Mechanism of Qingfei Huatan Zhuyu Decoction in Treatment of COPD Based on "Lung and Intestinal Co-treatment" / 中国实验方剂学杂志

ObjectiveTo observe the effect of Qingfei Huatan Zhuyu decoction on the lung and intestinal function of rats with chronic obstructive pulmonary diseases （COPD） and explore the deep-seated mechanism of its embodiment of lung and intestinal co-treatment. MethodA total of 60 Wistar rats were randomly divided into six groups， with 10 rats in each group， and the groups were control group， model group， acute syrup group （10 g·kg-1·d-1）， and low， medium， and high-dose groups （10， 15， 20 g·kg-1·d-1） of Qingfei Huatan Zhuyu decoction. The COPD rat model was established by lipopolysaccharide tracheal drip combined with the smoke inhalation method， and the acute syrup group and the Qingfei Huatan Zhuyu decoction group were administered by gavage with corresponding dose concentrations respectively， while the rest groups were controlled by saline gavage， and the lung function and blood gas indexes of rats were monitored after the last administration. The histopathological changes in the lung and intestine were observed microscopically. The expression of serum interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and secretory immunoglobulin A （IgA） in colon tissue were measured by enzyme-linked immunosorbent assay （ELISA）. The biochemical indexes such as serum diamine oxidase （DAO）， D-lactic acid， and malondialdehyde （MDA） were measured. Immunohistochemistry was used to detect the expression of tight junction protein （Occludin） in rat colon tissue. The expression of F4/80 positive alveolar macrophages in rat lung tissue， and the expression of α-actin （α-SMA） and colonic atresia small band protein-1 （ZO-1） were determined by immunofluorescence. The protein expression of p-NF-κB p65， NF-κB p65， p-p38 MAPK， and p-p38 MAPK and the expression of Occludin and ZO-1 in colon tissue were detected in rat lung tissue by Western blot. ResultCompared with the normal group， the model group had pulmonary dysfunction， reduced forced vital capacity （FVC）， arterial partial oxygen pressure （PaO2）， arterial oxygen saturation （SaO2）， and dynamic lung compliance （Cdyn） （P<0.01）， and the pathological changes in the lung and intestine were obvious. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were increased （P<0.05，P<0.01）， and the protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue was increased. The expression of F4/80 positive macrophages in lung tissue was enhanced. The expression of IgA， Occludin， and ZO-1 in colon tissue decreased （P<0.05，P<0.01）. Compared with the model group， the pulmonary function of the rats in the acute syrup group and groups of Qingfei Huatan Zhuyu decoction was significantly improved， and the FVC， PaO2， SaO2， and Cdyn were increased （P<0.05， P<0.01）. The pathological changes in the lung and intestine were significant. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were decreased （P<0.05，P<0.01）， and the expressions of F4/80 positive macrophages in lung tissue were decreased （P<0.01）. The protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue decreased （P<0.01）， and the expression of IgA， Occludin， and ZO-1 in colon tissue increased （P<0.01）. ConclusionQingfei Huatan Zhuyu decoction can effectively reduce the symptoms of COPD rats， and its mechanism of action is related to inhibiting the inflammatory response of lung tissue and improving the barrier function of the intestinal mucosa.

Research progress on early enteral nutrition in critically ill patients / 中华临床营养杂志

Intestinal barrier function impairment can lead to bacterial and toxin translocation in critically ill patients and is an important factor in gut-derived infections and even multiple organ failure. Early enteral nutrition (EEN) can nourish the intestine, prevent bacterial translocation, effectively maintain intestinal barrier function and immune function and provide metabolic substrates for the body, bringing clinical benefits. For critically ill patients such as those with severe acute pancreatitis, severe burns and severe traumatic brain injury and those after major abdominal surgery, there is evidence-based proof supporting EEN while in patients with uncontrolled shock and severe hypoxemia and acidosis, the initiation of EEN should be delayed. EEN in critically ill patients can be applied orally or through nasogastric tube. Dietary fiber-free intact protein preparations are recommended at initiation and administration via continuous pumping can improve EEN gastrointestinal tolerability.

Relationship between intestinal flora and intestinal barrier dysfunction in patients with sepsis / 中华急诊医学杂志

Objective:To explore the relationship between intestinal flora disorder and intestinal barrier dysfunction in patients with sepsis.Methods:A prospective observational study was conducted to include 10 patients with sepsis (sepsis group) admitted to the ICU of General Hospital of Ningxia Medical University from February 2017 to June 2017, 10 normal postoperative patients (non-sepsis group) admitted to the ICU of General Hospital of Ningxia Medical University in the same period, and 10 healthy persons (control group) were served as controls. General information was recorded. Fecal samples of the three groups of experimental subjects were detected and analyzed by using 16S rRNA gene sequencing technology. The venous blood of the sepsis and non-sepsis groups were collected and the levels of D-lactic acid and bacterial endotoxin in were measured by enzymatic method at the corresponding time points. The correlation between the levels of D-lactic acid and bacterial endotoxin and intestinal flora of patients with sepsis was analyzed.Results:The change consistency of pathogenic bacteria between clinical infection and intestinal pathogenic bacteria in patients with sepsis was observed and analyzed. Sputum culture of patients with sepsis was Acinetobacter baumannii (corresponding patient number: S5, S6, S8), Stenotrophomonas maltophilia (corresponding patient number: S6, S7), and Enterococcus (corresponding patient number: S7). In the intestinal flora of corresponding patients, the OUT abundance were increased. Patients with sepsis (corresponding patient number S7) showed E. coli in blood culture, and in his intestinal flora the OUT abundance was increased. Correlation analysis showed that the serum D-lactic acid level was negatively correlated with the proportion of Firmicutes in intestinal flora in the non-sepsis and sepsis groups, while was positively correlated with the proportion of Firmicutes (r value: -0.532, 0.468, respectively, P<0.05). Conclusions:The gut microbiota dysbiosis is correlated with intestinal barrier function in sepsis patients with sepsis. The spread of pathogenic bacteria between clinical infection and intestinal bacteria in sepsis patients has potential consistency.

Expert consensus on clinical application of intravenous alanyl-glutamine dipeptide / 中华临床营养杂志

Alanyl-glutamine dipeptide is an important component in parenteral nutrition, which can be decomposed into alanine and L-glutamine in vivo. It plays multiple functions including maintaining intestinal barrier, improving immunity, promoting protein synthesis, and regulating the production and release of inflammatory mediators. Substantial clinical evidences have demonstrated its favorable effectiveness and safety. Rational application of alanyl-glutamine dipeptide can reduce postoperative complications, shorten hospital stay and save medical costs. There are still controversies at home and abroad on the applicable population and dosage of alanyl-glutamine dipeptide. Chinese Society of Parenteral and Enteral Nutrition organized China's experts of related disciplines to compile international standards in accordance with the latest guidelines and consensus, so as to achieve the goal of standardized application and patient benefits.

Regulatory Mechanism of Total Glucosides of Paeony on Gut Microenvironment in Non-obese Diabetic Mice with Sjogren's Syndrome / 中国实验方剂学杂志

Objective:To investigate the effects of total glucosides of paeony （TGPs） on intestinal motility， barrier function， and gut microbiota in non-obese diabetic （NOD） mice with Sjogren's syndrome （SS）. Method:Thirty NOD mice were randomly assigned into the model group （deionized water）， prebiotic fructo-oligosaccharide （FOS） group （700 mg∙kg^-1）， and the low- （160 mg∙kg^-1）， medium- （320 mg∙kg^-1）， and high-dose （640 mg∙kg^-1） TGP groups， with six mice in each group. Moreover， the BALB/c mice were employed as the normal control and administered with deionized water. The food and water intakes， number of discharged fecal particles， and fecal moisture content were observed to evaluate the effect of TGPs on intestinal motility in SS mice. The levels of <italic>D</italic>-lactate （<italic>D</italic>-Lac） content， diamine oxidase （DAO）， and junction-associated protein zonula occludens-1 （ZO-1） in mouse serum were detected by enzyme linked immunosorbent assay （ELISA）. The fecal samples collected at different time points were determined by spread plate method and gas chromatography for uncovering the intestinal microbial communities and the content of short-chain fatty acids. Result:Compared with the normal group， the model group exhibited decreased food and water intakes （<italic>P</italic><0.01）， weakened intestinal propulsion （<italic>P</italic><0.01）， elevated <italic>D</italic>-Lac and DAO （<italic>P</italic><0.05，<italic>P</italic><0.01）， lowered ZO-1 and SCFAs （<italic>P</italic><0.05，<italic>P</italic><0.01）， and reduced number of intestinal bacteria （<italic>P</italic><0.01）. The comparison with the model group revealed that TGPs significantly increased the number of discharged fecal particles and fecal moisture content （<italic>P</italic><0.05，<italic>P</italic><0.01）， enhanced intestinal propulsion （<italic>P</italic><0.05， <italic>P</italic><0.01）， decreased serum <italic>D</italic>-Lac and DAO levels （<italic>P</italic><0.05，<italic>P</italic><0.01）， and up-regulated ZO-1 expression （<italic>P</italic><0.01）. Apart from increasing the proportions of <italic>Bifidobacterium</italic> and <italic>Lactobacillus</italic> and decreasing the proportion of<italic> Enterobacter </italic>in intestinal flora （<italic>P</italic><0.05，<italic>P</italic><0.01）， TGPs also accelerated the production of acetic acid and butyric acid （<italic>P</italic><0.05，<italic>P</italic><0.01）. Conclusion:TGPs attenuate SS-mediated constipation and restore the impaired intestinal barrier function in mice by increasing fecal moisture content， boosting intestinal motility， regulating intestinal microbial communities， elevating acetic acid and butyric acid levels， and up-regulating tight junction protein expression.

Clinical Efficacy of Modified Da Chengqitang by Enema on Treatment if Postoperative Inflammatory Intestinal Obstruction / 中国实验方剂学杂志

Objective: To discuss the clinical efficacy of modified Da Chengqitang by enema in treatment of postoperative inflammatory intestinal obstruction (EPISBO) after the operation and its effect on inflammatory factors, gastrointestinal motility and intestinal barrier function. Method: One hundred and six patients were randomly divided into control group (52 cases) and observation group (54 cases) by random number table. Patients in both groups were given fasting for solids and liquids, gastrointestinal decompression, maintaining water and electrolyte balance, nutritional support and other basic therapies. Patients in control group were given somatostatin for injection for continuous micro-pumping, 0.003 5 mg·h-1·kg-1, dexamethasone acetate tablets, 2.5-5 mg/time, 2 time/days. Patients with concurrent infection got ceftazidime for injection, 30-100 mg·kg-1, 2-3 intravenous drips. In addition to the therapy of control group, patients in observation group were also given modified Da Chengqitang, 125 mL/time, 2 times/days. A course of treatment was 5 days. Time of remission of abdominal distention, recovery of exhaust gas, bowel sounds and diet, defecation, hospitalization and transitional surgery were recorded. And main gastrointestinal symptoms and signs were scored. And levels of serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), vasoactive intestinal peptide (VIP), gastrin, motilin, diamine oxidase and D lactic acid were detected. Result: After treatment, according to rank sum test analysis, the clinical efficacy in observation group was better than that in control group (PPPPα, hs-CRP, VIP, DAO, D-lactic acid and scores of main gastrointestinal symptoms and signs were all lower than those in control group (PPConclusion: In addition of routine therapy of western medicine, modified Dachengqi Tang had effects in resisting inflammation, regulating gastrointestinal hormones, and protecting intestinal barrier function, so can improve gastrointestinal motility, alleviate symptoms, shorten the course of disease and improve the clinical efficacy.

Effects of ulinastatin on rat postoperative ileus and intestinal barrier function / 中国药理学通报

Aim To study the effect of ulinastatin(UTI) on postoperative ileus(POI) and the intestinal barrier function in SD rats. Methods UTI was injected in three doses before, after and during abdominal surgery in SD rats. Evans blue was given by gavage 48 hours after the surgery and gastrointestinal propulsion rate was measured 30 minutes later. The end of ileum was collected for HE staining and AB/PAS staining to make tissue sections. The morphology of the intestinal villi and the number of goblet cells were observed under a light microscope. D-lactate and endotoxin kits were used to evaluate intestinal permeability. cDNA was extracted from the intestinal tissues to detect the levels of inflammatory factors and intestinal barrier-related genes by qPCR. Results In POI model group, the gastrointestinal propulsion rate decreased, and villi structure of small intestine was severely damaged; the levels of D-lactate, endotoxin and inflammatory factor mRNA increased; the number of goblet cells in crypt increased; the levels of MUC2 and MUC3 mRNA increased; the level of HD5 mRNA decreased. Pretreatment with medium dose UTI could significantly reverse the above situation. Conclusions Pretreatment with medium dose UTI can effectively reduce the intestinal inflammation and restore partially the intestinal barrier function in POI rats, thus preventing and treating the decrease of gastrointestinal propulsion rate caused by POI.

Effects of cholesterol-lowering probiotics on intestinal barrier and gut microbiota in mice with non-alcoholic fatty liver disease and the possible mechanisms / 中华微生物学和免疫学杂志

Objective To investigate the effects of cholesterol-lowering probiotics, DM9054 com-bined with 86066, on the intestinal mucosal barrier and gut microbiota in mice with nonalcoholic fatty liver disease ( NAFLD) induced by high-fat diet and the possible mechanisms. Methods Twenty-four male mice deficient in the low-density lipoprotein receptor gene ( Ldlr- / - mice ) were randomly divided into three groups including control, NAFLD model and probiotic intervention groups. Mice in the three groups were given normal chow diet+normal saline, high-fat diet ( HFD)+normal saline, and HFD+cholesterol-lowering probiotics, respectively. The mouse model of NAFLD was established by feeding mice with high-fat diet (45％ of calories derived from fat diet) for 12 weeks. qPCR was performed to measure the expression of liv-er and intestinal inflammatory genes and liver cholesterol synthesis genes. Western blot assay was used to de-tect the expression of intestinal tight junction proteins and HMG-CoA reductase ( HMGCR ) . Pathological changes in tissues were evaluated by HE staining. Features of gut microbiota were analyzed by 16S rRNA gene sequencing. Results Cholesterol-lowering probiotics intervention attenuated HFD-induced hepatic steatosis, inflammatory responses and obesity and decreased the synthesis of liver cholesterol (P<0. 05). Moreover, inhibited gut inflammatory responses and improved intestinal barrier function were detected in the probiotic intervention group (P<0. 05). The composition of gut microbiota in mice of the probiotic intervention group was different from that of the model group, but similar to that of the control group. Con-clusions Cholesterol-lowering probiotics might attenuate NAFLD in mice through reducing liver cholesterol synthesis, alleviating liver and intestinal inflammation, improving intestinal mucosal barrier function and reg-ulating intestinal microbiota.

Research progress on the relationship between sepsis and intestinal barrier function / 国际儿科学杂志

Sepsis is attracting more attention recently, which endangering health of children. The gut, as the largest repository of bacteria, has long been hypothesized to be the motor of multiple organ dysfunc-tion syndrome. The changes are tightly associated with intestinal barrier function, epithelial cells and intestinal permeability. The intestinal commensal microflora is also altered in sepsis, with increases in microbial viru-lence and decreases in diversity, which leads to further pathologic responses within the host. This review focu-ses on the pathogenesis and the relation between sepsis and intestinal barrier function.

Chronic liver disease increases with damage to intestinal barrier function / 中华肝脏病杂志

Objective@#To probe into the correlation between chronic liver disease and intestinal barrier function.@*Methods@#1 491 cases of hospitalized patients were enrolled, of which 741 cases were of chronic liver diseases, including 397 cases of fatty liver diseases, 230 cases of chronic hepatitis, 114 cases of liver cirrhosis, and 750 cases of non-hepatic diseases. All admitted patients’ intestinal barrier function like diamine oxidase (DAO), D-lactate, lipopolysaccharide, and biochemical indicators of liver functions were tested. According to different data, statistical analysis was done using t-test, ANOVA, Dunnett’s test, χ 2 test of fourfold table, Pearson’s correlation, and binary logistic regression.@*Results@#The intestinal barrier dysfunction was more likely to occur in the chronic liver disease group than that of non-hepatic disease group [54.15% (379/741) vs. 18.53% (139/750), χ 2 = 193.58, P < 0.001]. The correlation analysis between biochemical indicators of liver function and intestinal barrier function in chronic liver disease group showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and total bilirubin levels were more susceptible to intestinal barrier dysfunction than those with normal indexes (P < 0.05 ). GGT had stimulated DAO (P < 0.05, OR > 1), D-lactate (P < 0.05, OR > 1), lipopolysaccharide (P < 0.05, OR > 1), ALT and AST.@*Conclusion@#Chronic liver disease increases with damage to intestinal barrier function.

Research advances in Escherichia coli Nissle 1917 and intestinal barrier function / 肠外与肠内营养

Gram-negative bacteria Escherichia coli Nissle 1917 (EcN) is a non-lactobacillus probiotic. It has long been recognized that EcN could colonize in the intestinal tract and has important biological functions through interacting with intestinal epithelial cells and other enteric microorganisms. Intestinal barriers play a key role in maintaining the homeostasis and physiological functions of the intestinal tract, and the impairment of the barrier function is closely associated with the pathogenesis and development of a variety of diseases. Discovery of some probiotic bacteria that could maintain and repair intestinal barrier function is therefore of critical importance, contributing to develop novel strategies for prevention and treatment of some related diseases. Previous studies have demonstrated that EcN has profoundly protective effects on the intestinal barriers. Here, we systematically reviewed the recent progress on the protective roles of EcN playing in the intestinal barriers and the potential mechanisms.

Research progress on relationship between bile acids and intestinal mucosal mechanical barrier function / 中华消化外科杂志

Intestinal mucosal mechanical barrier is one of the most important structure to maintain the body homeostasis.The occurrences of inflammatory bowel disease,necrotizing enterocolitis and poor prognosis of patients with obstructive jaundice are closely related to the damage of the mucosal barrier function.Long-term high fat diet and obstructive jaundice can cause the abnormality of bile acids metabolism.These pathological conditions are often associated with the destruction of intestinal mucosal barrier function.So the correlations between abnormal bile metabolism and intestinal mucosal mechanical barrier function have aroused interests of many researchers.They found that bile acids the important component of bile are closely related to the intestinal barrier function.The paper reviewed the recent articles and summarized the mechanisms of the deficiency of bile acids,excessive bile acids and abnormal bile acids composition damaging the intestinal mucosal barrier function.It will provide reference for the new fields of study,prevention of the toxic effects of bile acids and the improvement of the prognosis of patients.

Effect of general anesthesia combined with epidural anesthesia on gut barrier function in patients undergoing endoscopic radical gastrectomy / 中国基层医药

Objective To investigate the effect of general anesthesia combined with epidural block anesthesia on intestinal barrier function in patients with gastric cancer after radical resection.Methods 90 patients with gastric cancer undergoing laparoscopic radical resection were selected.They were randomly divided into observation group (epidural anesthesia plus general anesthesia) and control group (general anesthesia),45 cases in each group.The intraoperative blood loss,intraoperative infusion volume,postoperative exhaust time,postoperative complications and the function of intestinal barrier effects were compared between the two groups.Results The total incidence rate of postoperative complications in the observation group(8.89％) was significantly lower than that in the control group (28.89％) (x2 =4.83,P ＜ 0.05).The hospital stay in the observation group [(12.5 ± 4.23) d] was significantly shorter than that in the control group [(17.5 ± 5.26) d] (t =3.27,P ＜ 0.05).The two amine oxidase [(3.88 ± 0.98) U/L],D-lactic acid [(7.44 ± 5.23) mg/L],endotoxin [(13.44 ± 2.12) U/L] levels of the observation group were significantly lower than those of the control group [two amine oxidase (11.33 ± 1.25) U/L,D-lactic acid (15.34 ±3.21) mg/L,endotoxin (21.03 ± 0.82) U/L] (t =5.63,5.02,4.19,all P ＜ 0.05).Conclusion Compared with total intravenous anesthesia,total intravenous anesthesia combined with epidural anesthesia is beneficial to the recovery of intestinal barrier function after radical gastrectomy,and can shorten the postoperative hospital stay.It is worthy of clinical application and popularization.

The effect of enteral immunonutrition on intestinal barrier function and immune function in patients with severe pneumonia / 肠外与肠内营养

Objective:To investigate the effects of enteral immunonutrition on the intestinal barrier function and immune function in patients with severe pneumonia.Methods:Ninety patients with severe pneumonia were randomly divided into experimental group (n =45) and control group (n =45).All patients were received conventional therapy.In addition,patients in experimental group were given enteral immunonutrition,while patients in control group were given regular enteral nutrition.The changes of general conditions,intestinal barrier function index and immune function index were determined before treatment,on day 5 and 10 after treatment.The time of invasive mechanical ventilation,APACHE Ⅱ score and clinical effects of two groups were determined on day 10 after treatment.Results:Compared with those before treatment,in both groups,body temperature,respiration,heart rate,white blood cell count were all significantly decreased on day 5 and 10 after treatment (P ＜ 0.05).The above parameters were significantly lower in experimental group than control group on day 10 after treatment (P ＜ 0.05).The levels of serum ET,DAO were significantly decreased on day 5 and 10 after treatment in two groups compared with those before treatment (P ＜ 0.05),and these parameters were significantly lower in experimental group than control group(P ＜0.05).The number of CD3 and CD4 positive cell and the ratio of CD4 +/CD8 + were significantly increased on day 5 and 10 after treatment in two groups when compared with those before treatment (P ＜ 0.05),and these parameters were higher in experimental group than those in control group(P ＜ 0.05).The time of invasive mechanical ventilation,APACHE Ⅱ score were lower in experimental group than those in control group on day 10 after treatment (P ＜ 0.05).The rate of clinical response were higher in the experimental group than that in the control group on day 10 after treatment (P ＜ 0.05).Conclusion:Enteral immunonutrition is more effective in protecting the intestinal barrier function,improving the immune status,enhancing the immunity,reducing the time of invasive mechanical ventilation,and achieving the clinical effects of patients with severe pneumonia.

Effects of mesalamine on the expression of TNF-α, IL-6, IL-17 and intestinal barrier function with ulcerative colitis / 中国生化药物杂志

Objective To investigate the effect of mesalazine on the expression of TNF-α, IL-6, IL-17 and intestinal barrier function in patients with ulcerative colitis. Methods 76 patients with UC from January 2015 to April 2016 in The Fifth Central Hospital of Tianjin were collected and randomly divided into control group and observation group with 38 cases in each group. After admission were given maintenance of water and electrolyte, basic acid-base balance and nutritional support treatment, and the control group were treated with conventional drug sulfasalazine (SASP) treatment, two tablets each time, four times once day, four weeks for each course, the observation group was treated with mesalazine, four tablets each time, three times once day, four weeks each course of treatment. The levels of TNF-α, IL-6, IL-17, L/M and Baron endoscopic scores in the two groups were observed after two courses of treatment. The efficacy and side effects of the two groups were compared. Results No dropout or dropout cases in this study, two groups after the treatment of TNF-α, IL-6, IL-17, L/M, Baron scores were significantly decreased (P<0.05), but the observation group after treatment the above indexes were all significantly lower than the control group (P<0.05), the total effective rate of the observation group was 89.47%(34/38) higher than that of the control group 71.05%(21/38), the adverse reaction rate of 13.16% (5/38) was lower than that in the control group 34.21% (13/38), the differences were statistically significant(P<0.05). Conclusion Compared with conventional drug SASP, the effect of on the expression of TNF-α, IL-6 and IL-17 in serum of patients with UC and the improvement of intestinal barrier function can be effectively suppressed, which has the advantages of clinical efficacy and low adverse reaction rate.

Amelioration of low dose enteral nutrition on the intestinal barrier and systemic inflammation for septic shock patients combined with acute gastrointestinal injury / 肠外与肠内营养

Objective:To analyze the value of low dose enteral nutrition (EN) in treatment of septic shock combined with acute gastrointestinal injury Ⅲ (AGI Ⅲ).Methods:Clinical data of septic shock patients combined with AGI Ⅲ admitted at our hospital were analyzed.Patients were divided into two groups according to the nutrition therapy they received:treatment group (EN,n =41) and control group (no EN,n =46).The mortality and ICU hospital stays were collected.The intestinal barrier,inflammatory cytokines,and oxidative stress were evaluated before and after EN treatment.Results:For patients in the treatment group,the dosages of EN ranged from 200 to 410 kcal/d,with the median dose of 350 kcal/d.No significant differences were found on death rates between the two groups (24.4％vs 32.6％,P =0.398).Patients in the treatment group had shorter ICU hospital stays than those of the control group (11.8 ± 3.7 vs 16.2 ± 5.3,P ＜0.01).After one week EN treatment,patients in the treatment group had lower levels of CRP,IL-6,TNF-α,diamine oxidase,endotoxin and D-lactate than those of the control group (P ＜ 0.05).Conclusion:For septic shock patients combined with AGI Ⅲ,low dose EN can improve the intestinal barrier function and systemic inflammatory responses.

Analysis of the effects of laparoscopic radical gastrectomy for gastric cancer on inflammatory cytokines and intestinal barrier function in patients / 中国综合临床

Objective To study the effects of laparoscopic radical gastrectomy for gastric cancer on serum inflammatory cytokines and intestinal barrier function in patients.Methods Retrospective analysis was used to investigate a total of one hundred and forty gastric cancer patients in Ezhou Central Hospital from January 2014 to September 2016,including 66 cases with laparoscopic radical gastrectomy (laparoscopic group) and 74 cases with traditional open radical gastrectomy (traditional group),the perioperative indexes,inflammatory factors and intestinal barrier function of the two groups were compared.Results In the laparoscopic group,the amount of bleeding loss in the laparoscopic group ((86.8 ± 15.2) ml),the incision length ((6.2 ± 1.4) cm),the first anal exhaust time ((3.0 ± 0.6) d),the fluid diet time ((4.6 ± 0.9) d),the postoperative hospitalization ((8.8 ± 1.7) d) were all lower than those in the traditional group ((158.2±25.0) ml,(16.3±2.7) cm,(3.6±0.7) d,(5.1±0.8) d,(10.3±2.5) d),the differences were statistically significant (P=0.000,0.000,0.000,0.014,0.001);the operation time of the traditional group was (196.5±27.8) min,the number of lymph nodes was (21.6±2.8),compared with those in the laparoscopic group ((192.5±30.3) min,(22.0±3.1),P=0.421,0.137).The levels of WBC,IL-6,CRP,TNF-ɑ,COR,plasma D-lactic acid and diamine oxidase in the laparoscopic group were lower than those in the traditional group (P=0.000).Conclusion The effect of laparoscopic radical gastrectomy on serum inflammatory cytokines and intestinal barrier function in patients is not obvious.

Protective effect of parecoxib on intestinal barrier function of septic mice / 临床麻醉学杂志

Objective To observe the effect of parecoxib on intestinal barrier function of septic mice.Methods Sepsis was induced by cecal ligation and puncture (CLP) model.Twenty-one male C57BL/6 mice were randomly divided into three groups (n =7 in each group):group Sham,group CLP,group P (parecoxib 2 mg/kg was administered via gastric tube 2 h after CLP).In vivo intestinal permeability was measured using an in vivo ligated loop model 24 h after surgery.Twenty-one male C57BL/6 mice were randomly divided into three groups as before.The small intestine tissue sample was harvested 24 h after surgery.The intestinal pathological changes were observed under light microscope.The expression of tight junction proteins ZO-1,Occludin,and Claudin-1 in the ileum were measured by Western blot.IL-6 and PGE2 level in the ileum were measured by ELISA.Results Compared with group Sham,the intestinal permeability was significantly increased and there was a significant intestinal pathological injury in group CLP.IL-6 and PGE2 level in the ileum was sig nificantly increased and the expression of tight junction protein ZO-1,Occludin,and Claudin-1 in the ileum were reduced in the group CLP (P＜0.05).Compared with the group CLP,intestinal permeability and pathological injury was significantly reduced in the group P.The levels of IL-6 and PGE2 were significantly decreased (P＜0.05),the expression of ZO-1,Occludin,and Claudin 1 were upregulated in group P (P＜0.05).Conclusion Parecoxib can decrease the levels of proinflammatory factors and up-regulate the expression of tight junction to reverse intestinal barrier dysfunction caused by sepsis in mice.

Study on intestinal barrier function in children with different severity of hand -foot-mouth disease / 中国小儿急救医学

Objective To analyze the changes of levels of plasma diamine oxidase(DAO),D-lactate and endotoxin in children with different severity of hand-foot-mouth disease(HFMD),explore the changes of the function of intestinal mucosal barrier in children with HFMD,and investigate the sensitivity and early warning effect of the indexes described previously on the damage of intestinal mucosal barrier in children with severe HFMD.Methods Four hundred and seventy inpatient children in Xi′an Children′s Hospital from March 2016 to June 2017 suffered from HFMD were selected as the study group,and one hundred healthy children were selected as the control group in the same period.Children in the study group were divided into common group(n=300),severe group(n=110)and critical condition group(n=60)according to the sever-ity of the disease.The levels of plasma DAO,D-lactate and endotoxin from children in each group were com-pared.Results The plasma D-lactate level of the children in the study group was significantly higher than that in the control group,and the difference was statistically significant[(27.670 ± 6.273)mg/L vs.(25.585 ± 5.177)mg/L;t=3.515,P<0.05];but the differences of DAO and endotoxin compared with the control group were not statistically significant[(3.205 ± 0.956)U/L vs.(3.135 ± 0.884)U/L,P>0.05;(1.186 ± 0.486)U/L vs.(1.091 ± 0.494)U/L,P>0.05].The comparison of multiple groups showed that the differ-ence of plasma D-lactate levels was statistically significant(F=33.488,P<0.05),while the differences of the levels of DAO and endotoxin were not statistically significant among different severity groups(F=0.709, F=2.296,P>0.05).The level of plasma D-lactate in critical condition group[(32.502 ± 4.756)mg/L]was significantly higher than those in the severe group[(29.872 ± 6.468)mg/L],the common group [(25.896 ± 5.691)mg/L] and the control group,and the differences were statistically significant(P <0.05);the difference in plasma D-lactate levels in the severe and non-severe groups was statistically signifi-cant(P<0.05),and the difference between common group and control group was not statistically significant (P>0.05).Conclusion The intestinal permeability and intestinal mucosal barrier are impaired in children with severe and critical HFMD.Plasma D-lactate is significantly elevated in the early stage of intestinal barri-er injury.Compared with DAO and endotoxin,D-lactate is a sensitive and early warning index suggesting the impaired intestinal mucosal barrier function in severe and critical cases of HFMD.

Progress of Research on Stress-related Intestinal Barrier Dysfunction / 胃肠病学

Intestinal barrier is formed by intestinal mucous layer,epithelial cells,cellular tight junction,enterocyte membrane,submucosal lamina propria and immunologic factors,and plays a pivotal role in maintaining gastrointestinal function. Different types of stress can induce intestinal barrier dysfunction and increased intestinal permeability,leading to a series of gastrointestinal diseases. This article reviewed the progress of research on pathological changes and mechanism of stress-related intestinal barrier dysfunction.