Intestinal injury can be reduced by intra-arterial postischemic perfusion with hypertonic saline

AIM:To investigate the effect of local intestinal perfusion with hypertonic saline(HTS) on intestinal ischemia-reperfusion injury(IRI) in bothex vivo andin vivo rat models.METHODS:All experiments were performed on male Wistar rats anesthetized with pentobarbital sodium given intraperitoneally at a dose of 60 mg/kg.Ex vivo vascularly perfused rat intestine was subjected to 60-min ischemia and either 30-min reperfusion with isotonic buffer(controls),or 5 min with HTS of 365 or 415 mOsm/L osmolarity(HTS 365mOsm or HTS 415mOsm,respectively) followed by 25-min reperfusion with isotonic buffer.The vascular intestinal perfusate flow(IPF) rate was determined by collection of the effluent from the portal vein in a calibrated tube.Spontaneous intestinal contraction rate was monitored throughout.Irreversible intestinal injury or area of necrosis(AN) was evaluated histochemically using 2.3.5-triphenyltetrazolium chloride staining.In vivo,30-min ischemia was followed by either 30-min blood perfusion or 5-min reperfusion with HTS 365mOsm through the superior mesenteric artery(SMA) followed by 25-min blood perfusion.Arterial blood pressure(BP) was measured in the common carotid artery using a miniature pressure transducer.Histological injury was evaluated in both preparations using the Chui score.RESULTS:Ex vivo,intestinal IRI resulted in a reduction in the IPF rate during reperfusion(P < 0.05 vs sham).The postischemic recovery of the IPF rate did not differ between the controls and the HTS 365mOsm group.In the HTS 415mOsm group,postischemic IPF rates were lower than in the controls and the HTS 365mOsm group(P < 0.05).The intestinal contraction rate was similar at baseline in all groups.An increase in this parameter was observed during the first 10 min of reperfusion in the control group as compared to the sham-treated group,but no such increase was seen in the HTS 365mOsm group.In controls,AN averaged 14.8% ± 5.07% of the total tissue volume.Administration of HTS 365mOsm for 5 min after 60-min ischemia resulted in decrease in AN(5.1% ± 1.20% vs controls,P < 0.01).However,perfusion of the intestine with the HTS of greater osmolarity(HTS 415mOsm) failed to protect the intestine from irreversible injury.The Chiu score was lower in the HTS 365mOsm group in comparison with controls(2.4 ± 0.54 vs 3.2 ± 0.44,P = 0.042),while intestinal perfusion with HTS 415mOsm failed to improve the Chiu score.Intestinal reperfusion with HTS 365mOsm in the in vivo series secured rapid recovery of BP after its transient fall,whereas in the controls no recovery was seen.The Chiu score was lower in the HTS 365mOsm group vs controls(3.1 ± 0.26 and 3.8 ± 0.22,P = 0.0079 respectively,),although the magnitude of the effect was lower than in the ex vivo series.CONCLUSION:Brief intestinal postischemic perfusion with HTS 365mOsm through the SMA followed by blood flow restoration is a protective procedure that could be used for the prevention of intestinal IRI.

N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices. METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I(n-butyl-2-cyanoacrylate; Histoacryl), Group II(iso-amyl-2-cyanoacrylate; Amcrylate) and Group III(mixture of 72% chromated glycerin; Scleremo with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo. RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference,(P < 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference,(P > 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments. CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.

Effect of Hypertonic Versus Isotonic Saline Resuscitation on Heme Oxygenase-1 Expression in Visceral Organs Following Hemorrhagic Shock in Rats

To compare the early effects of hypertonic and isotonic saline resuscitation on heme oxygenase-1 （HO-1） expression in organs of rats with hemorrhagic shock. Rats were randomly divided into hypertonic saline resuscitation （HTS）, normal saline resuscitation （NS） and sham groups. HO-1 mRNA, protein expression and apoptosis were evaluated in organs. In the HTS group, significant difference was noted in HO-1 protein in small intestinal mucosa and liver compared with the NS and sham groups, and in HO-1 mRNA in liver and kidney compared with the sham group. The apoptosis of small intestinal mucosa, liver, heart, and lung was significantly lower in the HTS group than that in the NS group. In this study, small volume resuscitation with HTS can efficiently up-regulate the expression level of HO-1 in small intestinal mucosa and liver, which may be one of the mechanisms alleviating organ damage.

Pentoxifylline enhances the protective effects of hypertonic saline solution on liver ischemia reperfusion injury through inhibition of oxidative stress

BACKGROUND：Liver ischemia reperfusion（IR）injury triggers a systemic inflammatory response and is the main cause of organ dysfunction and adverse postoperative outcomes after liver surgery.Pentoxifylline（PTX）and hypertonic saline solution（HTS）have been identified to have beneficial effects against IR injury.This study aimed to investigate if the addition of PTX to HTS is superior to HTS alone for the prevention of liver IR injury.METHODS： Male Wistar rats were allocated into three groups. Control rats underwent 60 minutes of partial liver ischemia, HTS rats were treated with 0.4 mL/kg of intravenous 7.5% NaCl 15 minutes before reperfusion, and HPTX group were treated with 7.5% NaC1 plus 25 mg/kg of PTX 15 minutes before reperfusion. Samples were collected after reperfusion for determination of ALT, AST, TNF-α, IL-6, IL-10, mitochondrial respiration, lipid peroxidation, pulmonary permeability and myeloperoxidase. RESULTS： HPTX significantly decreased TNF-α 30 minutes after reperfusion. HPTX and HTS significantly decreased ALT,AST, IL-6, mitochondrial dysfunction and pulmonary myelo- peroxidase 4 hours after reperfusion. Compared with HTS only, HPTX significantly decreased hepatic oxidative stress 4 hours after reperfusion and pulmonary permeability 4 and 12 hours after reperfusion. CONCLUSION： This study showed that PTX added the beneficial effects of HTS on liver IR injury through decreases of hepatic oxidative stress and pulmonary permeability.

Variable change in renal function by hypertonic saline

AIM: To investigate the effects of hypertonic saline in the neurocritical care population.METHODS: We retrospectively reviewed our hospital's use of hypertonic saline(HS) since March of 2005, and prospectively since October 2010. Comparisons were made between admission diagnoses, creatinine change(Cr), and HS formulation(3% Na Cl, 3% Na Cl/sodium acetate mix, and 23.4% Na Cl) to patients receiving normal saline or lactated ringers. The patients(n = 1329) of the retrospective portion were identified. The data presented represents the first 230 patients with data. RESULTS: Significant differences in Acute Physiology and Chronic Health Evaluation Ⅱ scores and GlasgowComa Scale scores occurred between different saline formulations. No significant correlation of Cl- or Na+ with Cr, nor with saline types, occurred. When dichotomized by diagnosis, significant correlations appear. Traumatic brain injury(TBI) patients demonstrated moderate correlation between Na+ and Cr of 0.45. Stroke patients demonstrated weak correlations between Na+ and Cr, and Cl- and Cr(0.19 for both). Patients receiving HS and not diagnosed with intracerebral hemorrhage, stroke, subarachnoid hemorrhage, or TBI demonstrated a weak but significant correlation between Cl- and Cr at 0.29.CONCLUSION: Cr directly correlates with Na+ or Cl- in stroke, Na+ in TBI, and Cl- in other populations. Prospective comparison of HS and renal function is needed.

Application of Ji Desheng Snake Pills Combined with Hypertonic Glucose External Application in Treating Drug-Induced Superficial Phlebitis Caused by Parenteral Nutrition

Objective: The efficacy of Ji Desheng snake pills combined with hypertonic glucose external application in treating drug-induced superficial phlebitis caused by parenteral nutrition (PN) is observed. Methods: Fifty-two cases of drug-induced superficial phlebitis after peripheral parenteral nutrition (PPN) were selected, which were randomly divided into experimental group and control group in accordance with the phlebitis grading. In the experimental group, Ji Desheng snake pills were crushed to make a paste with 50% glucose solution, which was then applied to the affected area of phlebitis, the surface was covered with clean gauze, and properly fixed with tape or bandage. The drug was replaced once a day. In the control group, the gauze soaked with 50% magnesium sulfate solution was used, which was applied to the affected part three times a day in wet, and the efficacy was observed respectively on the 1st, 3rd, 5th and 7th days after applying the drug. Results: On the 1st and 3rd days after treatment, the observed effective rate of the experimental group was higher than that of the control group (42.31% vs. 15.38% and 76.92% vs. 46.15%, respectively). The difference was statistically significant (p th and 7th days after treatment, there was no statistical significance with respect to the efficacy between the experimental group and the control group (p > 0.05). Conclusion: The significant efficacy could be found in early stage after drug-induced superficial phlebitis was treated by Ji Desheng snake pills combined with hypertonic glucose external application, which was superior to that of the traditional treatment of wet application by using gauze soaked in 50% magnesium sulfate solution.

Aging-related Changes of Microglia and Astrocytes in Hypothalamus after Intraperitoneal Injection of Hypertonic Saline in Rats

To examine the aging-related changes of microglia and astrocytes in hypothalamus of rats after intraperitoneal injection of hypertonic saline in rats, old- and young-aged rats were injected with hypertonic saline solution into peritoneal cavity. Lectin histochemical techniques using Ricinus communis agglutinin-1 （RCA-1） and immunocytochemical method employing antibody against glial fibrillary acidic protein （GFAP） were used to demonstrate microglia and astrocytes in the hypothalamus of the rats, and the positively-stained cells were analyzed by computer-assisted image analysis system. Our results showed that the numbers of microglia and astrocytes were significantly increased in the hypothalamus of old-aged rats. After intraperitoneal injection of hypertonic saline, the number of microglia was significantly decreased in the hypothalamus of both young- and oldaged groups. After introperitoneal injection of hypertonic saline, the number of GFAP positive cells was significantly increased in the hypothalamus of young rats, but the number of GFAP positive cells did not show significant change in the hypothalamus of old rats. It is concluded that in the hypothalamus of old-aged rats, the increase of microglia may be related with the aging or degeneration of neurons, and the increase of astrocytes may provide more nourishment required by the aged neurons. The microglia and astrocytes in the hypothalamus of the two group rats may be affected by hypertonic saline, and the response of these cells to the stimuli is characterized by some aging-related changes.

Hypertonic saline:a brief overview of hemodynamic response and anti-inflammatory properties in head injury

Hypertonic saline （HS） has been applied in several med- ical areas such as pneumology （asthma, cystic fibrosis and bronchiolytis）, endocrinology （hyponatremia） and especially in emergency medicine, in traumatic and in- flammatory/infectious disorders. It may be composed of 3% or 7.5% sodium chlorate. By far, 3% solution is the most widely studied and used solution （Pinto et al., 2006, 2015; Dekker et al., 2014; Gantner et al., 2014; Shein et al., 2014）.

Blood flow variation and energy metabolism in the gastric mucosa following 7．5％ hypertonic saline resuscitation

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Inhaled hypertonic saline for cystic fibrosis: Reviewing the potential evidence for modulation of neutrophil signalling and function

Cystic fibrosis(CF) is a multisystem disorder with significantly shortened life expectancy. The major cause of mortality and morbidity is lung disease with increasing pulmonary exacerbations and decline in lung function predicting significantly poorer outcomes. The pathogenesis of lung disease in CF is characterised in part by decreased airway surface liquid volume and subsequent failure of normal mucociliary clearance. This leads to accumulation of viscous mucus in the CF airway, providing an ideal environment for bacterial pathogens to grow and colonise, propagating airway inflammation in CF. The use of nebulised hypertonic saline(HTS) treatments has been shown to improve mucus clearance in CF and impact positively upon exacerbations, quality of life, and lung function. Several mechanisms of HTS likely improve outcome, resulting in clinically relevant enhancement in disease parameters related to increase in mucociliary clearance. There is increasing evidence to suggest that HTS is also beneficial through its anti-inflammatory properties and its ability to reduce bacterial activity and biofilm formation. This review will first describe the use of HTS in treatment of CF focusing on its efficacy and tolerability. The emphasis will then change to the potential benefits of aerosolized HTS for the attenuation of receptor mediated neutrophil functions, including down-regulation of oxidative burst activity, adhesion molecule expression, and the suppression of neutrophil degranulation of proteolytic enzymes.

Comparison between Hypertonic Saline with Dextran and Mannitol on Vasodilatation of Encephalic Vessels Using a Magnetic Resonance Imaging in the Dogs

This study aimed to investigate whether a small volume of 7.2% hypertonic saline solution with 6% dextran 70 (HSD) is superior to mannitol in vasodilatation of encephalic vessels in the dogs using magnetic resonance imaging (MRI). Fifteen healthy 2.4 ± 0.9 year-old purpose-bred male Beagle dogs were assigned to receive 5 mL/kg of isotonic saline solution (ISS) as control, 20% mannitol or HSD infusion at a flow rate of 20 mL/kg/hours via right cephalic vein.Venous blood samples were collected immediately before fluid infusion (pre) and every 15 minutes until 120 minutes after the initiation of fluid infusion. Immediately after collection of each blood sample, T1 and T2-weighted magnetic resonance imaging recordings were undergone. Immediately after HSD infusion, the area of the cross-section of superior sagittal sinus was significantly greater than that of beagles in the other groups (p p < 0.001). Our results indicate that HSD induced a rapid and strong reduction in the area of the cross-section of CSF more than mannitol did. Therefore, it is suggested that 5 mL/kg of HSD might be superior to isovolume of mannitol in inducing vasodilatation in the dog.

Efficacy of Hypertonic Saline and Normal Saline in the Treatment of Chronic Sinusitis

Introduction: Chronic sinusitis affects all age groups and is a cause for significant morbidity. Recent realization that noninfectious inflammatory causes can predispose to infectious sinusitis has evoked renewed interest in developing and documenting efficacious ancillary therapies that could supplement antibiotic use. Hypertonic saline solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objectives: A double blinded randomized comparative study was undertaken to evaluate the effect of hypertonic saline (3.5%) nasal drops and normal saline (0.9%) nasal drops, to assess the tolerance of hypertonic saline nasal drops and to know if hypertonic nasal drops improve the “quality of life” in patients with chronic sinusitis. Methods: Fifty patients diagnosed as chronic sinusitis in the age group of 18-45 years were randomized into two groups;Group A was treated with normal saline and Group B with 3.5% hypertonic saline for a period of 4 weeks. Pre and Post treatment x-rays of the paranasal sinuses (Water’s view) were graded and radiological scores were given accordingly. The symptoms were evaluated before and after treatment using visual analogue score. Patients were queried about tolerance to the nasal solution and scores were given. Conclusion: Hypertonic saline nasal solution is more efficacious than normal saline solution in the treatment of patients with chronic sinusitis. Hypertonic saline nasal solution was well tolerated and it improved quality of life in these patients.

Ji Desheng Snake Pills Combined with Hypertonic Glucose External Application in the Treatment of Stage III and IV Pressure Injuries

Background: As a common surgical disease, pressure injury has become a long-standing problem in clinical treatment and nursing process. This research was conducted to explore the feasibility of Ji Desheng Snake Pills combined with hypertonic glucose external application in the treatment of stage III and IV pressure injuries. Methods: Patients with stage III and IV pressure injuries, who received treatment in our hospital between December 2018 and December 2019 were selected and divided into experimental group, conventional treatment group, and control group, 30 cases for each. The three groups received Ji Desheng Snake Pills combined with hypertonic glucose external application, moist dressing external application and surgical dressing change, respectively. The safety, therapeutic effect and cost benefit of the three treatment methods were compared. Results: There were no adverse reactions in the three groups of patients. The PUSH scores of the experimental group and the conventional treatment group were significantly lower than that of the control group on the 14th, 21th, and 28th days, and the result was statistically significant (p < 0.05), while there was no significant difference between the experimental group and the conventional treatment group (p > 0.05). The wound healing rates of the experimental group (70.14 ± 8.27%) and the conventional treatment group (73.99 ± 7.15%) were significantly higher than that of the control group (43.25 ± 8.53%) on the 28th day, with statistical significance (p < 0.05);there was no significant difference between the experimental group and the conventional treatment group (p > 0.05). The total treatment costs of the three groups were 569.73 ± 78.12 yuan, 1043.40 ± 135.31 yuan, and 186.47 ± 30.29 yuan. The cost of the conventional treatment group was the highest, followed by the experimental group, and the control group was the lowest. The result was statistically significant (p < 0.05). Conclusion: In the treatment of stage III and IV pressure injuries, there was no significant difference in the safety and therapeutic effect between the experimental group (Ji Desheng Snake Pills combined with hypertonic glucose external application) and the conventional treatment group (moist dressing external application), but the experimental group had better cost benefit.

Effect of hypertonic saline/dextran 70 on cardiac function in delayed resuscitation of dogs with burn shock

To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.

Hypertonic saline resuscitation contributes to early accumulation of circulating myeloid-derived suppressor cells in a rat model of hemorrhagic shock

Background Hemorrhagic shock is usually associated with complicated immune and inflammatory responses, which are sometimes crucial for the prognosis. As regulators of the immune and inflammatory system; proliferation, migration, distribution and activation of myeloid-derived suppressor cells （MDSCs） are intimately linked to the inflammation cascade. Methods In a model of severe hemorrhagic shock, thirty-five rats were randomly divided into control, sham, normal saline resuscitation （NS）, hypertonic saline resuscitation （HTS）, and hydroxyethyl starch resuscitation （HES）, with seven in each group. MDSCs were analyzed by flow cytometric staining of CD11b/c＊Gra~ in peripheral blood mononuclear cells （PBMC）, spleen cell suspensions, and bone marrow nucleated cells （BMNC）. Simultaneously, the expressions of arginase-1 （ARG-1） and inducible nitric oxide synthase （iNOS） mRNA in MDSCs were evaluated by quantitative reverse transcription-polymerase chain reaction （qRT-PCR）. Results In the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the MDSCs in the PBMC of NS, HTS and HES groups markedly increased, and MDSCs in BMNC of these groups decreased accordingly, significantly different to the control group. In hemorrhagic shock rats infused with HTS at the early resuscitation stage, MDSCs in PBMC increased about 2 and 4 folds, and MDSCs in BMNC decreased about 1.3 and 1.6 folds, as compared to the sham group respectively, with statistically significant difference. Furthermore, compared to the NS and HES groups, the MDSCs in PBMC of HTS group increased 1.6 and 1.8 folds with statistically significant differences; the MDSCs decrease in BMNC was not significant. However, there was no statistically significant difference in MDSCs of spleen among the five groups. In addition, compared to the control, sham, NS and HES groups, the ARG-1 and iNOS mRNA of MDSCs in PBMC, spleen and BMNC in the HTS group had the highest level of expression, but no statistically significant differences were noted. Conclusions In this model of rat with severe and controlled hemorrhagic shock, small volume resuscitation with HTS contributes to dramatically early migration and redistribution of MDSCs from bone marrow to peripheral circulation, compared to resuscitation with NS or HES.

Effect of hypertonic saline resuscitation on heme oxygenase-1 mRNA expression and apoptosis of the intestinal mucosa in a rat model of hemorrhagic shock

Background Massive blood loss due to trauma is the leading cause of death in trauma patients and military combatants. The fluid category of resuscitation for hypotensive trauma patients is open to debate. This study was conducted to investigate the early effects of hypertonic and isotonic saline solutions on heme oxygenase-1 （HO-1） mRNA expression and apoptosis in the intestinal mucosa of rats with hemorrhagic shock. Methods A model of severe hemorrhagic shock was established in 21 Sprague-Dawley rats. The rats were randomly divided into sham, normal saline resuscitation （NS）, and hypertonic saline resuscitation （HTS） groups, with 7 in each group. We assessed and compared the HO-1 mRNA expression and apoptosis in the small intestinal mucosa of rats after hemorrhagic shock and resuscitation using the SYBR Green I fluorescence quantitative reverse transcriptase polymerase chain reaction, fluorescein-iso-thiocyanate-annexin V/propidium iodide double staining, and flow cytometry. Results In the early stage of hemorrhagic shock and resuscitation, marked apoptosis occurred in the small intestinal mucosa from both the NS and HTS groups. The apoptotic rate in the NS group was higher than that in the HTS group （P 〈0.01）. Among the three groups, HO-1 mRNA mucosa from the HTS group had the highest level of expression; however, the differences were not significant. There was a significant negative correlation between HO-1 mRNA expression and apoptosis in the small intestinal mucosa from the NS and HTS groups after hemorrhagic shock and resuscitation. Conclusions In this rat model of severe hemorrhagic shock, HTS resuscitation with a small volume is more effective than NS resuscitation in reducing apoptosis of the intestinal mucosa. Further, HO-1 mRNA over-expression in the intestinal mucosa may be one of the molecular mechanisms of HTS in the resuscitation of hemorrhagic shock.

The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis

Background This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, com-pared to normal saline inhalations or standard treatment without inhalations as controls. Methods The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitaliza-tion rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies. For the effectiveness estimations, we made a meta-analysis summarizing the results of the meta-analysis of the Cochrane review in 2013 and the results of 10 studies published after it. Results The mean hospitalization rate was 24.7% in the HS inhalation group and 32.6% in the control group [risk ratio: 0.80, 95% confidence interval (CI) 0.67–0.96] and the mean LOS was 3.736 (HS group) and 4.292 (controls) days (mean difference: ? 0.55 days, 95% CI ? 0.96 to ? 0.15), respectively. The expected costs per patient, when both inpatients and outpatients were included, were €816 ($1111) in the HS inhalation group and €962 ($1310) in the control group. The expected costs per hospitalization, when only inpatients were included, were €2600 ($3540) in the HS inhalation group and €2890 ($3935) in the control group. Conclusions HS inhalations slightly reduced the expected hospitalization costs of infant bronchiolitis. However, the low effectiveness, rather than the cost, is the factor that will limit the use of HS inhalations in infant bronchiolitis.

Therapeutic effect of taurine with hypertonic saline on rat hemorrhagic shock complicated with hypernatremia

Abstract Objective To investigate the therapeutic effect of hypertonic saline (HS) and hypertonic saline with taurine (HST) hemorrhagic shock and hemorrhagic shock with hypernatremia rats. Methods Hypernatremic dehydration and hemorrhagic shock models were produced by Trachtma's and Krausz's methods in Sprague Dawley rats. Hemorrhagic changes of mean arterial blood pressure (MABP), left ventricular end diastolic pressure (LVEDP), ±dp/dtmax and heart rate (HR) were registered on polygraph. Plasma Na +, urea lactate and taurine content were assayed. Results After treatment with HS, the hemodynamic changes of hemorrhagic shock rats were significantly alleviated, and tissue fluid redistributed. When the hemorrhagic shock animals were treated with HS containing taurine (HST), in comparison with HS treatment, the hemodynamic improvement and hemodilution were more obvious. When the hemorrhagic animals complicated with hypernatremia were treated with HS, the symptoms of dehydration and shock further deteriorated, when the hemorrhage with hypernatremia animals were treated with an infusion of HST, the symptoms of dehydration and shock were significantly ameliorated. Conclusion The therapeutic effect of HS with taurine is obviously better than HS alone. So when hemorrhagic shock was complicated with hypernatremia, HS with taurine is recommended in stead of HS alone.

Resting-state connectivity in the default mode network and insula during experimental low back pain

Functional magnetic resonance imaging studies have shown that the insular cortex has a signif- icant role in pain identification and information integration, while the default mode network is associated with cognitive and memory-related aspects of pain perception. However, changes in the functional connectivity between the defauk mode network and insula during pain remain unclear. This study used 3.0 T functional magnetic resonance imaging scans in 12 healthy sub- jects aged 24.8 ± 3.3 years to compare the differences in the functional activity and connectivity of the insula and default mode network between the baseline and pain condition induced by intramuscular injection of hypertonic saline. Compared with the baseline, the insula was more functionally connected with the medial prefrontal and lateral temporal cortices, whereas there was lower connectivity with the posterior cingulate cortex, precuneus and inferior parietal lobule in the pain condition. In addition, compared with baseline, the anterior cingulate cortex exhibited greater connectivity with the posterior insula, but lower connectivity with the anterior insula, during the pain condition. These data indicate that experimental low back pain led to dysfunction in the connectivity between the insula and default mode network resulting from an impairment of the regions of the brain related to cognition and emotion, suggesting the impor- tance of the interaction between these regions in pain processing.

Fluid balance concepts in medicine:Principles and practice

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water(TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment(mainly sodium salts) and in the intracellular compartment(mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume(EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.