title: Resuscitation with hydroxyethyl starch solution prevents bone marrow mononuclear apoptosis in a rat trauma-hemorrhagic shock model.
abstract: BACKGROUND
  : Trauma-hemorrhagic shock (T/HS) has been associated with multiorgan dysfunction, including bone marrow failure. This study examined apoptosis and morphologic alterations in bone marrow mononuclear cells (BMMNCs) with different volume therapies after T/HS.
  
  
  METHODS
  : T/HS was induced in groups of male Sprague-Dawley rats through a fracture of the left femur and continual bleeding for 30 minutes, followed by resuscitation with Ringer's lactate solution (RL), 6% hydroxyethyl starch solution (HES), or 5% albumin (ALB). Mean arterial blood pressure was monitored during the T/HS and resuscitation, and the impacts of various resuscitative fluids on apoptosis and morphology of BMMNCs at 24 hours and 48 hours after resuscitation were examined using flow cytometry, transferase-mediated dUTP nick-end labeling assay, and hematoxylin and eosin staining.
  
  
  RESULTS
  : Fluctuations in mean arterial blood pressure were homogenous among the three treatment groups. The percentage of early BMMNC apoptosis increased significantly at 24 hours and 48 hours (24.65% +/- 5.41% and 29.09% +/- 2.07%, respectively; p < 0.05), and the percentage of late BMMNC apoptosis increased to 13.43% +/- 2.82% (p < 0.05) at 48 hours in the T/HS + RL group. In contrast, resuscitation with HES alone dramatically attenuated the apoptosis. Resuscitation with ALB alleviated BMMNC apoptosis, except for late apoptosis at 48 hours. A greater number of apoptotic BMMNCs as well as morphologic alterations were shown using the transferase-mediated dUTP nick-end labeling assay and hematoxylin and eosin stain in the T/HS + RL group than in the HES or ALB groups.
  
  
  CONCLUSIONS
  : Intravascular volume replacement with HES showed prevention of BMMNC apoptosis at first 48 hours after T/HS compared with RL and ALB. These findings provide new insights into the intervention mechanism of HES on T/HS-related multiorgan dysfunction.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery Key Laboratory of Multi-Organ Transplantation of Ministry of Public Health, Zhejiang University, Hangzhou 310003, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liang
authors.forename: Guodong
authors.initials: G
authors.lastname: Xu
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Junjiang
authors.initials: J
authors.lastname: Li
authors.forename: Tingbo
authors.initials: T
authors.lastname: Liang
mesh_terms: D000818:Animals; D017209:Apoptosis; D004195:Disease Models, Animal; D005264:Femoral Fractures / Q000150:complications / Q000473:pathology / Q000628:therapy; D005440:Fluid Therapy; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D009000:Monocytes / Q000473:pathology*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000077325:Ringer's Lactate; D012709:Serum Albumin / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000473:pathology* / Q000628:therapy*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012709:Serum Albumin