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Chronic critical illness (CCI) refers to a group of critically ill patients who survive the acute phase of intensive care, but with persistent organ dysfunction, thus entering a chronic period of continuous dependence on life support system, and still need to stay in intensive care unit (ICU) for a long time. Persistent inflammatory response-immunosuppression-catabolic syndrome (PICS) is the main pathophysiological feature of CCI. Three factors interact to form a vicious circle, leading to poor prognosis. Nutritional support therapy is a key link in the comprehensive treatment of CCI. Enteral nutrition (EN) should be started as soon as possible if conditions permit. If EN can not be implemented, temporary or transitional parenteral nutrition (PN) should be used, and EN should be added gradually in time. At the same time, the amount of PN should be gradually reduced. When EN meets more than 60% of patients’ energy and protein requirements, PN can be considered to be discontinued. The main strategies and functions of CCI nutritional support therapy are as follows: strengthening high protein supply to correct negative nitrogen balance and inhibit catabolism, selecting branched chain amino acids (BCAA) to promote anabolism, using immunomodulators (arginine, ω3 polyunsaturated fatty acids) to improve immune suppression and inflammatory response, supplementing micronutrients (vitamins and trace elements) to counteract the decrease in intake and the increase in consumption, and adding probiotics to maintain the intestinal microecological balance, and so on. Reasonable nutritional support therapy not only improve malnutrition of CCI patients, but also help to reduce complications, thus speeding up rehabilitation, improving prognosis, shortening ICU hospitalization time, and even reducing mortality.
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Objective To investigate the expression of immunophenotype in gastrointestinal stromal tumors and analyze its clinical value in the diagnosis and prognosis of gastrointestional stromal tumors.Methods Reviewed the clinical data of 323 patients with gastrointestinal stromal tumors in Fuzhou General Hospital of PLA from January 2004 to January 2014.Detected expressions of CD-117,DOG-1,CD-34,alpha-SMA,S-100.Desmin and Ki-67 by immunohistochemical S-P method,frequency statistics,independent sample t test and correlation analysis was carried out with SPSS 20.Results The positive rates of CD-117,DOG-1 and GIST in the group CD-34 were 97％,95.6％ and 86％ respectively,the positive rates of alpha-SMA,S-100 and Desmin were 59.8％,27.7％ and 17％ respectively,the positive expression of CD-117,CD-34,alpha α-SMA and Desmind in intestinal gastrointestinal stromal tumors and gastric gastrointestinal stromal tumors were significantly different,among them (P ＜ 0.05),the positive rates of gastrointestinal stromal tumors and alpha-SMA in intestinal CD-117 were significantly higher than those in gastric gastrointestinal stromal tumors (3.37 vs 2.99,P =0.002;1.59 vs 1.09 P =0.005).The positive expression of CD-34 and Desmin was significantly lower than that of gastric gastrointestinal stromal tumors (1.90 vs 3.02,P =0.000;0.12 vs 0.50,P =0.001).The expression of CD-117 was significantly correlated with location and risk grade (P =0.000,0.002).The expression of DOG-1 was significantly correlated with the risk grade,and the overall survival (P ＜0.05).The expression of CD-34 was significantly correlated with location,size,risk grade,status,and overall survival (P =0.000,0.007,0.016,0.001).There was a significant correlation between the expression of alpha-SMA and location (P =0.036).There was a significant correlation between the expression of S-100 and the overall survival (P =0.036).The expression of Desmin was significantly correlated with the age and location of the first visit (P =0.001).Conclusion In the diagnosis of gastrointestinal stromal tumors,CD-117,DOG 1 and CD-34 combined alpha-SMA and Desmin have good complementation,it is also helpful to judge the location of the intestine and stomach of gastrointestinal stromal tumors,if necessary,it can also be detected by gene mutation,with reference to the level of mitotic figures,which can reduce the misdiagnosis rate and increase the detection rate.
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Nutrition support is an important part of the comprehensive treatment for the critically ill patients with the pathophysiology changes of stress responses related to hypercatabolism, immunity inflammatory reaction disordered and organ dysfunction. Compared with other critical illness, gastrointestinal surgical critically ill patients have the complex characteristics of altered gastrointestinal anatomy and (or) function. Therefore, the nutritional support especially the enteral nutrition support for critical illness patients in gastrointestinal surgery is more difficult and demanding. Mastering the principles, including the timing, route, type and amount of nutrients delivered, and developing an individualized nutritional plan according to the patient's own characteristics, may help to improve its safety and tolerance. Early nutrition support, especially early enteral nutrition, can reduce complications and mortality, enhance recovery and improve outcome for gastrointestinal surgical severely ill patients.
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Humans , Critical Illness , Digestive System Surgical Procedures , Enteral Nutrition , Nutritional SupportABSTRACT
Objective To compare the clinical efficiency between laparoscopic and open complete mesocolic excision for right-sided colon cancer.Methods Between January 2011 and August 2012,a total of 134 patients with right-sided colon cancer who underwent CME at Fuzhou General Hospital of Nanjing Military Command were divided into laparoscopic (71) and open (63) groups.The intraoperative parameters,pathology,postoperative course and short-term outcomes were compared between groups.The chi-test and the student t test were used for statistics.Result There were no significant differences in the length of distal (P=0.427) and proximal margin (P=0.515),tumor diameter (P =0.440) and number of lymph nodes dissected (P =0.377).Postoperatively patients were followed for up to 12 months,no significant differences were found in local regional recurrence rates (4.2％ vs 1.6％) (P =0.622) and distal metastasis rates (5.6％ vs 3.2％) (P =0.684) between the two groups.The mean operative time (P =0.134) and postoperative complication rate (P =0.977) were similar.The mean intraoperative blood loss was less (P =0.000),bowel flatus passed earlier (P =0.000) and hospital stay shorter (P =0.000) in laparoscopic than that in open group.Conclusions Laparoscopic CME has the same oncologic clearance effects and short-term follow-up result compared with open CME for right-sided colon cancer,and laparoscopic CME is minimally invasive,less bleeding,less pain and quick recovery.
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Objective To compare the clinical safety and efficacy of complete mesoeolic excision (CME) for right-hemi colorectal cancer with traditional surgical treatment.Methods Collectting the clinical data of 69 cases,who randonly divided into two groups,A group induced 38 cases and were implemented regular CME,and B group induded 31 cases which were implemented traditional surgery of right-hemi colorectal cancer patients from the Department of General surgery,Fuzhou General Hospital of Nanjing Military Region from Jan.1 2010 to Oct.1 2010,and comparing the safety and efficacy.Results The differences between and traditional surgery in terms of operation time,blood loss,exhaust and defecation time,hospitalization time,the rate of postoperative complication,the number of removed lymph node of Ⅰ and Ⅱ phase,3-year recurrence rate of Ⅱ phase,3-year survival rate of Ⅱ phase and the number of removed lymph node of Ⅲ phase in mesentery root were not significant.The differences in terms of the number of removed lymph node of Ⅲ phase(22.76 ± 6.94,15.11 ± 7.85),3-year recurrence rate of Ⅲ phase(5.88％,45.45％),3-year survival rate of Ⅲ phase (94.12％,63.64％),the total number of removed lymph node(20.56 ± 7.11,13.92 ± 6.62),3-year overall recurrence rate(7.89％,29.03％)and 3-year overall survival rate (94.74％,77.42％) were significant.Conclusions Comparing with traditional surgery,CME significantly benefits the patients of right-hemi colorectal cancer with stage Ⅲ,but not for patients with stage Ⅰ and Ⅱ.
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Mesenehymal stem cells(MSCs)have been successfully isolated from almost all tissues in Mammals,and their multi-lineage differentiation ability leads to the attractive application of MSCs in regenerative medicine.More understanding of the biological characteristics of MSCs,the interaction between MSCs and the local environment,the molecules regulating MSC homing and differentiation have been achieved,which will benefit the effective clinical trials using MSCs as repair cells and/or vehicles for exogenous genes.
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ObjectiveTo investigate the protection effect of bifidobacterial adhesin for intestine ischemia/reperfusion (I/R) injury on gut barrier function in rat.MethodsSeventy-two male SD rats were randomly divided into sham operation group (n =24), I/R model group (n =24) and pretreatment group of bifidobacterial adhesin (pretreatment group, n = 24).Six rats were anatomized at 6 h, 1 d, 4 d and 7d after inducing I/R model in each group, respectively.The pathological changes of the terminal ilea and the blood levels of TNFα, IL-6, IL-10, diamine oxidase (DAO), and the activity and content of D-lactic acid were observed.ResultsThe blood levels of TNFα, IL-6, DAO and D-lactic acid in I/R model group were significantly higher than sham operation group at all time points (P ＜0.05) , while the blood level of IL-10 was no significantly change.The activity of IL-6 and DAO in pretreatment group was significantly lower than I/R model group at all time points (P ＜ 0.05), the blood level of TNFαt in pretreatment group was significantly lower than I/R model group at 1 d, the blood level of D-lactic was significantly lower than I/R model group at 4 d and 7 d (P ＜ 0.05). Intestinal pathological damages were obviously milder in pretreatment group than I/R model group at all time points (Chiu's pathological scores: 6 h, 3.22 ±0.22 vs 3.57 ±0.20;1 d,3.77 ±0.13 vs 3.90 ±0.12;4 d,2.93 ±0.23 vs 3.07 ±0.21;7 d,2.10 ±0.30 vs 2.22 ±0.17,all P ＜ 0.05).ConclusionThe pretreatment of bifidobacterial adhesin could protect the intestinal mucosa from I/R injury, and alleviate intestinal ischemic reperfusion injury.
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Objective To detect the spreading scope of rectal cancer to mesorectum by RT PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. Methods Forty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT PCR using CEA as a marker. Results Nine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages,the infiltrated depth of bowel wall, tumor differentiation and tumor type( P 0.05). Conclusion The excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.
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Objective: According to heparanase’s gene sequence of gene bank, to construct heparanase gene-targeted small interfering RNA (siRNA)and its expression vector and to observe its interfering effect on the expression of heparanase gene in human malignant breast cancer MDA-MB-231 cells. Methods: Heparanase gene-targeted hairpin siRNA was designed, two complementary oligonucleotide strand was synthesized and inserted into pGPU6/GFP/Neo vector,which was identified by sequence identify. Human malignant breast cancer MDA-MB-231 cells were transfected with the constructed vector with lipofectamine method. Western blot was per-formed to evaluate the expression of heparanase protein. Results: Four kinds of heparanase gene-targeted hairpin siRNA were designed, and were inserted into pGPU6/GFP/Neo vector after annealing. The vector containing siRNA was proved to be right by sequencing. The result of Western blot indicated that the expression of heparanase could be degraded by siRNA. Conclusion: The expression of heparanase can be degraded by siRNA method, and HPSE-A and HPSE-B showed the best results.
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Objective: To observe the effects of early enteral nutrition(EEN) on incidence of postoperative complication in gastric cancer patients. Methods: 150 patients with gastric cancer were randomly divided into early enteral nutrition group (n=82) and non-early enteral nutrition (N-EEN) group (n=68). The patients in group EEN were given enteral nutrition after operation, and the patients in group N-EEN were given total parenteral nutrition support. The postoperative complications were recorded. The serum albumin, prealbumin and transferrin were measured on postoperative day 1, 5 and 9. The serum level of alanine aminotransferase(ALT), bilirubin, blood urea nitrogen(BUN), creatinine, glucose, cholesteroland triglyceridewere monitored. Results: The complications occurred in 21patients. 5 of these patients belonged to EEN group and the other belonged to N-EEN group. In EEN group, the serum albumin, prealbumin and transferrin were significantly higher than in N-EEN group on postoperative day 9 (P