[Show abstract][Hide abstract] ABSTRACT: Acute lung injury (ALI) and end-stage acute respiratory distress syndrome (ARDS) are among the most common causes of death in intensive care units. Activation and damage of pulmonary endothelium is the hallmark of ALI/ARDS. Recent studies have demonstrated the importance of circulating endothelial progenitor cells (EPCs) in maintaining normal endothelial function as well as endothelial repairing after vascular injury. Here, the authors present the first study demonstrating the therapeutic potential of EPCs in a rabbit model of ALI/ARDS.
Circulating EPCs were obtained from rabbits using Ficoll centrifugation. One week after culturing, ALI was induced in rabbits by oleic acid (75 mg/kg, intravenous), and autologous EPCs were transplanted intravenously. Vasomotor function of isolated pulmonary artery and degrees of lung injury were assessed 2 days later.
Endothelial dysfunction in the pulmonary artery was significantly attenuated in rabbits treated with EPCs, whereas the endothelium-independent relaxation responses were not different. Expression of inducible nitric oxide synthase was suppressed in the pulmonary artery of EPC-treated animals. Infiltration of leukocytes in the lung parenchyma was significantly reduced after EPC transplantation. EPCs also decreased water content, hyaline membrane formation, and hemorrhage in lungs.
The authors demonstrated that autologous transplantation of EPCs preserves pulmonary endothelial function and maintains the integrity of pulmonary alveolar-capillary barrier. Transplantation of EPCs can be a novel cell-based, endothelium-targeted therapeutic strategy for prevention and treatment of ALI/ARDS.
[Show abstract][Hide abstract] ABSTRACT: Ventricular fibrillation (VF) although less common during noncardiac surgery often brings about severe complication as an aftermath. We report a case of VF which was highly suspected to be induced by air embolism at the moment when the surgeon was dissecting the collateral vessels of portal vein in liver transplantation surgery. The outcome of this patient was excellent due to aggressive resuscitative measures including open-chest cardiac massage. Transesophageal echocardiogram (TEE) was not applied in this patient in fear of increased risk of esophageal varicose bleeding in a liver cirrhotic patient. However, some reports described the use of TEE in cirrhotic patients without obvious complications. In this case, venous air embolism (VAE) happened during the dissection of collateral vessels of the portal vein, which to our knowledge was ever been reported in liver transplantation surgery. The related literature has been reviewed and the success of the resuscitation is also herein discussed.