Inducing type 2 immune response, induction of angiogenesis, and anti-bacterial and anti-inflammatory properties make Lacto-n-Neotetraose (LNnT) a therapeutic choice to accelerate the wound healing process.

The healing process of non-healing and full-thickness wounds is currently facing some serious challenges. In such ulcers, losing a large part of skin causes a chronic infection due to the entrance of various pathogens in the wound bed. Moreover, poor vascularization, uncontrolled inflammation, and delayed re-epithelialization increase the healing time in patients suffering from such wounds. In this light, tissue engineering provides a wide range of strategies using a variety of biomaterials, biofactors and stem cells to decrease the healing time and restore the function of the damaged site. A suitable wound healing agent should possess some critical parameters such as inducing re-epithelialization, anti-inflammatory and anti-bacterial properties, and angiogenic capability. The Lacto-n-Neotetraose (LNnT) with chemical formula C26H45NO21 is an oligosaccharide present in human milk and soluble antigens extracted from Schistosoma mansoni eggs. It is reported that LNnT induces type 2 immune response (Th2 immunity). Th2 immunity promotes re-epithelialization, angiogenesis and wound contraction by recruiting the cells which produce Th2-related cytokines. Moreover, LNnT shows some special characteristics such as angiogenic capability, anti-inflammatory, and anti-bacterial effects which can address the mentioned challenges in the treatment of non-healing and full-thickness wounds. Here, we hypothesize that utilizing LNnT is an appropriate biofactor which would improve the healing process in full-thickness and non-healing wounds.

Early traditional Chinese medicine bundle therapy for the prevention of sepsis acute gastrointestinal injury in elderly patients with severe sepsis.

This study aimed to study the effect of early traditional Chinese medicine bundle therapy on the prevention of sepsis-associated acute gastrointestinal injury (AGI). This was a multicenter, prospective, observational, non-randomized cohort study of 296 consecutive patients with severe sepsis during 2013/3 and 2014/11; 150 patients received standard treatments (controls) and 146 received traditional Chinese medicine bundle therapy (intervention group) (herbal decoction gavage based on syndrome differentiation, Chinese acupuncture, application of mirabilite, and defecation mixture). D-lactic acid, diamine oxidase, endotoxin, gastrin, motilin, and intra-abdominal pressure were measured. AGI was categorized into four levels. Compared with controls, D-lactic acid, diamine oxidase, endotoxin, gastrin, and intra-abdominal pressure in the intervention group were decreased, and motilin was increased on day 7. AGI incidence in the intervention group was lower than in controls. GIF scores of the intervention AGI II and III groups were lower than in controls. The APACHE II scores of the intervention AGI II, III, and IV groups were lower than in controls. Compared with controls, mechanical ventilation time and ICU stay in the intervention group were shorter, and 28-day overall and AGI-attributed mortality were lower. For elderly patients with severe sepsis, early traditional Chinese medicine bundle therapy could decrease AGI incidence and improve prognosis.

RGTA® or ReGeneraTing Agents mimic heparan sulfate in regenerative medicine: from concept to curing patients.

The importance of extracellular matrix (ECM) integrity in maintaining normal tissue function is highlighted by numerous pathologies and situations of acute and chronic injury associated with dysregulation or destruction of ECM components. Heparan sulfate (HS) is a key component of the ECM, where it fulfils important functions associated with tissue homeostasis. Its degradation following tissue injury disrupts this delicate equilibrium and may impair the wound healing process. ReGeneraTing Agents (RGTA®s) are polysaccharides specifically designed to replace degraded HS in injured tissues. The unique properties of RGTA® (resistance to degradation, binding and protection of ECM structural and signaling proteins, like HS) permit the reconstruction of the ECM, restoring both structural and biochemical functions to this essential substrate, and facilitating the processes of tissue repair and regeneration. Here, we review 25 years of research surrounding this HS mimic, supporting the mode of action, pre-clinical studies and therapeutic efficacy of RGTA® in the clinic, and discuss the potential of RGTA® in new branches of regenerative medicine.

Renal replacement therapy in acute poisonings--one center experience.

The authors described three groups of patients after acute poisonings. In the first group were 60 patients after carbon tetrachioride poisoning, the second group consisted of 81 patients after mushroom poisoning and 20 patients after ethylene glycol poisoning were in the third group. Besides two patients with rare poisonings after potassium dichromate and after paraquat poisoning were analysed. All groups of patients with the kidney damage were presented from the diagnostic, differential diagnostic, conservative, ntra- and extracorporeal elimination treatment point of view. In the group of patients suffering from acute carbon tetrachloride poisoning and with acute renal failure following therapy was used: conservative treatment, exchange blood transfusion--in 4 patients in hepatic coma, renal replacement therapy (peritoneal dialysis, haemodialysis, plasmapheresis). From the total number of 60 patients 58 survived and 2 patients died in liver coma. Survival of patients after mushroom poisoning depended on amount of oral use of mushroom (Amanita phalloides), on early admission in dialysis centre and on early beginning of renal replacement therapy within 24 hr after acute poisoning. Twenty four patients from 81 patients of this group died. Main clinical signs of ethylene glycol poisoning were various neurological symptoms (cramps, hemiparesis, coma), severe metabolic acidosis (pH = 7.06 +/- 0.14), leucocytosis (26.4 +/- 5.5x 10(9)/L) and the signs of acute toxic hepatitis and of acute renal failure. Calcium oxalic crystals in urine were present in 17 patients and leucocytosis was observed in every patient. In the first 4 patients we administered intravenously ethylalcohol as an antidotum and later in other patients we used ethylalcohol in dialysis solution. The concentration of ethylalcohol in dialysis solution was 100 mg%. Severe metabolic acidosis improved in 17 patients using bicarbonate haemodialysis and 3 patients died before the possibility to use bicarbonate haemodialysis. Eighty-four hours after acute potassium dichromate poisoning and 24 hours after exchange blood transfusion during haemodialysis a 41-year old man died in haemorhagic shock, which developed after the extensive chemical burns of mucous membrane of gastrointestinal tract caused by this poison. Our patient after paraquat poisoning was treated by repeated charcoal haemoperfusion and haemodialysis. Despite of that therapy the patient died in severe respiratory insufficiency.

Electrogastrography in experimental pigs: the influence of gastrointestinal injury induced by dextran sodium sulphate on porcine gastric erythromycin-stimulated myoelectric activity.

OBJECTIVES: Electrogastrography (EGG) is a non-invasive investigation of gastric myoelectrical activity. The aim of study was to evaluate the impact of erythromycin on EGG in gastrointestinal toxic injury induced by dextran sodium sulphate (DSS) in experimental pigs. METHODS: The experiments were carried out on 12 adult pigs (weighing 30-35 kg). EGG was recorded using Digitrapper equipment (Synectics Medical AB, Stockholm). Running spectrum activity was used for EGG evaluation. There were two groups of animals: Group I: 6 controls with erythromycin administration (1,600 mg intragastrically); Group II: 6 animals treated with DSS (for 5 days, 0.25 g/kg per day in a dietary bolus) followed by erythromycin administration. Baseline and subsequent six separate 30-minute EGG-recordings (from time 0 to 360 min) were accomplished in each animal. RESULTS AND CONCLUSION: A total of 84 records were analysed. Baseline dominant frequency of slow waves was fully comparable in both groups. In Group I, there was a significant increase in dominant frequency after erythromycin administration (maximum between 240-360 min). There was a flat non-significant and delayed increase in dominant frequency after erythromycin administration in Group II. The difference between Group I and II at particular time intervals was not significant but a diverse trend was evident. EGG recording enables us to register a gastric myoelectrical effect of prokinetic drugs. Erythromycin induced a significant increase in the dominant frequency of slow waves. DSS caused toxic injury to the porcine gastrointestinal tract responsible for the delayed and weaker myoelectrical effect of erythromycin in experimental animals.

Prophylactic feeding with immune-enhanced diet ameliorates chemoradiation-induced gastrointestinal injury in rats.

PURPOSE: To investigate the protective effect of immune-enhanced diet (IED) on chemoradiation-induced injury of the gastrointestinal mucosa. MATERIALS AND METHODS: Forty-eight Sprague-Dawley rats were divided into control (C, n=6), irradiation (IR, n=14), fluoropyrimidine (5-FU, n=14)-treated, IR + 5-FU (n=14)-treated groups. Half of each irradiated and/or 5-FU-treated groups were previously fed with IED containing arginine, omega-3-fatty acids and RNA fragments, while the other half were fed a standard rat diet (SD) for eight days before the induction of IR or injection of 5-FU. In IR groups, whole abdominal irradiation (11 Gy) was performed with 6 MV photons. In the 5-FU groups, fluoropyrimidine (100 mg/kg) was administered intraperitoneally 30 min prior to irradiation. All animals were sacrificed on the 4th day of IR or 5-FU injection. RESULTS: Bacterial colony counts in the ceca and mesenteric lymph nodes of IED-fed rats, which have received either 5-FU and/or irradiation were significantly lower than the corresponding SD-fed groups. Morphometric results revealed that gastric, ileal and colonic injuries were less in IED-treated IR or IR + 5-FU + IED groups, as compared to SD-fed groups. However, IED did not alter DNA fragmentation ratios. CONCLUSION: Prophylactic feeding of IED has a protective effect on chemoradiation-induced gastrointestinal injury, which appears to involve the eradication of bacterial overgrowth.

[Nutrition therapy for adult patients with caustic injuries to gastrointestinal tract]. / Terapia nutricional en pacientes adultos con quemaduras del tracto gastrointestinal por cáusticos.

OBJECTIVES: To present here the experience of our Nutrition Therapy Team of the Hospital El Tunal, for the nutritional management of adult patients with caustic injuries to gastrointestinal tract. MATERIALS AND METHODS: This is a retrospective, descriptive study of patients with caustic injuries to gastrointestinal tract managed by our Nutrition Therapy Team between January 2000 and December 2007. We revisited the clinical history of patients with diagnosis of caustic injury. Various nutritional variables, as well as the evolution and outcome were pooled and analyzed. RESULTS: A total of 30 patients, 17 male y 13 female with a mean age of 34.4 +/- 17.2 years old were found. The ingestion of caustics was suicidal intent in 22 (73.3%) and accidental in 8 (26.7%). The global mortality was high (43.3%). Weight loss was found in 46.9% of the patients and a negative nitrogen balance in 62.5%. Sixteen patients (53.12%) were managed with mixed nutrition (enteral and/or parenteral) for a mean time of 24 +/- 22 days. We compared two groups Moderate vs Severe, according to the severity of the caustic injury to gastrointestinal tract and found that mortality, the length of hospital stay and the final albumin value were significantly different among groups. CONCLUSIONS: Caustic injuries to gastrointestinal tract are not frequent, they are found mainly in young patients with suicidal intent and are associated with high mortality, especially in severe injuries. This aggression causes important catabolic state leading to a negative nitrogen balance and weight loss. These patients require early nutritional intervention sometimes extended for months.

Neuronal regulation of homeostasis by nutrient sensing.

In type 2 diabetes and obesity, the homeostatic control of glucose and energy balance is impaired, leading to hyperglycemia and hyperphagia. Recent studies indicate that nutrient-sensing mechanisms in the body activate negative-feedback systems to regulate energy and glucose homeostasis through a neuronal network. Direct metabolic signaling within the intestine activates gut-brain and gut-brain-liver axes to regulate energy and glucose homeostasis, respectively. In parallel, direct metabolism of nutrients within the hypothalamus regulates food intake and blood glucose levels. These findings highlight the importance of the central nervous system in mediating the ability of nutrient sensing to maintain homeostasis. Futhermore, they provide a physiological and neuronal framework by which enhancing or restoring nutrient sensing in the intestine and the brain could normalize energy and glucose homeostasis in diabetes and obesity.

Terapia nutricional en pacientes adultos con quemaduras del tracto gastrointestinal por cáusticos / Nutrition therapy for adult patients with caustic injuries to gastrointestinal tract

Objetivos: Presentar la experiencia del Grupo de Terapia Nutricional del Hospital El Tunal, en el manejo nutricional de pacientes adultos con quemaduras por cáusticos del tracto gastrointestinal. Materiales y métodos: Es un estudio retrospectivo, descriptivo de pacientes manejados por el Grupo de Terapia Nutricional por quemaduras por cáusticos del tracto gastrointestinal en un periodo comprendido entre Enero de 2000 y Diciembre de 2007. Se revisaron las historias clínicas de los pacientes que tenían diagnóstico de quemaduras por cáusticos. Se analizaron los datos pertinentes al manejo nutricional, la evolución y el resultado final de dichos pacientes. Resultados: Se atendieron 30 pacientes, 17 hombres y 13 mujeres con edad promedio 34,4 ± 17,2 años. La ingesta del cáustico fue por intento de suicidio en 22 (73,3%) pacientes y accidental en 8 (26,7%). La mortalidad global fue alta (43,3%). El 46,9% de los pacientes mostró perdida de peso y balance nitrogenado negativo el 62,5%. Diez y siete pacientes (53,12%) recibieron nutrición mixta (enteral y/o parenteral) por un tiempo promedio de 24 ± 22 días. Al comparar dos grupos clasificados como quemadura del TGI Grave vs Moderada se encontró que fue significativamente diferente la mortalidad, la estancia hospitalaria y el valor final de albúmina. Conclusiones: La quemadura del tracto gastrointestinal por cáusticos es una entidad poco frecuente, sucede principalmente en jóvenes por intento de suicidio y se asocia a alta mortalidad, sobre todo en quemaduras graves. Esta agresión lleva a catabolismo importante que produce balance nitrogenado negativo y perdida de peso. Estos pacientes requieren intervención nutricional temprana que puede extenderse por varios meses (AU)

Objectives: To present here the experience of our Nutrition Therapy Team of the Hospital El Tunal, for the nutritional management of adult patients with caustic injuries to gastrointestinal tract. Materials and methods: This is a retrospective, descriptive study of patients with caustic injuries to gastrointestinal tract managed by our Nutrition Therapy Team between January 2000 and December 2007. We revisited the clinical history of patients with diagnosis of caustic injury. Various nutritional variables, as well as the evolution and outcome were pooled and analyzed. Results: A total of 30 patients, 17 male y 13 female with a mean age of 34.4 ± 17.2 years old were found. The ingestion of caustics was suicidal intent in 22 (73.3%) and accidental in 8 (26.7%). The global mortality was high (43.3%). Weight loss was found in 46.9% of the patients and a negative nitrogen balance in 62.5%. Sixteen patients (53.12%) were managed with mixed nutrition (enteral and/or parenteral) for a mean time of 24 ± 22 days. We compared two groups Moderate vs Severe, according to the severity of the caustic injury to gastrointestinal tract and found that mortality, the length of hospital stay and the final albumin value were significantly different among groups. Conclusions: Caustic injuries to gastrointestinal tract are not frequent, they are found mainly in young patients with suicidal intent and are associated with high mortality, especially in severe injuries. This aggression causes important catabolic state leading to a negative nitrogen balance and weight loss. These patients require early nutritional intervention sometimes extended for months (AU)