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Objective: The study was designed to observe the effects of alanyl-glutamine (Aln-Gln) dipeptide on postoperative intestinal permeability and systemic inflammatory response.Methods: A prospective,randomized and controlled trial was taken.20 patients who underwent abdominal surgery were randomized into two groups: study group (intravenous administration of Aln-Gln dipeptide,0.5 g /(kg·d),for 4 days,n=10) and control group (equal normal saline as placebo,for 4 days,n=10).Temperatures,heart rates and respiration rates of all patients were daily recorded during administration.The white blood cell counts ,serum concentrations of glutamine (Gln),diamine oxidase (DAO) and interleukin-6(IL-6) and urine lactulose/mannito (L/M) ratio were measured before and after operation.Results: Serum Gln concentration was significantly decreased in control group and increased in study group on postoperative day 5.Urine L/M ratio,serum concentrations of DAO and IL-6 were significantly increased in control group and decreased in study group.The morbidity of SIRS was significantly decreased in the study group and the score of SIRS was also lower than in the control group.Conclusions: Administration of Aln-Gln dipeptide can increase the level of serum Gln,decrease the intestinal permeability,maintain the intestinal barrier and attenuate the systemic inflammatory response in the early period of postoperative patients.Aln-Gln dipeptide can be used in the fast track surgery to help patients recover rapidly.
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Objective Albumin is well known to decrease in response to sepsis, However, the.degradation and distribution in patients with severe sepsis to explore the mechanism of hypoalbuminemia in sepsis. Methods 10 volunteers and 10 patients with severe sepsis. 125I labeled albumin was administered intravenously to 10 healthy volunteers and 10 patients with severe sepsis. Each subject had frequent blood samples taken at 0,1,2,4,8,12,24 hours and on day 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, 18, 22, 25 to measure 125I concentration and draw the curve of concentration over time. Plasma was regarded as the central pool and body fluid as side pool, The curve of albumin concentration vs time was expected to follow two compartment model. Results Radioactivity of blood samples was counted and the results were graphically expressed. The half-life time(t1/2), apparent volume of distribution(Vd) and transportation rate(K12) of albumin from the central pool to the side pool were calculated. The half-life time in sepsis was obviously shorter than that in control group (8.2 1.4 vs 12.5 1.7days, P<0.001). The transportation rate in sepsis group was quicklier than that in control group [(4.4±1.9)× 10-2/h vs (2.4±0.6)×10-2/h, P<0.005]. There was no significant difference in apparent volume of distribution between two groups. Conclusions In patients with severe sepsis, the distribution rate of albumin from plasma to body fluid was obviously elevated and the decomposition rate of albumin was markedly increased.
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Objective: The study was designed to observe the effects of alanyl-glutamine (Aln-Gln) dipeptide on postoperative intestinal permeability and stress response. Methods: A prospective, randomized and controlled trial was taken. 20 patients who underwent abdominal surgery were randomized into two groups: study group [intravenous administration of Aln-Gln dipeptide, 0.5 g/(kg?d), for 4 days, n=10 and control group (normal saline as placebo, for 4 days, n=10)]. Serum concentrations of glutamine (Gln), diamine oxidase (DAO), cortisol, interleukin-6(IL-6) and urine lactulose/mannito (L/M) ratio were measured before and after operation. Results: Serum Gln concentration was significantly decreased in control group and increased in study group on postoperative day 5.Urine L/M ratio was significantly increased in control group and decreased in study group.The serum concentrations of DAO,cortisol and IL-6 were significantly decreased in study group while compared with control group. Conclusion: Administration of Aln-Gln dipeptide can increase the level of serum Gln,decrease the intestinal permeability and attenuate the stress response in the early period of postoperative patients. Aln-Gln dipeptide can be used in the fast track surgery.
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Objective: To study the intestinal permeability,body component analysis and their relationship in pancreatic cancer patient.Methods: A prospective,randomized and controlled trial was taken.15 patients with pancreatic cancer were chosen as experimental group and 15 healthy volunteers as control group.Urine lactulose/mannito ratio(L/M),concentration of TNF-? in serum and body component were measured.The correlations between intestinal permeability,serum TNF-? level and body component analysis were accounted for in experimental group.Results: ①The urine L/M ratio and concentration of TNF-? were significantly increased in experimental group compared with control group(P
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Objective:The study was designed to observe the change of intestinal permeability and its relationship with serum proteins in patient with pancreatic cancer. Methods: A prospective and controlled trial was taken. 15 patients with pancreatic cancer were chosen as experimental group. 15 healthy volunteers were as control group. Urine lactulose/mannito(L/M) ratio, serum concentration of TNF-? and serum levels of albumin(ALB), transferritin (TF) and prealbumin (PA) were measured. Results: The urine L/M ratio was significantly increased in experimental group compared with control group(0.331 vs 0.129, P
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s: Pancreatic cancer remains a major unsolved health problem.Over the past decade,antiproliferative effects of somatostatin and analogs have been reported in many somatostatin receptor-positive normal and tumor cell types.Somatostatin and analogs act through five somatostatin receptors(SSTR1-5)which are variably expressed in normal and tumor cells.The present review focuses on recent advances in biological mechanisms involved in the antineoplastic activity of somatostatin and analogs.
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0.05) and hospital mortality(both 3.1%) between the two groups.All the pancreatic fistula patients were cured by non-surgical treatment.Conclusion: The comparative study of the two reconstructive techniques revealed no difference in the incidence of pancreatic fistulas following pancreaticoduodenectomy.
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<p><b>OBJECTIVE</b>To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP).</p><p><b>METHODS</b>Thirteen ANP patients were involved in this study, including 4 females and 9 males, averaging 50.6 +/- 10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8.9 +/- 2.1. CVVH was maintained for at least 72 hours and the AN69 hemofilter (1.2 m(2)) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993.9 +/- 983.0 ml/h, the blood flow rate was 250 - 300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant.</p><p><b>RESULTS</b>CVVH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICU mortality of 23.1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE II score before CVVH was 15.2 +/- 6.5, but decreased significantly to 8.1 +/- 5.3, 7.5 +/- 4.9 and 8.0 +/- 5.2 at the 24th, 48th and 72nd hour after CVVH, respectively (P < 0.01). Serum concentration of IL-1beta and TNFalpha decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later. After CVVH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1beta and TNFalpha was 0.33 +/- 0.11 and 0.16 +/- 0.08.</p><p><b>CONCLUSION</b>CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1beta and TNFalpha; CVVH at early stages of SAP may contribute to the improvement of outcome.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Hemofiltration , Interleukin-1 , Pancreatitis, Acute Necrotizing , Therapeutics , Tumor Necrosis Factor-alphaABSTRACT
Objectives:To study the effects of glutamine on the change of intestinal permeability and investigate its relationship with systemic inflammatory response in abdominal postoperative patients. Methods: A prospective, randomized, double blind and controlled trial was taken. 20 patients who underwent abdominal surgery were randomized into two groups: Gln group(orally administrated glutamine, 30 g/d, for 7 day, n =10) and placebo group(orally administrated placebo, 30 g/d, for 7 day, n =10). Temperatures and heart rates of all patients were daily recorded during administration. The white blood cell counts and biochemical variables were measured before operation and days 4 and 7 after administration. Serum concentrations of glutamine, endotoxin, diamine oxidase and malondialdehyde and urine lactulose/mannito(L/M) ratio were measured before and the 7th day after administration. Results:The patients in the two groups were comparable prior to the administration. Serum Gln concentration was significantly decreased in placebo group and increased in Gln group after 7 days of administration. Urine L/M ratio was significantly increased in placebo group and decreased in Gln group. The serum concentrations of endotoxin, diamine oxidase and malondialdehyde were significantly decreased in Gln group when compared with those in placebo group. Temperatures, heart rates and WBC counts were significantly lower in Gln group than in placebo group. Conclusions:The gut is one of the sources of the systemic inflammatory response in abdominal postoperative patients and the glutamine can decrease the intestinal permeability,maintain the intestinal barrier and attenuate the systemic inflammatory response in the early period of postoperative patients.
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Bacterial translocation and endotoximia occurs in consequence of increased intestinal permeability after trauma. Glutamine can decrease intestinal permeability and improve the intestina mucosal barrier.
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Objectives:To observe the effect of metabolic intervention of anti TNF antibody on the hypermetabolism occurred in intra abdominal infection(IAI) complicated by multiple organ dysfunction syndrome(MODS). Methods:Twenty rabbits were operated on with cecal ligation plus puncture(CLP) inducing IAI and MODS and were randomly divided into two groups, one receiving the anti TNF serum raised against TNF ?(anti TNF group) at 0.5?h after CLP and another receiving the non specific serum (control group). All animals were placed in metabolic cages and maintained with intravenous infusion for the observation period of one week. Serum levels of cytokines(TNF, IL 6), hormones (cortisol, insulin, glucagon), biochemical indexes (glucose, cholesterol, triglyceride, albumin) and daily excretions of urea nitrogen (UN),creatinine (Cr) and 3 methylhistidine (3 MH) were dynamically determined for 7 days. The death of animals was also recorded. Results:Compared with the control group, the levels of serum TNF, IL 6 and cortisol were significantly decreased and the levels of insulin and glucagon were kept normal after the injection of immune serum in anti TNF group, with significant improvements of biochemical indexes and decreased excretions of UN, Cr and 3 MH in urine. The survival rate was significantly increased in the anti TNF group. Conclusions:The anti TNF antibody can attenuate the metabolic abnormalities of IAI and MODS, being of the metabolic intervention on the hypermetabolism.
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Sports fatigue was pivotal subject in the research of sports science.The effect of nutrition supplement on the elimination of sports fatigue was reviewed.
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It is still difficult to achieve optimal nutritional effect in the septic patient.The objectives of this prospective study are to determine the effect of increasing N intake on the metabolic response to TPN in the septic patient,containing either0 .2 5 g N/ (kg? d) or0 .35 g N/(kg? d) .On the high- but not the low- N intake there were further beneficial effects on net protein levels in blood and nitrogen balance.The results showed that TPN containing high N instake can further achieve nitrogen bal- ance in the septic patient,although it may stimulate the catabolism of protein and further evoke the stress to responses.
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The study was designed to observe the effects of fructose- 1 ,6 - diphosphate (FDP) on the stressed patients who were supported with total parenteral nutrition (TPN) after gastrectomy.Twelve cases of patients with gastric cancer were randomly divided into two groups.The control group was supported by TPN,and the FDP group received TPN plus FDP.The resulshowed thatin FDP group the serum levels of cortisol and glucogon declined and the urine 3- methyl- histidine excretin decreased with a better cumulative nutrogen balance when compared with control group.It sug- gested that FDP may lessen the protein catabolism and improve the results of nu- tritional support in stressed patients after trauma or surgical operation.
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Objective To evaluate spiral CT in diagnosing vascular complications of pancreatitis. Methods The clinical and surgical results and the CT findings of 316 patients with acute or chronic pancreatitis were comparatively analyzed. Special attention was paid to the CT findings of the patients with peritoneal hemorrhage and vascular abnormality. CT Hu of celiac blood effusion was measured. Pseudoaneurysms, phlebothrombosis and venous thrombosis of peripancreatic vessels in CT enhancement were carefully analyzed. Results Acute pancreatitis was found in 275 out of the 316 patients, and chronic pancreatitis in 41 cases. Among those with acute pancreatitis, 20 had peritoneal cavity vascular complications. In the 13 cases of peritoneal cavity hemorrhage(including 5 patients complicated with digestive tract hemorrhage), CT identified 11 with as regional or diffuse slight high density fluid collections, and failed in 2 cases. CT scans detected gastric varices in 4 out of 7 patients with digestive tract hemorrhage. Of those with chronic pancreatitis, CT found celiac artery pseudoaneurysm in one, spleen artery pseudoaneurysm in one and splenic vein thrombosis with gastric varices in one. Conclusions (1)Regional or diffuse slight high or high density fluid collections were common CT findings of peritoneal cavity hemorrhage. (2)Enhanced spiral CT scanning could demonstrate peripanreatic vascular pseudoaneurysms. (3)Varices in gastric fundus and necrosis in pancreatic body and tail often indicate the formation of spleen venous thrombosis.
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Objective: The study was designed to observe the effects of alanyl-glutamine(Aln-Gln) dipeptide on postoperative intestinal permeability and immmunologic function in abdominal patients. Methods: A prospective,randomized and controlled trial was taken.20 patients who underwent abdominal operation were divided into two groups: study group(intravenous administration of Aln-Gln dipeptide,0.5 g/(kg?d),for 4 days,n =10) and control group(equal normal saline as placebo,for 4 days,n =10).Serum concentrations of glutamine(Gln) and diamine oxidase(DAO),blood total lymphocyte count(TLC) and human leukocyte antigen(HLA)-DR and urine lactulose/mannito(L/M) ratio were measured before and after operation. Results: Serum Gln concentration was significantly decreased in control group and increased in study group on postoperative day 5.Urine L/M ratio and serum DAO level were significantly increased in control group and decreased in study group after operation.Blood TLC and HLA-DR expression in the study group were significantly higher than those in control group on postoperative day 5. Conclusion: Intravenous administration of Aln-Gln dipeptide can increase the serum Gln level,decrease the intestinal permeability,maintain the intestinal barrier and improve the immmunologic function in the early period of postoperative patients.Aln-Gln dipeptide can be used in the fast track surgery to help patients recover rapidly.
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Multiple organ failure (MOF) is a severe complication induced by intra-abdominal sepsis (IAS) in surgical patients. The study was planned to evaluate the role of metabolic support with different formulas of nutrient substants in 42 rabbits of MOF model which was establishei before. The results showed that metabolic support in the early stage of MOF induced by IAS coul increase body weight in varying degree, promote protein synthesis and decrease protein degration in rabbits. Lower non-protein calorie supplied with glucose might decrease stress response, increase nitrogen retention and improve lung function. Overloads of amino acid nitrogen could increase stress response, increase urinary nitrogen excretion and deteriorate the respiratory function.