Remote ischemic postconditioning protects against gastric mucosal lesions in rats

AIM:To investigate the protective effects of remote ischemic postconditioning(RIP)against limb ischemiareperfusion(IR)-induced gastric mucosal injury.METHODS:Gastric IR was established in male Wistar rats by placing an elastic rubber band under a pressure of 290-310 mmHg on the proximal part of both lower limbs for 3 h followed by reperfusion for 0,1,3,6,12or 24 h.RIP was performed using three cycles of 30 s of reperfusion and 30 s of reocclusion of the femoral aortic immediately after IR and before reperfusion for up to 24 h.Rats were randomly assigned to receive IR(n=36),IR followed by RIP(n=36),or sham treatment(n=36).Gastric tissue samples were collected from six animals in each group at each timepoint and processed to determine levels of malondialdehyde(MDA),superoxide dismutase(SOD),xanthine oxidase(XOD)and myeloperoxidase(MPO).Additional samples were processed for histologic analysis by hematoxylin and eosin staining.Blood samples were similarly collected to determine serum levels of lactate dehydrogenase(LDH),creatine kinase(CK),tumor necrosis factor(TNF)-αand interleukin(IL)-10.RESULTS:The pathologic changes in gastric tissue induced by IR were observed by light microscopy.Administration of RIP dramatically reduced the gastric damage score after 6 h of reperfusion(5.85±0.22 vs7.72±0.43;P<0.01).In addition,RIP treatment decreased the serum activities of LDH(3.31±0.32 vs 6.46±0.03;P<0.01),CK(1.94±0.20 vs 4.54±0.19;P<0.01)and the concentration of TNF-α(53.82±0.85vs 88.50±3.08;P<0.01),and elevated the concentration of IL-10(101.46±5.08 vs 99.77±4.32;P<0.01)induced by IR at 6 h.Furthermore,RIP treatment prevented the marked elevation in MDA(3.79±0.29vs 6.39±0.81)content,XOD(7.81±0.75 vs 10.37±2.47)and MPO(0.47±0.05 vs 0.82±0.03)activities,and decrease in SOD(4.95±0.32 vs 3.41±0.38;P<0.01)activity in the gastric tissue as measured at 6 h.CONCLUSION:RIP provides effective functional protection and prevents cell injury to gastric tissue induced by limb IR via anti-inflammatory and antioxidant actions.

Sepsis Associated Encephalopathy Predicts Poor Outcome among Acute Supratentorial Intracerebral Hemorrhage with Coma

Background: Both sepsis associated encephalopathy (SAE) and supratentorial intracerebral hemorrhage (SICH) are a significant cause of coma and death throughout the world. The aim of this study was to investigate whether the presence of SAE among acute SICH with coma would predict a poor outcome. Methods: A retrospective of consecutive patients was selected for study. All registered an adult intensive care unit (ICU) of university teaching hospital between June, 2013 and July, 2015. Brain computed tomography (CT) scans were analyzed on admission and at coma onset or after coma onset. Univariate and Cox regression analyses were performed. Results: A total of 379 SICH with coma was studied. Among these, 245 (64.6%) SICH patients with coma due to SAE and 134 (35.4%) SICH with coma no SAE was compared. Our data showed that the frequency of the SAE in SICH patients increased at about double the proportion over the four SIRS criteria. The SICH patients with SAE were more likely to present with infection (100% vs 35.8%) and multiple organ failure (1.2 ± 0.9 vs 0.1 ± 0.3), especially nosocomal brain failure (60.4%). The 30 days mortality was significantly higher in the SAE group than those who did not (60.8% vs 11.2%). In Cox multivariate logistic analysis, the SAE (RR, 4.4;95% CI, 2.296 - 8.422;P = 0.000) was more likely to related to risk on death in SICH patient with coma. Conclusions: SAE is a frequent complication of SICH, which greatly increased risk of death among SICH patients with coma.