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Objective: To compare the efficacy and safety of early nasogastric enteral nutrition [EN] with total parenteral nutrition [TPN] in patients with severe acute pancreatitis [SAP]
Methods: From July 2008 to July 2014,185 patients with SAP admitted to our centre were enrolled in this retrospective study. They were divided into EN group [n=89] and TPN group [n=96] based on the nutrition support modes. Patients in EN group received nasogastric EN support, while patients in TPN group received TPN support within 72 hours of disease onset. The medical records were reviewed and clinical factors were retrospectively analyzed
Results: There were no significant differences in baseline characteristics between two groups. EN group had significantly lower incidence of pancreatic infections [P=0.0333] and extrapancreatic infections [P=0.0431]. Significantly shorter hospital stay [P=0.0355] and intensive-care stay [P=0.0313] were found in EN group. TPN group was found to have significantly greater incidence of multiple organ dysfunction syndrome [MODS] [P=0.0338] and mortality [P=0.0382]. Moreover, the incidence of hyperglycemia was significantly higher in TPN group [P=0.0454]
Conclusions: Early nasogastric EN was feasible and significantly decreased the incidence of infectious complications as well as the frequency of MODS and mortality caused by SAP
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Objective To explore the effect of prophylactic hepatic artery infusion chemotherapy (HAIC) on survival after curative resection in patients with primary pancreatic cancer. Methods A total of 106 patients with pancreatic cancer after pancreatectomy received 2 cycles of HAIC plus 4 cycles of systemic chemotherapy (HAIC) or 6 cycles of sys-temic chemotherapy alone (Control). Both the HAIC and systemic chemotherapy regimen consisted of 5-fluorouracil 1000 mg/m2 on day 1 and Gemcitabine 800 mg/m2 on day 1 and 8. The treatment was started on an average of 3 weeks after surgery and repeated every 4 weeks. The disease-free survival , overall survival and liver metastases-free survival were compared. Results Significant differences were found in 3-year overall survival (HAIC, 23.08 %; Control, 14.81%;P=0.0473) and liver metastases-free survival (HAIC, 80.77%;Control, 55.56%;P=0.0014). There was no significant difference in adverse effects between two groups. Conclusion HAIC effectively and safely prevented liver metastases and improved the prognosis of patients with pancreatic cancer after pancreatectomy.
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Objective To evaluate the effects of preoperative regional intra-arterial infusion chemotherapy for patients with advanced gastric cancer (AGC). Methods A total of 82 patients with clinical stage Ⅲ,Ⅳ gastric cancer received two cycles of neoadjuvant regional intra-arterial infusion chemotherapy (arterial infusion group, n=42) or neoadjuvant systemic chemotherapy (systemic chemotherapy group, n=40). The operation was administrated in 10 to 15 days before chemotherapy. All patients received 6 course of systemic chemotherapy after surgery. Chemotherapy toxicity and sur-vival rate were retrospectively analyzed. Results No significant difference was found in chemotherapy toxicity between two groups. The median survival period was 25.3 months in arterial infusion group and 19.1 months in systemic chemotherapy group. 3-year survival rate was 36.4% in arterial infusion group and 21.0% in systemic chemotherapy group respectively, there were significant differences (P<0.05). Conclusion Preoperative regional intra-arterial infusion chemotherapy is well tolerated in advanced gastric cancer patients and could improve short-term survival.
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Objective To study the protective effect of δ opioid receptor agonist DADLE(D-Ala2-D-Leu5-enkephalin)on mitochondrial respiratory function in a rat model of sepsis. Methods Sixty SD rats were randomly divided in to sham operated group (SO), septic group (SEP), and DADLE group (DADLE), each of 20 cases. Sepsis model was produced by cecal ligation and puncture (CLP). In SO group,the abdomen was opened without any other treatment. In DADLE group, DADLE (0.5 mg/mL) was administer at a dose of 5 mL/kg by intra-peritoneal injection after CLP. All rats were sacrificed 8 hours after CLP. ALT and AST in blood were determined. Mitochondrial respiratory function was evaluated by the clark oxygen eletrode. The levels of ATP, ADP, AMP were determined by high performance liquid chromatogra phy (HPLC). Results RCR and ADP/O in DADLE group were much higher than that in SEP group (P<0.05). ATP in DADLE groups were much higher than SEP group (P<0.05), while ALT and AST of DADLE group were significantly lower than SEP group (P<0.05). Conclusion DADLE can protect mitochondrial respiratory function and improve the hepatocellular energy metabolism in sepsis.
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Objective To investigate the effects of δ-opioid receptor agonist DADLE (D-Ala2-D-Leu5-enkephalin) on the hemodynamics and oxygen metabolism in rats with sepsis. Methods Eighty healthy male SD rats were randomly divided into 4 groups ( n = 20 each) : sham operation group (group S), sepsis group (group SEP) ,DADLE, group and DADLE2, group. Sepsis was induced by cecum ligation and puncture (CLP) in SEP, DADLE,and DADLE2 groups. In DADLE1 and DADLE2 groups, 0.5 mg/ml DADLE 10 mg/kg was injected intraperitoneally (IP) 0.5 h before CLP and immediately after CLP respectively. Mean arterial pressure (MAP), left ventricular systolic pressure (LVSP) and ± dp/dtmax were recorded at 0, 2, 4 and 6 h after CLP (T1-4). Blood samples from left common carotid artery and right external jugular vein were collected at T4 for blood gas analysis. The cardiac index (CI), O2 delivery (DO2), O2 consumption (VO2) and O2 extraction rate (ERO2) were calculated.Results Compared with group S, MAP and LVSP were significantly increased at T2, while decreased at T3,4, and ± dp/dtmax was significantly increased in group SEP, MAP was significantly increased at T2, while decreased at T3,4, LVSP was significantly increased at T2,3, while decreased at T4 , and ± dp/dtmax was significantly increased in DADLE, and DADLE2 groups, and CI, DO2 and VO2 were significantly decreased and ERO2 was increased in SEP, DADLE, and DADLE2 groups (P＜0.05). Compared with group SEP, MAP, LVSP and ± dp/dtmax at T3,4 and CI, DO2 and VO2 were significantly increased, while ERO2 was significantly decreased in DADLE1 and DADLE2 groups (P ＜ 0.05). There was no significant difference in the parameters mentioned above between DADLE1 and DADLE2 groups ( P ＞ 0.05). Conclusion δ-opioid receptor agonist DADLE can obviously improve the hemodynamics and oxygen metabolism in septic rats.
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Objective To investigate the effect of δ-opioid receptor agonist D-Ala2-D-Leu5-enkephalin (DADLE) on the celluar immune function in septic rats. Methods One hundred and fifty healthy male SD rats weighing 154-198 g were randomly divided into 3 groups (n = 50 each):group Ⅰ sham operation (group S);group Ⅱ sepsis (group SEP) and group Ⅲ DADLE. Sepsis was induced by cecum ligation and punture (CLP) in group Ⅱ and Ⅲ. In group Ⅲ 0.5 rmg/kg DADLE 10 ml/kg was injected intraperitoneally (IP) immediately after CLP operation. Seven day survival rate was calculated. Blood samples were collected from 10 animals at 4, 8 and 12 h after operation (T1-3) respectively in each group for determination of serum TNF-α and IL-10 concentrations by ELISA and changes in T-cell subsets by flow cytometry. Results CLP significantly increased serum TNF-α and IL-10 concentrations and TNF-α/IL-10 ratio at T1-3 and decreased CD4+ and CD4+/CD8+ ratio and increased CD8+ at T3 in group Ⅱ as compared with group S (group Ⅰ). DADLE treatment significantly attenuated the CLP-induced above changes. Seven-day survival rate was significantly higher in DADLE group than in CLP group.Conclusion δ-opioid receptor agonist DADLE can improve the celluar immune function of rats with sepsis and increase the survival rate.
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Objective To study the protective effects of DADLE on pulmonary function in rats with sepsis and the mechanism.Methods Seventy-two SD rats were randomly divided into sham operated group(SO),septic group(SEP),and DADLEtreated group (DADLE).Sepsis model was induced by cecal ligation and puncture(CLP).In SO group,the abdomen was opened without any other treatment.In DADLE-treated group,DADLE(0.5 mg/ml) was administerd at a dose of 5 ml/kg by intravenous injection after CLP.Rats were sacrificed at the 2nd,6th and 10th h after CLP.Arterial blood was collected for blood gas analysis.The wet-to-dry lung weight ratio was measured,and the levels of TNF-a and IL-6 in blood were detected.The levels of MPO,MDA and ATP in lung tissue were determined.The pathologic changes of the lungs were examined under a light microscope.Results As compared with SEP group,PaCO_2,and PaO_2 were significantly increased(P<0.05),while the wet-to-dry ratio and levels of serum TNF-a and IL-6 were significantly reduced(P<0.05),and levels of MPO and MDA were significantly reduced(P<0.05) and content of ATP in lung tissue was significantly increased (P<0.05)in DADLE group.More severe pathological changes were found in SEP group than in DADLE group.Conclusion DADLE has pulmonary protective effects in rats with sepsis.