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OBJECTIVES@#To study the influence of enteral feeding initiation time on intestinal flora and metabolites in very low birth weight (VLBW) infants.@*METHODS@#A total of 29 VLBW infants who were admitted to the Department of Neonatology, Children's Hospital of Chongqing Medical University, from June to December, 2020, were enrolled as subjects. According to the enteral feeding initiation time after birth, the infants were divided into two groups: <24 hours (n=15) and 24-72 hours (n=14). Fecal samples were collected at weeks 2 and 4 of hospitalization, and 16S rDNA high-throughput sequencing and gas chromatography-mass spectrometry were used to analyze the microflora and short-chain fatty acids (SCFAs) respectively in fecal samples.@*RESULTS@#The analysis of microflora showed that there was no significant difference between the two groups in Chao index (reflecting the abundance of microflora) and Shannon index (reflecting the diversity of microflora) at weeks 2 and 4 after birth (P>0.05). The analysis of flora composition showed that there was no significant difference in the main microflora at the phylum and genus levels between the two groups at weeks 2 and 4 after birth (P>0.05). The comparison of SCFAs between the two groups showed that the <24 hours group had a significantly higher level of propionic acid than the 24-72 hours group at week 4 (P<0.05), while there was no significant difference in the total amount of SCFAs and the content of the other SCFAs between the two groups (P>0.05).@*CONCLUSIONS@#Early enteral feeding has no influence on the diversity and abundance of intestinal flora in VLBW infants, but enteral feeding within 24 hours can increase the level of propionic acid, a metabolite of intestinal flora.
Subject(s)
Child , Humans , Infant , Infant, Newborn , Enteral Nutrition/methods , Fatty Acids, Volatile , Gastrointestinal Microbiome , Infant, Very Low Birth Weight , Propionates , Prospective StudiesABSTRACT
Objective:To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy,our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation.Methods:Having approved by hospital ethical committee and local government administration,a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb.2016 in our department.Under general anaesthesia,the operation was performed through 3 lumbar ports.After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed.Then the kidney was taken out quickly and flushed with 4 ℃ kidney preserving fluid immediately,the donor kidneys were then preserved in iced saline until kidney transplantation.Clinical data about operation time,volume of blood loss,perioperative complications,renal function of both donors and recipients before and after operation were collected.Results:The 193 retroperitoneal laparoscopic living donor nephrectomy operations were successful with only one operation was converted to open living donor nephrectomy because of hemorrhage and unclear operation field during the operation.The average operation time was 85 min (55-135 min),the average blood loss was 60 mL (20-200 mL),and no donor needed blood transfusion during or after operation.Three donors were found to have hematoma of renal fossa after operation and none of them required further treatment.The average hospital stay after operation was 5.7 days (4-9 days).In the study,162 donors were followed up for an average of 42 months (1-58 months) and they were all healthy.Two kidney recipients had urinary bladder anastomosis leakage after operation and both needed surgical repair,a new anastomosis of ureter and bladder were made.Three kidney recipients had kidney subcapsular hematoma but required no further treatment.One kidney recipient had delayed graft function and recovered finally and the renal function of other recipients were all normal.Renal function of both donors and recipients during the follow up period were normal.Conclusion:Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable technique,it may become a standardized operation for living kidney transplantation after continuous technical improvement.Precautions must be taken to avoid complications and a skilled hand is necessary for success.
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Objective: To investigate the efficacy of patients with cancer-induced bone pain (CIBP) treated with morphine in combination with dexamethasone through intrathecal pumping injection and its mechanism. Methods: Seventy-six patients with CIBP undergoing implantation of an infusion port with intrathecal catheter were randomly divided into group A (n = 38, intrathecally injected with morphine alone and group B (n = 38, intrathecally injected with morphine in combination with dexamethasone). The pain relief degree by 11-Point Numeric Rating Scale (NRS-11) score, the frequency of breakthrough pain, quality of life and SF-36 scale score were evaluated before treatment and the 1st, 3rd and 7th days after the beginning of intrathecal pumping. On the 7th day after treatment, the concentrations of â-endorphin (â-EP) and motilin in plasma as well as prostaglandin E2 (PGE2), substance P (SP) and calcitonin gene-related peptide (CGRP) in cerebrospinal fluid (CSF) were determined. Results: The pain was relieved significanly in group B, and the frequencies of breakthrough pain per day were less than those in group A on the 1st, 3rd and 7th days after treatment (all P 0.05); in group B, the SF-36 scale score and quality of life were both improved significantly on the 3rd and 7th days after treatment as compared with those of group A (all P 0.05), but the motilin level in plasma in group B was significantly higher than that in group A (P < 0.05); the PGE2, SP and CGRP levels in CSF in group B were significantly lower than those in group A (all P < 0.05). Conclusion: Intrathecal pumping injection of morphine in combination with dexamethasone can be of great help in decreasing the frequency of breakthrough of CIBP, improving the quality of life, and increasing the motilin level in plasma, but decreasing PGE2, SP and CGRP levels in CSF which may contribute to alleviating the tolerance of morphine, thus enhance the analgesic effect.
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<p><b>OBJECTIVE</b>To compare the effect of different types and concentrations of sweet solutions on neonatal pain during heel lance procedure.</p><p><b>METHOD</b>Totally 560 full term neonates (male 295, female 265) were randomized into 7 groups:placebo group (plain water), 10% glucose, 25% glucose, 50% glucose, 12% sucrose, 24% sucrose and 30% sucrose groups.In each group, 2 ml corresponding oral solutions were administered through a syringe by dripping into the neonate's mouth 2 minute before heel lance. The procedure process was recorded by videos, from which to collect heart rate, oxygen saturation and pain score 1 min before puncture, 3, 5 and 10 min after puncture.</p><p><b>RESULT</b>The average heart rate increase 3, 5 and 10 min after procedure in the 25% and 50% glucose groups, 12% and 24% and 30% sucrose groups was significantly lower than those in the placebo group (P < 0.01 or 0.05). The average heart rate increase 3 min after procedure in the sucrose group was lower than that in the glucose group (P < 0.01).Neonates who received 30% sucrose has a significantly lower average heart rate increase than those who received 12% and 24% sucrose 3 min after heel lance (both P < 0.05) . The average oxygen saturation decrease 3, 5, 10 min after procedure was significantly lower than those in the placebo group (P < 0.01). The average oxygen saturation decrease 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P < 0.01). The average pain score 3, 5, 10 min after procedure was significantly lower than those in the placebo group (P < 0.01). The average pain score 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P < 0.01).</p><p><b>CONCLUSION</b>Oral administration of sweet solutions is an effective way to relieve neonatal pain on procedure, and sucrose has a better pain relief action than glucose, moreover, 30% sucrose provides better effect in control of heart rate increase 3 min after heel lance, but the best concentration of sucrose for pain relief needs further study.</p>