Repair of damaged intestinal mucosa in a mouse model of sepsis / 世界急诊医学杂志（英文）

BACKGROUND:The intestine is not only the main target attacked by sepsis but also the vital organ which mediated sepsis. The recovery of the damaged intestinal barrier structure and function is related to the occurrence and outcome of multiple organ dysfunction syndrome (MODS). How to protect and reduce the damage of the intestinal mucosa and how to promote the reconstruction of the intestinal mucosa have been the important topics in sepsis for many years. This study aimed to investigate the influential factors of intestinal mucosal reconstruction after intestinal epithelial injuryin vivo in a mouse model of sepsis.METHODS:Mice were subjected to cecal ligation and puncture (CLP) for induction of sepsis to assess intestinal mucosal damage, epithelial cell apoptosis, and transformed number of goblet cells, and to detect the concentration of TNF-α, IL-1 and TGF-β1 and TFF3 (trefoil factor 3) expression in the small intestinal mucosa. All above were performed by HE staining, western blot, ELISA and immunohistochemistry respectively. The experimental animals were divided into a sepsis group and a sham-operation group. The animals with sepsis were separately killed at 6 (7 animals), 24 (7 animals) and 48 hours (7 animals) after CLP.RESULTS:Injured intestinal mucosa was observed in the 3 groups under a light microscope, in which damage scores in the 24-hour and 48-hour groups were higher than in the 6-hour group and no difference was found between the two groups. Moreover, less of goblet cells or other epithelial cells adjacent to the injured surface migrated into the wound to cover the denuded area. The number of goblet cells was substantially decreased in the three CLP groups compared with the sham-operation group. Protein levels of IL-1 and TNF-α were significantly increased by 3-4 fold at all time points when compared with the sham-operation group, and cleaved caspase-3 by 4 fold. Although TFF3 expression was modestly increased for 6 hours after the onset of CLP, it appeared to decline at 24 hours and 48 hours as shown by Western blot. A similar tendency was observed upon TGF-β1, i.e. the protein level was not elevated at 24 hours and 48 hours, but increased modestly at 6 hours.CONCLUSIONS:Sepsis from CLP shows less restitution on the surface of injured intestinal mucosa. There is evidence that both constant inflammatory reaction and epithelial cell apoptosis may affect mucosal reestablishment of the intestine at the onset of sepsis. Mucosa after severe sepsis showed the state of high inflammation, and declined goblet cell function and mucosal reconstruction, which affected the repair of damaged intestinal barrier. Constant inflammatory reaction, and declined goblet cell function and mucosal reconstruction ability may affect the reestablishment of intestinal mucosa at the onset of sepsis.

Synthesis of colon-specific prodrug of indomethacin and its inhibitory effect on liver metastasis from colon cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To develop a colon-specific prodrug of Indomethacin microbially triggered, carry out in vitro/in vivo evaluation of drug release, and appraise its inhibitory effect on liver metastasis from colon cancer.</p><p><b>METHODS</b>Indomethacin prodrugs were synthesized and characterized by FTIR and NMR, and dissolution test simulating gastrointestinal tract was employed to screen the colon-specific prodrug. Then, the pharmacokinetic profile of portal vein and peripheral blood in Sprague-Dawley rats was studied. Lastly, the inhibitory effect on liver metastasis from colon cancer in nude mice was observed.</p><p><b>RESULTS</b>The chemical structure characterized by FTIR and NMR demonstrated that six kinds of indomethacin-block-amylose with different drug loading (IDM-AM-1-6) were synthesized, among which IDM-AM-3 was degraded 1.3%, 9.3% and 95.3%, respectively, in simulated gastric fluid for 4 h, small intestine for 6 h, and colon for 36 h. The pharmacokinetic test of IDM-AM-3 showed that absorption was delayed significantly (P < 0.01), peak time [(11.35 + or - 2.45) h], elimination half-life [(16.74 + or - 4.04) h] and mean residence time [(22.27 + or - 0.52) h] were significantly prolonged (P < 0.01), as well as peak serum concentrations [(9.69 + or - 2.40) mg/L] and AUC(0-t) [(236.7 + or - 13.1) mg x L(-1) x h] were decreased markedly (P < 0.01) as compared with those of IDM regarding to portal vein. Additionally, its AUC(0-t) in peripheral blood was remarkably lower than that in Portal vein (P < 0.01). The tumor suppression observation showed that it could remarkably reduce the number of liver metastases in contrast to IDM (P < 0.05).</p><p><b>CONCLUSION</b>Colon-specific IDM-AM-3 possesses advantage of sustained release in portal vein providing some experimental basis for colon-specific delivery system applied to sustained release in the portal vein.</p>

Meta-analysis of suture techniques for midline abdominal incisions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of suture techniques for midline abdominal incisions with systematic review and meta-analysis.</p><p><b>METHODS</b>The articles about suture techniques for midline abdominal incisions published from year of 1981 to 2009 in MedLine and Embase databases were retrieved. All the trials with a minimal follow-up of one year that randomized patients for midline laparotomy with different suture techniques and/or suture materials were subjected to meta-analysis. The outcomes included incisional hernia, wound dehiscence, wound infection and suture sinus formation.</p><p><b>RESULTS</b>Total of 13 articles were collected in this analysis. Compared with continuous sutures, interrupted sutures had significantly more incisional hernias (OR = 0.80, 95%CI: 0.66 - 1.00;P = 0.05). Continuous rapidly absorbable suture was associated with significantly more incisional hernias than continuous slowly absorbable suture or continuous non-absorbable suture (15.8%, 10.0% and 8.3%, respectively; P < 0.05). More suture sinuses occurred in patients with continuous non-absorbable suture than in those with continuous rapidly absorbable suture (5.6% vs. 1.0%, P < 0.05); And more suture sinuses occurred in patients with interrupted non-absorbable suture than in those with interrupted rapidly absorbable suture (8.8% vs. 0, P < 0.05). Compared with continuous slowly absorbable suture, more suture sinuses occurred in patients with continuous non-absorbable suture (OR = 0.47, 95%CI: 0.24 - 0.92; P < 0.05). Less incisional hernias occurred in patients with a suture length/wound length ratio (SL/WL) of ≥ 4:1 than those with the ratio less than 4:1 (P < 0.05).</p><p><b>CONCLUSION</b>To reduce the incidence of incisional hernia without increasing wound infection frequency, the ideal suture technique is mass closure using a continuous suture, with an adequate suture length/wound length ratio no less than 4:1, the suture materials should be slowly absorbable.</p>

Open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the operation skills and evaluate the effects of open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision.</p><p><b>METHODS</b>From June 2008 to December 2009, 106 patients with inguinal hernia received open total extraperitoneal herniorrhaphy via a ventral midline incision, the clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>Of the patients, 86 cases were male, 20 were female, the mean age was 60.2 years (range, 21 - 86 years). The mean operation time was (32.6 ± 10.5) minutes. The postoperative hospital stay was (2.3 ± 0.7) days. Intra-operative peritoneal perforation occurred in 2 cases. Four cases experienced urine retention and seroma happened in 2 cases, 6 cases suffered early surgical-site pain, and all of the complications were cured with conservative treatment. Three cases developed scrotal hydrocele. No neuralgia or incisional infection occurred in this group. During a 3- to 22-months follow-up period (mean, 10.2 months), no patient complained of discomfort or foreign body sensation in the inguinal area. Two cases recurred 2 and 11 months after the surgery, respectively; the recurrence rate was 1.9%, the two patients healed after reoperation.</p><p><b>CONCLUSIONS</b>Open total extraperitoneal herniorrhaphy operation via a ventral midline incision is a safe, effective and convenient technique for inguinal hernia with few postoperative complications. This method is worth popularizing.</p>