Roles of citric acid in conjunction with saline nebulization in experimental tracheostomy in guinea pigs.

PURPOSE: Tracheostomy usually accompanied by the impairment of cough reflex, which may affect the clearance of secretions and result in the occurrence and development of pulmonary inflammation. Previous research has demonstrated that citric acid could effectively evoke cough. However, there are limited data available on this topic specific to the cough stimulation method, and the roles of citric acid in tracheostomy still remain obscure. The aims of present study were to identify the potential roles of citric acid in conjunction with saline nebulization in tracheostomy in guinea pigs. MATERIALS AND METHODS: Experimental tracheostomy model was induced in guinea pigs, and different nebulization interventions were implemented. The expression of P-selectin and platelet count were analyzed by flow cytometer and automatic globulimeter, the histological changes in trachea and lung tissue were assessed by hematoxylin and eosin staining, and the inflammatory cytokines and substance P (SP) levels in bronchoalveolar lavage fluid were evaluated by enzyme-linked immunosorbent assay. RESULTS: Tracheostomy resulted in the disorder of trachea mucosa and cilia, the inflammatory cell infiltration in lung tissue, the increase of IL-6, TNF-α levels and the decrease of SP level. Citric acid alone increase the SP level, and the joint action of citric acid and saline nebulization further showed significantly beneficial effects on pathological, inflammatory changes and SP level. CONCLUSIONS: Citric acid combined with saline nebulization contributes to the alleviation of tracheotomy-induced tracheal damage and pulmonary inflammation in an experimental tracheostomy model in guinea pigs. This may provide novel insights into the inflammation management and cough recovery after tracheostomy.

P2X7 Participates in Intracerebral Hemorrhage-Induced Secondary Brain Injury in Rats via MAPKs Signaling Pathways.

This study aimed to study the role of P2X7 in intracerebral hemorrhage (ICH)-induced secondary brain injury (SBI) and the underlying mechanisms. An autologous blood injection was used to induce ICH model in Sprague-Dawley rats, and cultured primary rat cortical neurons were exposed to oxyhemoglobin to mimic ICH in vitro. siRNA interference and over-expression of P2X7, agonists and antagonists of P2X7, p38 MAPK and ERK were exploited. The protein levels were assessed using Western blotting and immunofluorescence staining. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining and Fluoro-Jade B were conducted to detect apoptotic and degenerating neurons. The protein levels of P2X7, phosphorylated p38, ERK, active caspase-3 and NF-κB were significantly increased by ICH, which could be further increased by BzATP (P2X7 agonist) and reduced by BBG (P2X7 antagonist). And BzATP demonstrated a significant increase in cell death ratio and brain water content, while BBG led to a reverse results. In addition, Over- P2X7 increased the levels of P2X7, phosphorylated p38, ERK, active caspase-3 and NF-κB, and aggravated cell apoptosis, while si P2X7 resulted in opposite effects. Finally, the protein levels of phosphorylated P38 and active caspase 3 were decreased by BzATP plus Hydrochloride (p38 MAPK antagonist) and increased vy BBG plus Asiatic acid (p38 MAPK agonist), while the protein levels of phosphorylated ERK and NF-κB were decreased with BzATP plus Nimbolide (ERK antagonist) and increased with BBG plus Saikosaponin C (ERK agonist). This study demonstrates that inhibition of P2X7 could prevent ICH-induced SBI via MAPKs signaling pathway.

Chewing gum for intestinal function recovery after caesarean section: a systematic review and meta-analysis.

BACKGROUND: Gum chewing has been reported to enhance the intestinal function recovery after caesarean section, current perspectives and practice guidelines vary widely on the use of gum chewing, more studies on the role of gum chewing after caesarean section are needed. METHODS: We performed a comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy of gum chewing after caesarean section. Studies were identified by searching EMBASE et al database (until June 30, 2016). Summary odd ratios or weighted mean differences with 95% confidence intervals were calculated for each outcome with fixed- or random-effects model. RESULTS: Ten RCTs with a total of 1659 women were included in our meta-analysis. Gum chewing provided significant benefits in reducing the time to first passage of flatus, first defecation, first bowel sound, first bowel movement and the length of hospital stay, but not in the time to first feeling of hunger. CONCLUSIONS: Gun chewing hastens the intestinal function recovery after caesarean section and offers a safe and inexpensive option. High-quality and larger-scale RCTs are still warranted to clarify the role of gum chewing in intestinal function recovery after caesarean section.

The physician-nurse collaboration in feeding critically ill patients: A multicenter survey.

AIMS: Describe physician-nurse collaboration in feeding critically ill patients and explore the influence factors related to this collaboration, which can provide information for clinical practice and future studies. BACKGROUND: Appropriate nutrition support is essential and significant for critically ill patients, and the importance of physician-nurse collaboration in other fields has been confirmed, yet there are limited studies put insights into the status of physician-nurse collaboration in feeding critically ill patients. METHODS: A cross-sectional survey with a covering of 15 hospitals was conducted. A 21-item questionnaire was administered to physicians and nurses in critical care units. Descriptive statistics, univariate and multiple stepwise regression analysis were performed to evaluate the physician-nurse collaboration in feeding critically ill patients. RESULTS: A total of 331 respondents completed the questionnaire. Nurses and physicians were found to have differing perceptions of the physician-nurse collaboration in feeding critically ill patients, with nurses reporting lower levels of collaboration. Nurses consistently gave more negative responses on every survey question compared with physicians. Age, education and clinical experience significantly influenced the nurses' perceptions of cooperation, and age, education, ICU type, and seniority affected the physicians' perceptions of collaboration. CONCLUSIONS: Physicians, nurses and hospital administrators should highlight the physician-nurse collaboration in feeding critically ill patients and reinforce the cooperation based on potential influencing factors. Further research is required to establish feasible cooperative protocol and evaluate the effectiveness of the approach.

Development of an Animal Model for Inducing Various Degrees of Severity of Incontinence-Associated Dermatitis.

PURPOSE: The purpose of this study was to describe the biological changes after incontinence-associated dermatitis (IAD) induction by pancreatin in the guinea pigs and to explore the potentially appropriate timing and pancreatin concentration for IAD induction with different severity. DESIGN: In vivo, experimental study. SUBJECTS AND SETTING: An experimental animal model (guinea pig) in a controlled laboratory setting was used for investigation. METHODS: We developed an IAD model in guinea pigs by occluded application of 1%, 5%, and 10% pancreatin solutions for 1, 3, and 5 days, respectively. The irritant was applied to the posterior aspect of shaved guinea pigs. We used an adapted visual scoring system to evaluate IAD and its severity. We also measured differences of the fluid absorption rate as a proxy for transepidermal water loss and enzyme-linked immunosorbent assays of interleukin 2 and interferon-γ expression as indicators of IAD-related inflammation. Analysis of variance (ANOVA) was used to examine group differences. RESULTS: Higher pancreatin concentrations led to more severe skin responses and higher mean visual scale scores, yet the statistically score differences were only observed in the 1% and 5% pancreatin groups after 3 and 5 days of exposure compared with 1 day of exposure (P < .05). The average absorbed fluid rate increased from 1 to 3 days of exposure and reached a plateau at 3 days; significant differences were observed in 3 and 5 days of exposure (P < .05) when compared with 1 day of exposure but not between 3 and 5 days of exposure. CONCLUSIONS: Exposure of a guinea pig animal model to 1%, 5%, and 10% pancreatin solutions over a 3-day period induced IAD with different levels of severity. Additional studies using this model are warranted.

The role of osmolality in saline fluid nebulization after tracheostomy: time for changing?

BACKGROUND: Saline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear. OBJECTIVES: To investigate the biological changes in the early stage after tracheostomy, to verify the efficacy of saline fluid nebulization and explore the potential role of osmolality of saline nebulization after tracheostomy. METHODS: Sprague-Dawley rats undergone tracheostomy were taken for study model, the sputum viscosity was detected by rotational viscometer, the expressions of TNF-α, AQP4 in bronchoalveolar lavage fluid were assessed by western blot analysis, and the histological changes in endothelium were evaluated by HE staining and scanning electron microscopy (SEM). RESULTS: Study results revealed that tracheostomy gave rise to the increase of sputum viscosity, TNF-α and AQP4 expression, mucosa and cilia damage, yet the saline fluid nebulization could significantly decrease the changes of those indicators, besides, the hypertonic, isotonic and hypertonic saline nebulization produced different efficacy. CONCLUSIONS: Osmolality plays an important role in the saline fluid nebulization after tracheostomy, and 3% saline fluid nebulization seems to be more beneficial, further studies on the role of osmolality in saline fluid nebulization are warranted.

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND: This meta-analysis was performed to assess the efficacy and safety of chewing gum in intestinal function recovery after colorectal cancer surgery. METHODS: A systematic search was conducted in PubMed, Embase, Science Direct, and Cochrane library for relevant randomized controlled trials (RCTs) published until April 2017. Summary risk ratios or weighted mean differences with 95% confidence intervals were used for continuous and dichotomous outcomes, respectively. RESULTS: 17 RCTs with a total number of 1845 patients were included. Gum chewing following colorectal cancer surgery significantly reduced the time to first passage of flatus (WMD -0.55; 95% CI -0.94 to -0.16; P = 0.006), first bowel movement (WMD -0.60; 95% CI -0.87 to -0.33; P < 0.0001), start feeding (WMD -1.32; 95% CI -2.18 to -0.46; P = 0.003), and the length of postoperative hospital stay (WMD -0.88; 95% CI -1.59 to -0.17; P = 0.01), but no obvious differences were found in postoperative nausea, vomiting, abdominal distention, pneumonia, and mortality, which were consistent with the findings of intention to treat analysis. CONCLUSIONS: Chewing gum could accelerate the recovery of intestinal function after colorectal cancer surgery. However, it confers no advantage in postoperative clinical complications. Further large-scale and high-quality RCTs should be conducted to confirm these results.

Neuroprotection of Botch in experimental intracerebral hemorrhage in rats.

Notch1 maturation participates in apoptosis and inflammation following intracerebral hemorrhage (ICH). It has been reported that Botch bound to and blocked Notch1 maturation. Here we estimated the role of Botch in ICH-induced secondary brain injury and underlying mechanisms. Experimental ICH model was induced by autologous arterial blood injection in Sprague-Dawley rats, and cultured primary rat cortical neurons were exposed to oxyhemoglobin to mimic ICH in vitro. Specific small interfering RNAs and expression plasmids encoding wild type Botch and Botch with Glu115Ala mutation were exploited. The protein levels of Botch and Notch1 transmembrane intracellular domain (Notch1-TMIC) were increased within brain tissue around hematoma. Botch overexpression led to an increase in unprocessed Notch1 full-length form accompanied by a significant decrease in Notch1-TMIC, while Botch knockdown resulted in an approximately 1.5-fold increase in Notch1-TMIC. There were increased cell apoptosis, necrosis and neurobehavioral deficits after ICH, which was inhibited by Botch overexpression and enhanced by Botch knockdown. Double immunofluorescence showed a colocalization of Botch and Notch1 in the trans-Golgi. Overexpression of wild type Botch, but not Botch E115A mutant, led to an increase in the interaction between Botch and Notch1, reduced the formation and the nuclear localization of Notch1 intracellular domain, and attenuated cell apoptosis and inflammation. In conclusion, Botch exerts neuroprotection against neuronal damage via antagonizing the maturation of Notch1 in Glu115-denpendent manner. However, neuroprotection mediated by endogenous Botch is not enough to reverse ICH-induced secondary brain injury.