The effects of hemodilution on acute inflammatory responses in a bleomycin-induced lung injury model

The role of acute normovolemic hemodilution in reducing allogeneic blood transfusion in glioblastoma surgery: a case-control study

BACKGROUND

Acute normovolemic hemodilution (ANH) was first introduced in glioblastoma surgery, and its role in reducing allogeneic blood transfusion was investigated in this study.

METHODS

This study enrolled supratentorial glioblastoma patients who received total resection. In the ANH group, the patients were required to draw blood before the operation, and the blood will be transfused back to the patient during the operation. The association between ANH and clinical features was investigated.

RESULTS

Sixty supratentorial glioblastoma patients were enrolled in this study, 25 patients were allocated in the ANH group, and another 35 patients were included in the control group. ANH dramatically reduced the need for allogeneic blood transfusion (3 [12%] vs 12 [34.3%], P = 0.049), and the blood transfusion per total of patients was dramatically decreased by the application of ANH (0.40 ± 1.15 units vs 1.06 ± 1.59 units, P = 0.069). Furthermore, ANH also markedly reduced the requirement of fresh frozen plasma (FFP) transfusion (2 [8%] vs 11 [31.4%], P = 0.030) and the volume of FFP transfusion per total of patients (32.00 ± 114.46 mL vs 115.71 ± 181.00 mL, P = 0.033). The complication rate was similar between the two groups.

CONCLUSIONS

ANH was a safe and effective blood conservation technique in glioblastoma surgery.

Osthole Alleviates Bleomycin-Induced Pulmonary Fibrosis via Modulating Angiotensin-Converting Enzyme 2/Angiotensin-(1-7) Axis and Decreasing Inflammation Responses in Rats

Studies have shown that angiotensin-converting enzyme 2 (ACE2) plays modulating roles in lung pathophysiology, including pulmonary fibrosis (PF) and acute lung injury. Pulmonary fibrosis is a common complication in these interstitial lung diseases, and PF always has a poor prognosis and short survival. To date, there are few promising methods for treating PF, and they are invariably accompanied by severe side effects. Recent studies have showed that the traditional Chinese herbal extract, osthole, had beneficial effects on lipopolysaccharide (LPS) induced acute lung injury (ALI) via an ACE2 pathway. Here we further investigated the protective effects of osthole on bleomycin induced pulmonary fibrosis and attempted to determine the underlying mechanism. PF mode rats were induced by bleomycin (BLM) and then subsequently administered osthole. Histopathological analyses were employed to identify PF changes. The results showed that BLM resulted in severe PF and diffuse lung inflammation, together with significant elevation of inflammatory factors and a marked increase in expression of angiotensin II (ANG II) and transforming growth factor-beta 1 (TGF-β1). ACE2 and angiotensin-(1-7) [ANG-(1-7)] were both greatly reduced after BLM administration. Meanwhile, osthole treatment attenuated BLM induced PF and inflammation, decreased the expression of these inflammatory mediators, ANG II, and TGF-β1, and reversed ACE2 and ANG-(1-7) production in rat lungs. We conclude that osthole may exert beneficial effects on BLM induced PF in rats, perhaps via modulating the ACE2/ANG-(1-7) axis and inhibiting lung inflammation pathways.

Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats

Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

Lung injury induced by the pulmonary instillation of povidone-iodine in rats

PURPOSE

Povidone-iodine (polyvinylpyrrolidone iodine, PI), which is commonly used as a pre- and postoperative oral antiseptic, has been reported to cause pneumonia secondary to its pulmonary aspiration. Because no studies have yet investigated the underlying mechanisms of PI-induced pneumonia, we conducted an animal study to analyze the effect of PI on the lung following its pulmonary instillation.

METHODS

The lungs of 61 male Sprague-Dawley rats (150-250 g) were instilled with varying volumes of either phosphate-buffered saline or PI solutions varying in strength from 0.01% to 10%. The lungs were harvested from the rats 1 h or 1, 3, 5, 7, 14, or 21 days after instillation for radiologic examination, macroscopic and light and scanning electron microscopic assessment, and an assessment of pulmonary toxicity using an MTT-based cytotoxicity assay.

RESULTS

Macroscopically, atelectasis was the primary pulmonary lesion after PI instillation. The primary light and scanning electron microscopic findings were an initial inflammatory phase with edema, alveolar rupture, and leukocyte infiltration into the pulmonary interstitium, which progressed into a phase of lung parenchyma loss, and then resolved itself with scar tissue formation. Lung tissue viability following 1-day exposure to 0.01%, 0.1%, 1%, or 5% PI progressively decreased in a significant dose-dependent manner.

CONCLUSIONS

PI aspiration can cause lung injury, including pulmonary fibrosis.