相关的肺损伤的保护作用

目的:观察他克莫司(Tacrolimus)对重症急性胰腺炎(SAP)大鼠的潜在治疗作用并探究其机制.方法:健康雌性SD大鼠90只,随机分为对照组、SAP模型组、SAP Tacrolimus治疗组(0.5、1.0、1.5mg/kg),逆行胆胰管注射5%牛磺胆酸钠制备SAP模型.观察肺组织及胰腺组织的病理变化,检测各组大鼠血清TNF-α及MMP-9表达、支气管肺泡灌洗液(BALD蛋白含量、胰腺组织髓过氧化物酶(MPO)活性.结果:SAP组胰腺、肺组织病理损伤随病情进展而逐渐加重,经tacrolimus治疗后缓解.SAP大鼠组血清TNF-α及MMP-9表达、肺灌洗液(BALF)蛋白含量及胰腺组织MPO活性较对照显著升高(P＜0.01),但是经tacrolimus治疗后升高幅度呈非浓度依赖性的明显降低(P＜0.01),各组大鼠存活率提高(P＜0.01).结论:Tacrolimus可有效降低SAP大鼠急性重症胰腺炎的严重程度,其机制可能包括减少肺脏的毛细血管渗透性,抑制由TNF-α,MMP-9以及中性粒细胞(PMN)所释放的MPO等炎症介质产生的炎症反应.     

大鼠胰腺炎相关性急性肺损伤模型的探讨

目的研究5%牛磺胆酸钠(TAC)逆行胆胰管注射诱发急性胰腺炎相关肺损伤的大鼠模型。方法采用改进的胆胰管逆行注射TAC造成大鼠急性出血坏死型胰腺炎(AHNP)模型,将大鼠随机分为3组:AHNP组、假手术组、地塞米松(DXM)治疗组。造模成功后,立即静脉注射大剂量DXM(5 mg/kg)。术后于3、6、12 h处死,留取外周血测定血清淀粉酶、脂肪酶,取右肺中叶测定肺湿干比值及作病理切片,计算等级评分评价肺损伤;行支气管肺泡灌洗,以灌洗液白蛋白与血清白蛋白含量比值计算肺指数。结果AHNP组36、、12 h肺通透性指数、湿干比值及病理学评分逐渐增加,经单因素方差分析,61、2 h组高于3 h组(P<0.05),前两者于6、12 h组组内比较差异不显著(P>0.05)。DXM组于术后61、2 h,各项肺损伤指标均低于AHNP组(P<0.05)。结论TAC胆胰管逆行注射造成AHNP模型大鼠于术后6 h即出现明显的肺损伤表现,符合PALI病理改变,与临床AHNP合并急性肺损伤(ALI)的病理过程相似,可于此时相点作为研究AHNP合并肺损伤的模型。     

Changes in the Serum Levels of Trace Elements Before and After the Operation in Thyroid Cancer Patients

The present study aims to examine the changes in the serum levels of trace elements before and after the operation in thyroid cancer patients. The study registered 50 individuals, of whom 25 were female and 25 were male. The patients were allocated to four groups: group 1: male thyroid cancer patients group (n = 15), group 2: female thyroid cancer patients group (n = 15), group 3: male control group (n = 10), group 4: female control group (n = 10). The subjects in groups 1 and 2 were the patients who were post-operatively diagnosed with a pathological malignancy in the thyroid tissue samples. Blood samples were collected from all subjects before the operation, immediately after the operation, and on the post-operative day 15. Additionally, thyroid tissue samples were taken from all subjects post-operatively. Some elements in the blood and tissue samples were determined using the atomic emission method. Zinc and selenium levels of groups 1 and 2 in the pre- and post-operative measurements were significantly lower than those in the control groups (p < 0.05), but were higher in the thyroid tissue (p < 0.05). Serum zinc and selenium levels measured in the subjects on the post-operative day 15 were similar to those measured in the controls. Our study show that changes in the serum and thyroid tissue levels of trace elements like zinc and selenium, which play a critical role in thyroid function, might be associated with the pathogenesis of thyroid cancer.     

Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome

ObjectiveIt has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS), but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.MethodsEighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAP_SB) and abdominal muscle paralysis group (BIPAP_AP). All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH₂O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO₂ of 35–60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV) and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL)-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.ResultsFor the comparable ventilator setting, as compared with BIPAP_SB group, the BIPAP_AP group presented higher EELV (427±47 vs. 366±38 ml) and oxygenation index (293±36 vs. 226±31 mmHg), lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml) and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml) in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7) and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9) in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAP_AP group (22.5±2.0 vs. 25.2±2.1).ConclusionAbdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.     

Association between Serum Tissue Inhibitor of Matrix Metalloproteinase-1 Levels and Mortality in Patients with Severe Brain Trauma Injury

Objective

Matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) play a role in neuroinflammation after brain trauma injury (TBI). Previous studies with small sample size have reported higher circulating MMP-2 and MMP-9 levels in patients with TBI, but no association between those levels and mortality. Thus, the aim of this study was to determine whether serum TIMP-1 and MMP-9 levels are associated with mortality in patients with severe TBI.

Methods

This was a multicenter, observational and prospective study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of TIMP-1, MMP-9 and tumor necrosis factor (TNF)-alpha, and plasma levels of tissue factor (TF) and plasminogen activator inhibitor (PAI)-1 plasma were measured in 100 patients with severe TBI at admission. Endpoint was 30-day mortality.

Results

Non-surviving TBI patients (n = 27) showed higher serum TIMP-1 levels than survivor ones (n = 73). We did not find differences in MMP-9 serum levels. Logistic regression analysis showed that serum TIMP-1 levels were associated 30-day mortality (OR = 1.01; 95% CI = 1.001–1.013; P = 0.03). Survival analysis showed that patients with serum TIMP-1 higher than 220 ng/mL presented increased 30-day mortality than patients with lower levels (Chi-square = 5.50; P = 0.02). The area under the curve (AUC) for TIMP-1 as predictor of 30-day mortality was 0.73 (95% CI = 0.624–0.844; P<0.001). An association between TIMP-1 levels and APACHE-II score, TNF- alpha and TF was found.

Conclusions

The most relevant and new findings of our study, the largest series reporting data on TIMP-1 and MMP-9 levels in patients with severe TBI, were that serum TIMP-1 levels were associated with TBI mortality and could be used as a prognostic biomarker of mortality in TBI patients.     

NDRG2在大鼠肺缺血再灌注损伤中的表达

目的:通过建立大鼠肺缺血再灌注损伤(Lung ischemia-reperfusion injury,LIRI)模型,观察肺缺血再灌注损伤后,肺组织中N-myc下游调节基因2(N-myc downstream regulated gene,NDRG2)表达水平的变化.方法:将70只健康成年雄性SD大鼠随机分成对照组(C)、缺血组(I)、缺血再灌注组(I/R)(后两组各含3个亚组),每组10只.麻醉固定大鼠,颈部切口行气管插管.右侧开胸,肺缺血组依次分别选择游离夹闭右肺门(即右主支气管,右肺动、静脉)缺血30 min、60 min、120 min后,麻醉处死大鼠获取肺组织.肺缺血再灌注组同样选择游离夹闭右肺门,于夹闭右肺门60 min后松开,分别取再灌注30 min、60 min、120m in后麻醉处死大鼠获取肺组织样本.采用免疫组化对肺组织NDRG2进行蛋白定位检测、RT-PCR对肺组织NDRG2 mRNA含量进行检测、Western-blot对肺组织NDRG2蛋白含量进行检测.结果:肺缺血组与对照组比较,肺组织NDRG2的表达无明显变化(P＞0.05);肺缺血再灌注组与对照组比较,NDRG2蛋白含量和mRNA表达量逐渐下降,在60 min时达最低,之后又有所回升,但仍低于对照组(P＜0.05).结论:肺缺血再灌注损伤可下调肺组织中NDR G2的表达含量,NDRG2可能是肺缺血再灌注损伤的靶向调控位点.     

Trace Element, Antioxidant Activity, and Lipid Peroxidation Levels in Brain Cortex of Gerbils After Cerebral Ischemic Injury

Proper trace element level and antioxidant enzyme activity are crucial for the brain in maintaining normal neurological functions. To our knowledge, alteration of lipid peroxidation status, trace element level, and antioxidant activity in the homogenates of brain cortex after cerebral ischemia in gerbil, however, has not been investigated so far. Male Mongolian gerbils were divided into control and ischemic subjects. Cerebral ischemia was induced by occlusion of the right middle cerebral artery and right common carotid artery for 1 h. Experimental results showed that a significant increase (P?<?0.01) of the malondialdehyde level was found in the ischemic brain as compared with the control group. Trace element analysis indicated that a remarkable elevation (P?<?0.01) of the level of iron (Fe), chromium (Cr), and a statistical decrease of selenium (Se) and zinc (Zn) (P?<?0.05) concentration were observed in the ischemic brain as compared with the control subject. No significant change (P?>?0.05) of the copper (Cu) level was found in both experimental groups. Additionally, antioxidant activity of superoxide dismutase (P?<?0.01) and catalase (P?<?0.05) was significantly decreased in the ischemic brain as compared with the control subject. Taking all results together, it is conceivable to manifest the experimental findings that cerebral ischemia not only may result in an enhanced oxidative stress but also may lead to further oxidative injury. Moreover, disturbance of trace element level combined with declined antioxidant activity seems to play a significant role in responsible for the etiology of cerebral ischemia.     

大潮气量致急性肺损伤犬呼吸机相关性肺损伤模型的构建

目的建立大潮气量致急性肺损伤（ALI）犬呼吸机相关性肺损伤（VILI）模型。方法健康雄性杂种犬12只用油酸静脉注射法制备犬ALI模型,造模成功后进行支持通气15min过渡,然后随机分为VILI组及对照组行机械通气6 h,每组6只。VILI组潮气量（Vt）=20 mL/kg,对照组Vt=6 mL/kg,两组呼气末正压（PEEP）均为10 cmH2O。动态观察各组血气交换指标变化。通气6 h后取支气管肺泡灌洗液（BALF）作白蛋白浓度检查,取肺组织作病理切片肺损伤评分。结果各组在油酸静脉注射后（2.50±0.80）h达到ALI标准。VILI组在犬机械通气6 h后PaO2、SaO2及氧合指数（OI）较对照组略下降（P〈0.05）,而PaCO2波动不大,且心率、血压波动也较对照组小（P〈0.05）。VILI组BALF中蛋白浓度和肺组织损伤评分均较对照组显著升高（分别P〈0.05,P〈0.01）。结论本实验成功建立了大潮气量致ALI犬VILI模型。     

Trace Elements in Pleural Effusion Correlates with Smokers with Lung Cancer

Smoking leads to the presence of various elements, including toxic metals and metalloids, in tissues and fluids, thus contributing to cancer risk. This study assessed the concentrations of 14 elements (Ag, Al, As, Co, Cr, Cu, Fe, Ni, Mn, Mo, Pb, Sn, V, and Zn) and biochemical parameters (glucose, lactate dehydrogenase, and total protein) in the pleural effusion (PE) of patients with lung cancer. The potential association of these parameters with smoking was assessed. Total of 48 patients with lung cancer (26 non-smokers and 22 smokers) received thoracocentesis for PE removal. Analysis results revealed that among the biochemical parameters, only the glucose concentration was significantly higher in current smokers than in non-smokers; the other parameters showed no significant difference. The concentration of Zn in the PE was significantly lower in all smokers (10 former and 12 current smokers) than in non-smokers, but the other elements did not differ significantly between the two groups and smoker subgroups. Simultaneously, Zn correlated negatively with glucose concentrations in all smokers, positively with lactate dehydrogenase (LDH) concentration in current smoker, and positively with total protein (TP) concentrations in non-smokers. This is for the first time the relation between Zn and certain biochemical parameters in PE was found, the observation requiring further studies to explain the potential interactions between this element and glucose, LDH, and TP concentrations.     

Monitoring Environmental Levels of Trace Elements near a Hazardous Waste Incinerator

In 1998, we initiated an environmental surveillance program of the only hazardous waste incinerator (HWI) in Spain. The concentrations of a number of metals (As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sn, Tl, and V) were analyzed in soil and vegetation samples collected around the facility. Since then, periodical measurements of these same elements have been performed in both matrices. In 2009 and 2010, soil and vegetation samples were again collected, and the levels of the above elements were determined. In general terms, the temporal trends in metal concentrations were not homogeneous, showing significant changes between the baseline and the latest surveys. Metal levels in soil and herbage samples analyzed in the current survey were similar to recent data reported for other urban and industrial areas, being notably lower than the reference values set by national regulatory organisms. Moreover, more than 10?years after regular operations of the HWI, exposure to metals would not mean, either now or in past surveys, any carcinogenic or non-carcinogenic health risks for the population living in the neighborhood.     

Regional Levels of Lactate and Norepinephrine After Experimental Brain Injury

Abstract: The recently developed controlled cortical impact model of brain injury in rats may be an excellent tool by which to attempt to understand the neurochemical mechanisms mediating the pathophysiology of traumatic brain injury. In this study, rats were subjected to lateral controlled cortical impact brain injury of low grade severity; their brains were frozen in situ at various times after injury to measure regional levels of lactate, high energy phosphates, and norepinephrine. Tissue lactate concentration in the injury site left cortex was increased in injured animals by sixfold at 30 min and twofold at 2.5 h and 24 h after injury ( p < 0.05). At all postinjury times, lactate concentration was also increased in injured animals by about twofold in the cortex and hippocampus adjacent to the injury site ( p < 0.05). No significant changes occurred in the levels of ATP and phosphocreatine in most of the brain regions of injured animals. However, in the primary site of injury (left cortex), phosphocreatine concentration was decreased by 40% in injured animals at 30 min after injury ( p < 0.05). The norepinephrine concentration was decreased in the injury site left cortex of injured animals by 38% at 30 min, 29% at 2.5 h, and 30% at 24 h after injury ( p < 0.05). The level of norepinephrine was also reduced by ∼20% in the cortex adjacent to the injury site in injured animals. The present results suggest that controlled cortical impact brain injury produces disorder in the neuronal oxidative and norepinephrine metabolism.     

Altered Expression of Inducible Nitric Oxide Synthase After Sciatic Nerve Injury in Rat

Nitric oxide is known to contribute to neuronal damage as well as to peripheral neuronal regeneration following injury. Sciatic nerve injury is a common and serious complication of intramuscular injections. In order to ascertain the role of inducible nitric oxide synthase (iNOS) in the injured sciatic nerve, we studied the expression of this enzyme by RT-PCR and immunohistochemistry, in a rat model of sciatic nerve injury. In sham-operated control rats iNOS expression was undetectable by immunohistochemistry and its mRNA level was also very low. In contrast, in the experimental group that was subjected to sciatic nerve injury, both mRNA and protein of iNOS were found to be significantly elevated. The protein level of iNOS, as revealed by positive immunostaining, peaked at 7 days post-surgery followed by a decrease. Similarly, the iNOS mRNA levels remained elevated at 1, 3, 7 days but declined to very low level by day 21, after surgery. This study indicates that the increased expression of iNOS after sciatic nerve injury in rats may contribute to nerve regeneration. Thus our results suggest that excessive expression of iNOS after nerve injury is not conducive to nerve regeneration.     

Incidence and Outcome of Early Acute Kidney Injury in Critically-Ill Trauma Patients

Objective

To determine the incidence and effect on mortality of early acute kidney injury in severely injured trauma patients using the Acute Kidney Injury Network creatinine criteria.

Design

A retrospective cohort study of severely injured trauma patients admitted to the shock trauma intensive care unit.

Setting

Texas Trauma Institute, a state designated level I trauma unit certified by the American College of Surgeons Committee on Trauma.

Patients

901 severely injured trauma patients admitted over a 15 month period to the shock trauma intensive care unit.

Interventions

Retrospective analysis of prospectively collected data abstracted from an electronic trauma database.

Measurements and Main Results

Of 901 eligible patients admitted to the shock trauma intensive care unit after traumatic injury, 54 patients (6%) developed acute kidney injury, of whom 10 (19%) required renal replacement therapy. The 30-day mortality rate for the entire cohort was 83/901 (9.2%). Patients with early acute kidney injury had a mortality rate of 16/54 (29.6%). When corrected for multiple covariates including injury severity scores, the development of early acute kidney injury was associated with a significantly higher risk of death at 30 days with an OR of 3.4 (95% CI 1.6-7.4).

Conclusions

Applying the Acute Kidney Injury Network creatinine criteria in severely injured trauma patients, the incidence of early acute kidney injury was 6%. After correction for injury severity, development of early acute kidney injury was independently associated with significantly higher 30-day mortality.     

Analysis of Trace Elements in Bronchoalveolar Lavage of Patients with Diffuse Lung Diseases

Airborne trace elements are implicated in the etio-pathogenesis of a large number of pulmonary diseases. The aim of this study was to evaluate the reliability and effectiveness of direct determination of Cd, Cr, Cu, Fe, Mn, Ni, Pb, V, and Zn concentrations in bronchoalveolar lavage (BAL) samples from patients with sarcoidosis, idiopathic pulmonary fibrosis, and Langerhans cell histiocytosis and healthy (smoking and non-smoking) controls. A total of 44 individuals were recruited among sarcoidosis, idiopathic pulmonary fibrosis, and Langerhans cell histiocytosis patients and healthy (smoking and non-smoking) controls. Average Mn concentrations in BAL from patients were 45% lower than in controls (p < 0.01) and remarkable decreases in average concentrations of Cr, Ni and Zn were also found in BAL from patients with idiopathic pulmonary fibrosis and Langerhans cell histiocytosis. As these diseases are characterized by the enhanced activation of certain immunomodulatory cells and by generation of free radicals, the depressed Mn, Zn, Cr and Ni concentrations in BAL from patients may be due to oxidative stress. These preliminary results indicate that assessment of the elemental composition of BAL is a promising approach to study the pathogenesis of diffuse lung diseases and Langerhans cell histiocytosis.