Ziqi Dihuang decoction ameliorates thrombosis in septic rats by inhitbiting plasminogen activator inhibitor-1.

Introduction: Sepsis is now a global medical burden with high morbility and mortality. The focus of this study was to evaluate the effects of Ziqi Dihuang (ZQDH) decoction on inflammatory and thrombosis-related parameters in septic rats. Mothods: A rat model of sepsis was established by cecal ligation and puncture (CLP). Male Sprague-Dawley rats were randomly divided into Sham group, CLP group, ZQDH-1ow group (0.735 g/kg) and ZQDH-high group (1.47 g/kg). Rats in ZQDH groups were given ZQDH decoction by gavage for 7 days before CLP. White blood cells (WBC), inflammatory cell infiltration of liver, kidney and lung, as well as serum levels of tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and reactive oxygen species (ROS) were used to assess systemic inflammatory response. Coagulation and fibrinolytic indexes included platelet count, coagulation function, fibrin deposition, and levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in serum, liver, kidney and lung. Results: LPS rats showed significant changes in inflammatory and thrombosis-related parameters such as increased WBC and inflammatory factors, decreased platelet counts, and increased tPA and PAI-1 concentrations in serum and organs. ZQDH decoction pretreatment can significantly inhibit the infiltration of inflammatory cells in the lung, and inhibit the production of TNF-α, IL-6 and ROS in a dose-dependent manner. ZQDH decoction also ameliorated thrombocytopenia, renal fibrin deposition, and tPA and PAI-1 levels in serum and organs. Conclusion: These results suggest that ZQDH decoction can dose-dependently relieve systemic inflammatory injury and regulate fibrinolysis system in septic rats, which may be mediated by PAI-1.

[Neutrophil extracellular trap increase the risk of sepsis: a two-sample, one-way Mendelian randomization study].

OBJECTIVE: To investigate the causal relationship between neutrophil extracellular trap (NET) and sepsis based on Mendelian randomization analysis. METHODS: The genome wide association study (GWAS) dataset for the NET biomarker myeloperoxidase (MPO)-DNA complex based on Donkel et al. 's Rotterdam study (RS) and GWAS dataset for identifying sepsis from the UK biobank were selected to screen single nucleotide polymorphisms (SNPS) associated with MPO-DNA complex as instrumental variable (IV) for genetic variation, using MPO-DNA complex as exposure factor. Potential causal associations between MPO-DNA complex and the risk of occurrence of sepsis, 28-day death from sepsis, need for intensive care due to sepsis, and 28-day death from sepsis requiring intensive care were analyzed using a two-sample, one-way Mendelian randomization analysis primary analysis method of inverse analysis of variance (IVW). Potential pleiotropy was assessed using the MR Egger regression intercept test. Sensitivity analysis was performed using the "leave one out" test. RESULTS: The GWAS data were obtained from a European population of both sexes, and the screening criteria was based on the three main assumptions of Mendelian randomization, resulting in 22 SNP entering the Mendelian randomization analysis. The results of the Mendelian randomization causal association effect analysis using the IVW method showed that for every standard deviation increase in the level of the MPO-DNA complex, the risk of sepsis increased by approximately 18% [odds ratio (OR) = 1.18, 95% confidence interval (95%CI) was 1.07-1.29, P < 0.001], the risk of 28-day death from sepsis increased by approximately 51% (OR = 1.51, 95%CI was 1.27-1.81, P < 0.001), an increase of approximately 38% in the risk of occurrence of needing intensive care due to sepsis (OR = 1.38, 95%CI was 1.12-1.70, P = 0.002), and an increase of approximately 125% in the risk of 28-day death from sepsis requiring intensive care (OR = 2.25, 95%CI was 1.21-4.18, P = 0.01). MR Egger regression intercept test suggested that there was no horizontal pleiotropy in the included SNP, and the MR-PRESSO test did not find outliers. Sensitivity analysis suggested that the results of Mendelian randomization were robust. CONCLUSIONS: Rising NET can increase the risk of sepsis onset, progression and death as derived from Mendelian randomization analysis.

Understanding clinical characteristics influencing adverse outcomes of Omicron infection: a retrospective study with propensity score matching from a Fangcang hospital.

Objectives: The epidemic of coronavirus disease 2019 (COVID-19) is causing global health concerns. The aim of this study was to evaluate influence of clinical characteristics on outcomes during the Omicron outbreak. Methods: A total of 25182 hospitalized patients were enrolled, including 39 severe patients and 25143 non-severe patients. Propensity score matching (PSM) was applied to balance the baseline characteristics. Logistic regression analysis was used to assess the risk of severe disease, as well as the risk of prolonged viral shedding time (VST) and increased length of hospital stay (LOS). Results: Before PSM, patients in the severe group were older, had higher symptom scores, and had a higher proportion of comorbidities (p<0.001). After PSM, there were no significant differences in age, gender, symptom score and comorbidities between severe (n=39) and non-severe (n=156) patients. Symptoms of fever (OR=6.358, 95%CI 1.748-23.119, p=0.005) and diarrhea (OR=6.523, 95%CI 1.061-40.110, p=0.043) were independent risk factors for development of severe disease. In non-severe patients, higher symptom score was associated with prolonged VST (OR=1.056, 95% CI 1.000-1.115, p=0.049) and LOS (OR=1.128, 95% CI 1.039-1.225, p=0.004); older age was associated with longer LOS (OR=1.045, 95% CI 1.007-1.084, p=0.020). Conclusion: The overall condition of the Shanghai Omicron epidemic was relatively mild. Potential risk factors for fever, diarrhea, and higher symptom score can help clinicians to predict clinical outcomes in COVID-19 patients.

[Effect of acupuncture combined with rehabilitation training on cognitive function and amino acid metabolism in children with cerebral palsy].

OBJECTIVE: To observe the effect of acupuncture combined with rehabilitation training on cognitive function and amino acid metabolism in children with cerebral palsy. METHODS: Twenty children with cerebral palsy (cerebral palsy group) were randomly divided into an acupuncture and rehabilitation group (11 cases) and a rehabilitation group (9 cases), and 10 healthy children were included as the normal group. The rehabilitation group was treated with rehabilitation training, 30 min each time; on the basis of rehabilitation training, the acupuncture and rehabilitation group was treated with acupuncture at Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Dazhui (GV 14), Shenzhu (GV 12), Mingmen (GV 4), etc. The Sishenzhen (left and right points) and the ipsilateral Niesanzhen were respectively connected with a group of electrodes, intermittent wave, frequency of 2 Hz for 30 min. Both groups were treated once every other day, three times a week, totaling for 3 months. The Gesell developmental diagnostic scale (GESELL) was used to evaluate the developmental quotient (DQ) scores before and after treatment, and the blood samples of children with cerebral palsy before and after treatment and normal children were collected for amino acid metabolomics. RESULTS: Compared before treatment, the DQ scores of adaptation, fine motor and social in the acupuncture and rehabilitation group was increased after treatment (P<0.05), and the DQ score of fine motor in the rehabilitation group was increased after treatment (P<0.05). Compared with the normal group, the serum L-glutamate, L-ornithine, L-tyrosine, L-methionine and L-arginine in the cerebral palsy group were down-regulated, and L-histidine, L-citrulline, 5-hydroxylysine and L-glutamine were up-regulated before treatment. The functional pathways mapped by different metabolites between the cerebral palsy group and the normal group included arginine biosynthesis, arginine and proline metabolism, etc. Compared with the cerebral palsy group, the serum L-histidine was decreased, and L-citrulline showed decreasing trend in the acupuncture and rehabilitation group after treatment. CONCLUSION: Acupuncture combined with rehabilitation training could improve cognitive function in children with cerebral palsy, and the effect may be related to the down-regulation of L-histidine and L-citrulline metabolism.

Efficacy and safety of methylprednisolone against acute respiratory distress syndrome: A systematic review and meta-analysis.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is caused by an inflammatory injury to the lung. Dysregulated inflammation is the cardinal feature of ARDS. Methylprednisolone is an option for treating ARDS. However, the benefits and adverse effects of methylprednisolone have not been well assessed in patients with ARDS. This study aimed to evaluate the efficacy and safety of methylprednisolone against ARDS. MATERIAL AND METHODS: The electronic database of Embase, PubMed, the Cochrane Library, CNKI, and Wanfang were searched, and randomized controlled trials (RCTs) reporting the efficacy and safety of methylprednisolone for ARDS were included. Revman 5.3 and Stata 15.0 were used to conduct the analysis. The fixed-effects model was used to calculate summary odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: Ten RCTs studies involving 692 patients with ARDS. The summary results demonstrated that, compared with placebo, methylprednisolone had a statistically significant effect on mortality (OR = 0.64; 95% CI: 0.43-0.95, I2 = 42%); the time of mechanical ventilation (MD) = -2.70, 95% CI: -3.31 to -2.10; I2 = 0%) in patients with ARDS, but it was not associated with increased rates of adverse events (OR = 0.80; 95% CI: 0.34-1.86; I2 = 58%). CONCLUSIONS: This systematic review and meta-analysis demonstrated that Methylprednisolone is safe against ARDS. It may reduce mortality and shorten the time of mechanical ventilation. However, well-designed and large-sample studies were required to fully characterize the efficacy and safety of methylprednisolone against ARDS.

Effect of "Tonifying Kidney and Invigorating Brain" acupuncture in children with spastic cerebral palsy analyzed by multi-modality MRI combined with dynamic electroencephalogram.

INTRODUCTION: Cerebral palsy is the most common motor disability of childhood. Spastic cerebral palsy accounts for 60% to 70% of cases. Research has shown that acupuncture can improve the quality of life of children with cerebral palsy, but the mechanism of action remains unclear. This study aims to determine the effectiveness of acupuncture for treatment of children with spastic cerebral palsy and to assess the value of multimodal magnetic resonance imaging (MRI) and ambulatory electroencephalogram (EEG) for evaluation of treatment effect. METHODS AND ANALYSIS: This randomized controlled trial will enroll a total of 72 children with CP from 2 hospitals-Jiangsu Province Hospital of Chinese Medicine and Nanjing State Hospital of Pediatric-with 36 participants from each hospital. Patients will be randomly assigned (1:1 ratio) to receive "Tonifying Kidney and Invigorating Brain" acupuncture treatment plus standardized physical rehabilitation treatment (treatment group) or only standardized physical rehabilitation (control group). All participants will receive 3 treatment sessions per week for 3 consecutive months; they will then be followed up for another 3 months. The primary outcome measures will include multimodal magnetic resonance imaging (MRI), ambulatory electroencephalogram (EEG), and Gesell Developmental Diagnostic Schedules. The secondary outcome measures will include Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Functional Independence Measure (WeeFIM), and Modified Ashworth Scale score. Outcome measures (including primary and secondary outcome measures) were collected at the baseline, 3 months and 6 months prior to the intervention.Ethics and dissemination PATIENTS CONSENT:: Obtained. ETHICS APPROVAL: The central independent ethics committee of Jiangsu Province Hospital of Traditional Chinese Medicine approved the protocol (2017NL-115-02). SAFETY CONSIDERATIONS: Routine blood tests and liver and kidney function tests will be conducted to exclude patients with severe heart, liver, or kidney diseases. The same examinations will be performed again at the end of the study to detect any possible side effects. Possible acupuncture-related adverse events (e.g., fainting, needle stick injury, local infection, subcutaneous hematoma, and low-grade fever) will be documented. Serious adverse events will be reported to the principal investigator immediately. All unexpected and unintended responses, even those not necessarily related to the acupuncture intervention, will be documented as adverse events. CASE DROPOUT MANAGEMENT: Participants have a right to withdraw from the study at any time if they feel uncomfortable upon receiving the treatments or being diagnosed with serious complications or diseases. They will then be referred to the preferred department for further treatment and management. If cases of dropout, the researcher need to contact the participant to reason the problem out, collect and record all the necessary assessments on the last visit as well as the date of last visit. All data available until the date of withdrawal will be stored for further statistical analysis. DISCUSSION: This research is being conducted to assess the value of acupuncture as an intervention for rehabilitation of children with spastic cerebral palsy and also to evaluate the usefulness of multimodal MRI and ambulatory EEG for identifying changes in brain function. TRIAL REGISTRATION: This trial is registered with Chinese Clinical Trials Register, ChiCTR 1900024546 (registered 15 July 2019; retrospective registration, http://www.chictr.org.cn/showproj.aspx?proj=35763).

[Clinical Trial of Electroacupuncture Treatment for Relieving Stress Responses in Patients Undergoing Gastrointestinal Surgery].

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) at Zusanli (ST 36) and Neiguan (PC 6) on stress responses of patients undergoing gastrointestinal surgery. METHODS: A total of 40 patients undergoing gastrointestinal surgery were randomized into conventional treatment group (control) and EA group (n＝20 in each group). Patients of the EA group received conventional treatment (pre- and post-surgical fasting, measures for gastrointestinal decompression, parenteral nutrition support, and patient controlled analgesia pump, etc.) and EA stimulation (2 Hz, 30 min) of bilateral ST 36 and PC 6 (twice after surgery, at an interval of 6 h), and patients of the control group received conventional treatment only. The visual analogue scale (VAS) score was used to assess the patients' pain severity and the blood glucose levels were detected once every 4－6 h within 24 h after operation. Serum cortisol (Cort) and adrenocorticotropic hormone (ACTH) levels were detected by chemiluminescence method, and serum D-lactic acid level (for assessing gastrointestinal mucosal injury) was assayed by ELISA. RESULTS: After the treatment, the levels of serum Cort, ACTH, D-lactate acid and the highest blood glucose were significantly lower in the EA group than those in the control group (P<0.05, P<0.01), suggesting a reduction of stress reactions after EA. But no significant difference was found between the control and EA groups in the VAS score (P>0.05). CONCLUSION: EA at ST 36 and PC 6 can alleviate stress responses and reduce intestinal mucosal damage in patients undergoing gastrointestinal surgery.

Tracheobronchomegaly in Intubated Ventilation of ARDS / Traqueobroncomegalia en intubación y ventilación mecánica en un caso de síndrome de dificultad respiratoria aguda (SDRA)

No disponible

[Statin in the treatment of ALI/ARDS: a systematic review and Meta-analysis based on international databases].

OBJECTIVE: To confirm the effects of statin therapy on mortality of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: PubMed/Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched for articles using the terms "acute lung injury", "ALI", "acute respiratory distress syndrome", "ARDS", "statin", "simvastatin" and "rosuvastatin" updated to November 17, 2015. Randomized controlled trial (RCT) or observational cohort studies investigating the effects of statin therapy on mortality in patients with ALI or ARDS were all identified, without date or language restriction. The control group was given conventional treatment, while the experimental group was treated with statins additionally. The primary outcome was in-hospital mortality. Meanwhile, ventilator-free day, intensive care unit (ICU)-free day, ICU length of stay (LOS) and ICU mortality were also analyzed. RevMan 5.2 and STATA 13 software were used for systematic review and Meta analysis, and funnel plot was used to analyze the publication bias. RESULTS: A total of five trials including three randomized controlled trials and two observational studies were included. Among 1 636 patients enrolled in the study, there were 739 patients in experimental group, and 897 in control group. It was shown by Meta analysis that there was no significant difference in in-hospital mortality between experimental group and control group [relative risk (RR) = 0.96, 95% confidence interval (95%CI) = 0.79-1.15, P = 0.63]. The subgroup analysis based on RCT and cohort study, or the subgroup analysis of different statins showed that there was no significant difference in in-hospital mortality between the experimental group and the control group (both P > 0.05). There were no significant differences in ventilator-free days [mean difference (MD) = 1.41, 95%CI = -0.32-3.13, P = 0.11], ICU-free days (MD = -0.23, 95%CI = -1.61-1.15, P = 0.75), ICU length of stay (MD = -1.03, 95%CI = -6.55-4.50, P = 0.72), or ICU mortality (RR = 0.88, 95%CI = 0.68-1.14, P = 0.33) between the experimental group and the control group. It was shown by funnel plot that there was no publication bias in in-hospital mortality. CONCLUSIONS: The systematic review and meta-analysis suggests that statin may not be associated with a significant reduction in mortality, ventilator-free day, ICU-free day and ICU length of stay in patients with ALI/ARDS.

Role of Cholinergic Anti-Inflammatory Pathway in Treatment of Intestinal Ischemia-Reperfusion Injury by Electroacupuncture at Zusanli.

Electroacupuncture (EA) at Zusanli is a widely used method for the treatment of intestinal ischemic disease. The current study attempts to investigate the possible mechanism from the point of cholinergic anti-inflammatory pathway (CAP) in rats. Thirty rats were divided into five groups: control group, I/R group, EA group (I/R + EA), PNU group (I/R + α7 nAChR agonist), and α-BGT group (I/R + EA + α7 nAChR antagonist). EA and medicine injection were performed immediately after ischemia. After 2 h of reperfusion, blood and intestine samples were collected and intestinal histopathological score, mRNA expression of mucosal α7 nAChR and NF-κBp65, and serum cytokine levels (IL-6, TNF-α) were examined. Compared with the I/R group, the EA group and PNU group could significantly attenuate the mucosal damage, promote α7 nAChR mRNA expression, and reduce levels of NF-κBp65, IL-6, and TNF-α. Compared with the EA group, α7 nAChR mRNA was decreased, while concentrations of NF-κBp65, IL-6, and TNF-α increased in the α-BGT group. EA at Zusanli could inhibit NF-κBp65 and proinflammatory cytokines production after intestinal I/R injury; its mechanism may be related to the cholinergic anti-inflammatory pathway.

Synergistic Effects of Electroacupuncture and Mesenchymal Stem Cells on Intestinal Ischemia/Reperfusion Injury in Rats.

Electroacupuncture (EA) and transplantation of bone marrow mesenchymal stem cells (MSCs) are both promising therapeutic applications for intestinal disorders. The current study examined their combined effect on rat intestinal ischemia/reperfusion (I/R) injury and the possible mechanism. Five groups were performed: con group (shame operation),I/R group (model group), MSC group (I/R + MSC), EA group (I/R + EA), and combined group (I/R + MSC + EA). Intestinal histological damage, crypt cell proliferation degree, mucosal cytokines expression, and levels of inflammation factors were studied for each group. Compared with the I/R group, crypt cell proliferation index and mucosal mRNA concentration of SDF-1, CXCR4, EGF, EGFR in MSC group and EA group were significantly increased, with mucosal NF-кBp65 and serum inflammation factor (TNF-α, IL-6) levels significantly decreased. Above all of these indicators except NF-кBp65 were improved more notably in combined group than the other two treatment groups. Chiu's score was only ameliorated remarkably in the combined group. The combined treatment of MSC transplantion and electroacupuncture could protect intestinal mucosal barrier from I/R injury.

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study.

BACKGROUND: It is known that intra-abdominal hypertension has high morbidity in acute pancreatitis and has detrimental effects on patients. For third trimester pregnancy complicated by acute pancreatitis, the intra-abdominal pressure may have its own characteristic. This article will discuss this clinical scenario. METHODS: This observational study in a cohort group was performed in the surgical intensive care unit of a tertiary hospital. Medical records were reviewed from each acute pancreatitis exactly in third trimester pregnancy. The main statistical methods were Mann-Whitney U test and bivariate Pearson correlation analysis. RESULTS: During the study interval, there were totally 17 pregnancies complicated by acute pancreatitis in the third trimester. All cases with moderate or severe acute pancreatitis had intra-abdominal hypertension of mean value of 16.7 mm Hg (range, 12.9-22.0 mm Hg). The intra-abdominal pressure had significant correlation with APACHE II score (r = 0.7456, p = 0.0006), while a negative correlation was showed with the umbilical artery pH value and with 1-min Apgar score (r = -0.8232, p = 0.0005; r = -0.7465, p = 0.0034; respectively). The intra-abdominal pressure of those with live infants was lower than that of those with dead ones (13.78 ± 2.554 vs. 19.84 ± 1.695, p = 0.0019). CONCLUSIONS: The incidence of intra-abdominal hypertension seems higher in moderate or severe acute pancreatitis in third trimester pregnancy than the non-pregnant cases but there's no significance in this study. Acute elevated intra-abdominal pressure accounts for great association with mother's serious scenario and fetal mortality.

[Effect of qi benefiting stasis removing method on systemic inflammatory response and coagulation function in MODS patients].

OBJECTIVE: To observe the effect of qi benefiting stasis removing method (QBSRM) on systemic inflammatory response and coagulation function in multiple organ dysfunction syndrome (MODS) patients. METHODS: Totally 40 MODS patients who were admitted to Affiliated Hospital of Nanjing University of Traditional Chinese Medicine between May 2010 to December 2011 were randomly assigned to two groups, the experimental group (21 cases) and the control group (19 cases). Patients in the control group were treated with routine Western therapy, while those in the experimental group additionally took decoction for benefiting qi removing stasis. Inflammatory factors (including interleukin-1, interleukin-6, tumor necrosis factor-alpha) and coagulation parameters [including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (DD)] were observed before treatment, and 3, 7, and 14 days after treatment in the two groups. RESULTS: At day 7 after treatment,levels of interleukin-1, interleukin-6, and PT were significantly lower in the experimental group than in the control group (P < 0.05). At day 14 after treatment, tumor necrosis factor-x and DD were significantly lower in the experimental group than in the control group (P < 0. 05). There was no statistical difference in APTT or FIB at day 3, 7 and 14 after treatment (P > 0.05). CONCLUSION: QBSRM could relieve systemic inflammatory response and improve coagulation functions.

A double-blind, randomized, controlled study to explore the efficacy of rFVIIa on intraoperative blood loss and mortality in patients with severe acute pancreatitis.

BACKGROUND: Severe acute pancreatitis is a life-threatening disease. Patients with peripancreatic necrotic infection often require surgical removal of necrotic infected tissue and a wide debridement will cause blood loss and worsen the condition. AIM: To assess whether treatment with NovoSeven, a recombinant activated FVII (rFVIIa), could improve coagulation function and therefore reduce blood loss, blood transfusion and all-cause mortality during necrosectomy in patients with infected necrosis secondary to severe acute pancreatitis. MATERIALS AND METHODS: Severe acute pancreatitis patients admitted to Nanjing Jinling Hospital for necrosectomy were enrolled and randomized to receive either standard treatment or standard treatment plus an intravenous infusion of rFVIIa (40µg per kilogram of body weight per hour) before operation. The prospectively defined primary end points were perioperative coagulation parameters (prothrombin time, activated partial thromboplastin time), blood transfusion unit and blood loss. The secondary end points were operation time, ICU stay and all-cause mortality at 28days after the operation. RESULTS: A total of 64 patients were enrolled (31 in the rFVIIa group and 33 in the control group). Treatment with rFVIIa was associated with a reduction in operation time, red blood cell and fresh froze plasma transfusion, blood loss and prothrombin time compared to the control group (p<0.05 for all). Activated partial thromboplastin time and mortality were similar between the two groups (P>0.05). CONCLUSION: Treatment with rFVIIa significantly improved the extrinsic coagulation function in patients with severe acute pancreatitis and was associated with decreased risk of bleeding. However, rFVIIa did not improve intrinsic coagulation or reduce over-cause mortality. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR-TRC-1300389.

Effects of Delayed Enteral Nutrition on Inflammatory Responses and Immune Function Competence in Critically Ill Patients with Prolonged Fasting.

Although different studies suggest that early enteral nutrition (EEN) has benefits in reducing infectious complications, there is no data that addresses whether delayed enteral nutrition (EN) is detrimental and if it may have effects on inflammatory responses and immune function. Forty-five critically ill patients with long fasting were randomly allocated in two groups according to the type of nutritional support. The first group included patients assuming a standard enteral nutrition (EN, n = 22) and the second group assuming a parenteral nutrition (PN, n = 23). The daily nutritional amount was 25 kcal (105 kJ)/kg for all patients. The inflammatory markers white blood cells (WBC), C-reactive protein (CRP), TNF-α, IL-1-ß, IL-6, IL-4, IL- 10 and the immune T-lymphocyte sub-populations CD3+, CD4+, CD8+, and HLA-DR+ were evaluated at day 1, and after 2, 3 and 7 days. IL-4, IL-10, CD3+, CD4+, CD8+ and the CD4+/CD8+ ratio were not statistically different between the two groups. WBC and TNF-α in EN patients were higher than those in PN after 3 and 7 days (P < 0.05). CRP and IL-6 levels were higher in EN patients than those assuming a PN after 2 and 3 days (P < 0.05). HLA-DR levels in patients assuming an EN were found higher than those in PN at day 7 (P < 0.05). Delayed EN for critically ill patients with long-term fasting increased systemic inflammatory responses, whereas EN could modify immune function, therefore reducing hospital stay and costs.

Epidermal growth factor promotes proliferation and improves restoration after intestinal ischemia-reperfusion injury in rats.

Epidermal growth factor (EGF) is an attractive and promising therapeutic application for intestinal disorders. The current study examined its influence on proliferation and restoration after ischemia-reperfusion (I/R) injury in rat small intestine. Six groups were performed: sham operation (Con); ischemia for 30 min with subsequent reperfusion for 30 min (I/R); I/R injured with 500 µg/kg EGF injected 5 min before ischemia (Pre-l); I/R injured with 50 µg/kg EGF injected 5 min before ischemia (Pre-s); I/R injured with 500 µg/kg EGF injected 5 min after reperfusion (Post-l); and I/R injured with 50 µg/kg EGF injected 5 min after reperfusion (Post-s). Intestinal histological damage, crypt cell proliferation degree, mucosal permeability, tight junction proteins expression, and levels of inflammation factors were studied for each group. Compared with the I/R group, administration of EGF in the Pre-l, Pre-s, and Post-l groups all presented a significant proliferation effect. The levels of FD4, IL-6, and TNF-α were dramatically decreased in all EGF-treated groups. Histological destruction was improved and TJs recovery was notably accelerated in all EGF-treated groups except the Post-s group. D-lactate concentration was only diminished in the Pre-l group. These results suggest that mucosally applied EGF can promote intestinal proliferation and improve restoration after I/R injury. EGF intraluminal administration is an effective treatment against intestinal I/R injury.

Temporal variations of the ileal microbiota in intestinal ischemia and reperfusion.

Gastrointestinal bacteria and epithelia contribute to systemic inflammation and infections in critically ill patients, but the gut microbiota in these diseases has not been analyzed dynamically by molecular fingerprinting methods. This study aimed to identify ileal flora dysbiosis pattern and bacterial species that changed significantly in a rat model of intestinal ischemia and reperfusion and illustrate time courses of both epithelial alterations and gut flora variations in the same injury. Forty-eight rats were randomized into eight groups (n = 6/group). Six groups underwent superior mesenteric artery occlusion for 30 min and were killed at 1, 3, 6, 12, 24, and 72 h following reperfusion, respectively; a group of rats were killed just after anesthesia (control), and a sham-operated group received 12-h reperfusion. Denaturing gradient gel electrophoresis of ileal microbiota showed that gut flora pattern changed early after intestinal ischemia and reperfusion, differed significantly at 12 h of reperfusion, and then started to recover toward normal pattern. The specific dysbiosis were characterized by Escherichia coli proliferation and Lachnospiraceae and Lactobacilli reduction. These bacteria that contributed most were identified by principal component analysis and sequencing and confirmed by real-time polymerase chain reaction. In addition, alterations of ileal microbiota followed epithelial changes in the time course of reperfusion.

Percutaneous catheter drainage for infective pancreatic necrosis: is it always the first choice for all patients?

OBJECTIVE: To learn the clinical outcome of percutaneous catheter drainage (PCD) for patients with infective pancreatic necrosis and the possible influencing factors. METHODS: A retrospective review of medical records of patients with infective pancreatic necrosis who received PCD as the first choice for treatment in the recent 2 years. The patients were divided into 2 groups: (1) PCD success group and (2) PCD alteration group. Characteristics, complications, and PCD process were compared. RESULTS: In this study, 19 of 34 patients were cured by PCD alone (55.9%), whereas open necrosectomy were needed for 15 patients (44.1%). Between these 2 groups, most baseline and clinical characteristics did not show any statistical difference, including the number and size of catheter used and the bacterial culture result. The PCD alteration group had higher mean computed tomographic density (P = 0.012) and larger distribution range of infected pancreatic necrosis (4.53 ± 1.35 vs 5.93 ± 1.62; P = 0.009) than the PCD success group (P < 0.01). The logistic regression analysis revealed the same facts. CONCLUSION: The mean computed tomographic density and distribution range of infective pancreatic necrosis could significantly influence the success rate of PCD; higher values of them indicate less appropriate for PCD; thus, it should be considered seriously before the treatment decision.

Severe acute pancreatitis during pregnancy: eleven years experience from a surgical intensive care unit.

OBJECTIVE: Acute pancreatitis during pregnancy is a rare and dangerous disease. This study attempts to present a comprehensive analysis of severe acute pancreatitis (SAP) during pregnancy and to identify the factors associated with poor outcomes. METHODS: This study was a retrospective review of the medical records of SAP patients during pregnancy consecutively admitted into the Research Institute of General Surgery from 1999 to 2010. RESULTS: Information was collected on presentation, management, and outcome. Eighteen patients were identified to have been diagnosed with SAP during pregnancy. Eleven patients (61.1%) were nulliparous; most attacks (88.9%) occurred during the third trimester. There were seven cases with preterm labor, six with fetal losses, and no maternal death. The etiology was biliary disease in seven patients (38.9%), hypertriglyceridemia in five patients (27.8%), both biliary and hypertriglyceridemia in four patients (22.2%), and idiopathic in two patients (11.1%). Patients with failure in more than one (≥2) organ were more likely to result in fetal loss (OR = 25, P = 0.016). CONCLUSIONS: SAP during pregnancy is predominantly biliary in etiology, but a significant proportion is caused by hypertriglyceridemia. Patients with failure in at least two organs result in relatively worse fetal outcomes.