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Objective:To investigate the effects of early enteral nutrition intervention on systemic inflammation and intestinal injury in rats with acute pancreatitis and its mechanism.Method:Rat acute pancreatitis model was established. The rats were divided into sham surgery groups, model group, 12 h nutrition support group, 24 h nutrition support group, 48 h nutrition support group, and 48 h nutrition support group +PMA group according to the random number chart method, with 10 rats in each group. After laparotomy, the rats in sham operation group were closed after gently turning the pancreas. The sham operation group and model group were injected with the same amount of physiological salt. Nutritional support group for 12 h, nutritional support group for 24 h and nutritional support group for 48 h were given enteral nutrition support for 12, 24 and 48 h, respectively. Nutritional support group for 48 h +PMA group, intraperitoneal injection of 5 mg/kg NF-κB signaling pathway activator PMA was given after modeling, and nutritional support was given for 48 h. The contents of lipase, amylase and creatinine in serum of each group were detected by automatic biochemical analyzer. The serum levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) and D-lactic acid were detected by enzyme-linked immunosorbent assay (ELISA). The content of diamine oxidase (DAO) was detected by colorimetry. Hematoxylin-eosin (HE) staining was used to detect the pathological changes of intestinal mucosa. Western blot was used to detect the expression of NF-κB pathway-related proteins in pancreatic tissue of rats in each group.Results:(1) Lipase, amylase and creatinine in sham operation group, model group, 12 h nutrition support group, 24 h nutrition support group and 48 h nutrition support group were (4.37±0.61) vs (12.021±1.00) vs (8.77±0.62) vs (6.88±0.63) vs (5.20±0.41) U/ml, (1674.03±172.24) vs (4356.30±229.38) vs (3676.11±382.43) vs (2990.06±251.93) vs (1919.75±179.40) U/L, (32.12±3.37) vs (91.73±9.76) vs (72.38±6.83) vs (53.72±5.98) vs (41.82±4.00) U/L. Compared with sham operation group, the contents of serum lipase, amylase and creatinine in model group were significantly increased. Compared with model group, the contents of lipase, amylase and creatinine were significantly decreased after 12, 24 and 48 h of nutritional support, and were time-dependent ( P<0.05). (2) The levels of IL-6, IL-1β, TNF-α and IL-10 were (40.26±3.93) vs (123.34±13.19) pg/ml in sham operation group, model group, 12 h nutritional support group, 24 h nutritional support group and 48 h nutritional support group, respectively vs (108.97±12.70) vs (77.36±6.75) vs (49.18±4.97) pg/ml, (77.53±9.95) vs (316.36±23.76) vs (254.79±13.96) vs (177.92±17.20) vs (119.19±13.17) pg/ml, (62.94±5.39) vs (353.16±28.03) vs (275.87±22.11) vs (198.78±24.33) vs (94.60±9.41) pg/ml, (41.21±4.29) vs (6.92±1.01) vs (10.76±0.66) vs (21.24±1.64) vs (35.33±1.69) pg/ml. Compared with sham operation group, the contents of serum inflammatory cytokines IL-6, IL-1β and TNF-α in model group were significantly increased, while the content of IL-10 was significantly decreased. Compared with model group, the contents of IL-6, IL-1β and TNF-α were significantly decreased after 12, 24 and 48 h of nutritional support, while the contents of IL-10 were significantly increased in a time-dependent manner ( P<0.05). (3) The intestinal histopathological scores, DAO and D-lactic acid of sham operation group, model group, 12 h nutritional support group, 24 h nutritional support group and 48 h nutritional support group were (0.00±0.00) vs (4.20±0.60) vs (3.00±0.45) points, respectively vs (1.90±0.54) vs (1.30±0.64) points, (4.92±0.42) vs (14.95±1.20) vs (11.87±1.13) vs (9.02±0.53) vs (6.30±0.59) U/L, (2.39±0.22) vs (6.92±0.46) vs (5.21±0.28) vs (3.64±0.39) vs (2.95±0.15) nmol/ml. Compared with sham operation group, intestinal histopathological scores, DAO and D-lactic acid levels were significantly increased in model group. Compared with model group, intestinal histopathological scores, DAO and D-lactic acid levels were significantly decreased after 12, 24 and 48 h of nutritional support ( P<0.05). (4) The protein expressions of NF-κB p65 and p-IκBα were (0.23±0.03) vs (0.94±0.10) vs (0.75±0.06) vs (0.62±0.06) in sham operation group, model group, 12 h nutrition support group, 24 h nutrition support group and 48 h nutrition support group, respectively. vs (0.41±0.06), (1.06±0.12) vs (0.25±0.04) vs (0.47±0.03) vs (0.62±0.08) vs (0.85±0.08). Compared with sham operation group, NF-κB p65 protein level in model group was significantly increased, while p-IκBα protein level was significantly decreased. Compared with model group, the NF-κB p65 protein level was significantly decreased after 12, 24 and 48 h of nutritional support, while the P-iκBα protein was significantly increased ( P<0.05). (5) NF-κB p65, p-IκBα, IκBα, IL-6, IL-1β, TNF-α, IL-10, lipase, amylase and creatinine were (0.41±0.06) vs (0.82±0.06) in the 48 h group and the 48 h +PMA group, respectively. (0.85±0.08) vs (0.37±0.02), (1.05±0.11) vs (1.10±0.14), (49.18±4.97) vs (105.68±10.69) pg/ml, (119.19±13.17) vs (247.16±23.41) pg/ml, (94.60±9.41) vs (328.24±30.86) pg/ml, (5.20±0.41) vs (10.33±1.01) U/ml, (1919.75±179.40) vs (4023.40±334.56) U/L, (5.20±0.41) vs (10.33±1.01) U/ml, (41.82±4.00) U/L vs (81.33±7.96) U/L. Compared with the 48 h group, the expression level of NF-κB p65 protein, IL-6, IL-1β, TNF-α, lipase, amylase and creatinine in the 48 h +PMA group were significantly increased, while the expression level of P-iκBα protein and the content of IL-10 were significantly decreased ( P<0.05) . Conclusion:Early nutritional intervention can inhibit inflammatory response, reduce intestinal injury and control the development of acute pancreatitis by regulating NF-κB signaling pathway.
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Objective:To analyze the current status of referral of stroke inpatients and explore the characteristics of the referral network in Changsha, for the reference to improve and promote the hierarchical medical system of stroke.Methods:Data of the inpatient medical record of stroke patients and the annual reports of medical institutions in Changsha in 2018 were collected from the health statistics network direct reporting system of Health Commission of Hunan province, for analysis of the referrals of inpatients in different medical institutions. Social network analysis was adopted to analyze the density, centrality and K-core of the referral network of stroke inpatients.Results:A total of 82 medical institutions for stroke inpatients were included with 2 859 referrals of patients. Most of the referrals were made between tertiary hospitals(1 515), especially within hospitals of a stroke alliance(1 123). The density of referral network was 0.613.Tertiary hospitals were in the center of the network, the entry points of secondary hospitals were in the center of the network and primary medical institutions were located at peripheral positions. Most of the tertiary hospitals in the 15-core(14, 72.68%), 12 of them were the units of Hunan Stroke Alliance.Conclusions:Tertiary hospitals played an important role in the region, secondary hospitals were able to receive patients referred by tertiary hospitals, but few patients were transferred to primary care institutions; The primary medical institutions failed to play due roles in the referral network. The establishment of stroke alliances could promote the cooperation of hospitals in the alliance, but the division of labor and cooperation among different levels of medical institutions in the region needed to be further optimized.
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After rice is processed into parboiled rice, it becomes a food with low glycemic index.Due to the effect of parboiled rice-preparing process on the rice, the changed starch structure and digestibility have induced a reduced hyperglycemic response to rice.After changes in starch structure, direct chain starch content increases with the result in digestive rate decrease.Furthermore, the proportion of the slowly digesting-starch(SDS)in the starch, and the content of the resistant starch(RS)go up, which induces an decreased digestive rate.In addition, parboiled rice also confers greater protection against oxidative stress.It also contains high fat and protein with strong sense of satiety, which reduces the level of blood glucose after eating.The parboiled rice is suitable for patients with diabetes and for the individuals with high risk for diabetes, and can also be applied to patients with hypertension, obesity and other metabolic diseases.
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Nutritional treatment of intensive care patients may require an accurate, effective and personalized approach in the future. Using nutritional risk assessment to guide nutritional treatment, factors including timing, energy expenditure and goal, pathway and dosage should be considered. Through testing the individual nutritional molecular markers, the benefits and risks can be evaluated. So nutritional therapy can enhance the nutritional and metabolic status of intensive care patients, and improve clinical outcomes.
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Objective To investigate the effect of Glutamine (Gln) on heat stress-induced dysfunction of intestinal epithelial barrier. Methods Human intestinal epithelial Caco-2 cells were pre-incubated with Gln for 24h and then exposed to heat 43℃ for 1h. Cell counting kit-8 (CCK-8) was used to detect the cellular proliferation with various concentrations of Gln and choose an optimum concentration for subsequent experiments. The barrier integrity was measured by transepithelial electrical resistance (TEER) and horseradish peroxidase (HRP) permeability. Levels of tight junction protein occludin and ZO-1 were analyzed by Western blotting. Cytoskeleton using Coomassie blue staining was observed by microscopy. Results At 0.7mmol/L concentration, Gln showed the most effective cell proliferation compared with other concentration groups (P<0.05). Therefore, 0.7mmol/L Gln was used as effective concentration in following experiments. Gln attenuated the TEER decrease and impairment of intestinal permeability induced by heat exposure compared with 43℃ group (P<0.01). The expressions of occludin and ZO-1 were significantly elevated by pretreatment with Gln. The distortion of cytoskeleton was also effectively prevented. Conclusion 0.7mmol/L Gln is potentially beneficial for protecting against heat stress-induced permeability dysfunction and epithelial barrier damage.
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BACKGROUND: Homogenate meals, as a replacement of normal diet, can be used in either hospitals or families. The homogenate meal as nutritious supplements should contain multiple components when it is applied in senior patients with chronic diseases because of the longterm application and complex complications.OBJECTIVE: To investigate the impact of longterm tube feed of finished product of homogenate meal on the nutritious supplements of senior patients.DESIGN: A cross-sectional study based on diagnosis.SETTING, PARTICIPANTS and METHODS: Totally 24 senior patients with chronic diseases who had been used self-made finished products of homogenate meal for more than 1 year were selected for nutritious supplement from Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA. The changes of nutritious index at before and 4, 8 and 12 months after supplement were observed.MAIN OUTCOME MEASURES: Anthropometric measurement index and laboratorial index of 24 senior patients with chronic diseases before and after intervention were compared.RESULTS: Serous albumin at before nutritious supplements, and 4, 8 and 12 months after supplements were[ (36.4 ± 4.03), (36.60 ± 4.42),(38.20 ± 3.77), and(40.40 ± 3. 33) ] g/L respectively. Phosphorus and peripheral lymphocytes were significantly heightened while blood sugar began to decrease since 4 months after intervention, which all had significant differences compared with that of before intervention( t =2. 196 -2. 356,P <0.05; t=2.958-3.431. P <0.01) .Anthropometric measurement index also improved compared with that of before intervention.CONCLUSION: Longterm application of finished product of homogenate meal can improve the nutritious status of senior patients with chronic diseases.
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Objectives:To observe the supporting effect of blenderized diet on the nulritional statusin the old patients. Methods:Twenty four patients were given blenderized diet made in our department as nutrition support.The nutritional assessments were preformed before and after the support. Results:The serum levels of albumin and phosphorus and the total lymphocyte count were increased after the support( P