RESUMO
BACKGROUND: The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel's diverticulum (MD) complicated by digestive tract hemorrhage. Moreover, we aimed to evaluate the value of double-balloon enteroscopy (DBE) in MD diagnosis and the prognosis after laparoscopic diverticula resection. AIM: To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding. METHODS: The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations, auxiliary examination, and follow-up after laparoscopic resection of diverticula. RESULTS: (1) Among 84 MD patients complicated with hemorrhage, 77 were male, and 7 were female with an average age of 31.31 ± 10.75 years. The incidence was higher in men than in women of different ages; (2) Among the 84 MD patients, 65 (78.40%) had defecated dark red stools, and 50 (58.80%) had no accompanying symptoms during bleeding, indicating that most MD bleeding appeared a dark red stool without accompanying symptoms; (3) The shock index of 71 patients (85.20%) was < 1, suggesting that the blood loss of most MD patients was less than 20%-30%, and only a few patients had a blood loss of > 30%; (4) The DBE-positive rate was 100% (54/54), 99mTc-pertechnetate-positive scanning rate was 78% (35/45) compared with capsule endoscopy (36%) and small intestine computed tomography (19%). These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding, especially DBE was a highly precise examination method in MD diagnosis; (5) A total of 54 MD patients with hemorrhage underwent DBE examination before surgery. DBE endoscopy revealed many mucosal manifestations including normal appearance, inflammatory changes, ulcerative changes, diverticulum inversion, and nodular hyperplasia, with ulcerative changes being the most common (53.70%). This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding; and (6) Laparoscopic dissection of diverticulae was performed in 76 patients, The patients who underwent postoperative follow-up did not experience any further bleeding. Additionally, follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding. These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis. CONCLUSION: Bleeding associated with MD was predominantly observed in male adolescents, particularly at a young age. DBE was a highly precise examination method in MD diagnosis. Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.
RESUMO
Gynostemma pentaphyllum (GP) is a plant commonly used in diabetic therapy in China. GP having potent antioxidant effect against various free radicals. The purpose of the current investigation to identify the cardioprotective effect of GP against streptozotocin (STZ)/ high fat diet (HFD) induced cardiac dysfunction in rats via alteration of AMPK/Nrf2/HO-1 pathway. Wistar rats were used for the current protocol. The rats were received the intraperitoneal injection of STZ and HFD to induce the cardiac remodelling. Blood glucose level, insulin and lipid parameters were estimated. Blood pressure and heart rate were also estimated. Cardiac parameters, antioxidant, cytokines, total protein and inflammatory mediators were analysed. The mRNA expression was detected using the RT-qPCR, respectively. GP significantly (p < 0.001) decreased the BGL and improved the insulin level. GP altered the ratio of heart/BW, liver/BW, and lung/BW. GP treatment significantly (p < 0.001) suppressed the heart rate and blood pressure (diastolic, systolic and mean pressure). GP significantly (p < 0.001) reduced the level of TC, LDL, TG, VLDL and increased the level of HDL. DCM induced rats received the GP administration exhibited reduction in the level of CK and LDH. GP significantly (p < 0.001) reduced the levels of MDA, hydrogen peroxide, peroxynitrite, ROS and increased the level of GSH, SOD, CAT and GPx. GP significantly (p < 0.001) reduced the levels of cytokines (TNF-α, IL-6, IL-1ß) and inflammatory parameters (COX-2 and NFκB). GP significantly (p < 0.001) suppressed the NLRP3 and NF-κB expression. GP also boosted mitochondrial biogenesis by boosting the PGC-1α, HO-1 and Nrf2 expression in cardiac tissue. GP treatment showed the cardioprotective effects against STZ induced diabetic cardiac dysfunction via alteration of AMPK/Nrf2/HO-1 pathway.