Early enteral trophic feeding for improvement of intestinal mucosa barrier in seriously traumatic patients / 中华急诊医学杂志

Objective To investigate the value of early trophic feeding on maintenance of the integrity of intestinal mucosa barrier in severe traumatic patients.Methods The seriously traumatic patients were eligible for enrollment to this study from January 1st,2014 to March 31st,2015 in the intensive care unit of Xiangcheng People's Hospital.All patients were randomly divided into early enteral nutrition (EEN)group and the control group.Within 12 to 24 hours after ICU admission,all patients were fed on enteral nutrition.In the EEN group,the nutrient was reached to 25％ of target nutrient amount [104.6 kJ/ (kg · d)],and in the control group,the nutrition was reached to 60％ of the target nutrient amount.Comparisons of feeding intolerance,incidence of newly developed lung infection,the total length of hospital stay,ICU medical costs,and the markers of mucosa barrier function including lactulose/mannitol ratios (L/M),serum lactic acid level,and diamine oxidase (the first day,the third day and the seventh day) between two groups were carried out.Results Of them,56 patients were treated with early enteral nutrition.Early enteral feeding intolerance and ICU associated infection complications were significantly lower in EEN group than those in control group (P =0.012,P =0.046).There were no significant differences in ICU associated infection complications,the length of ICU stay,the length of hospital stay,ICU medical costs,L/M ratios,D-lactic acid level and diamine oxidase concentration between the two groups (P=0.135,P=0.126,P =0.223,P =0.235).Conclusions Under the seriously traumatic stress,the significantly increased intestinal mucosal permeability will be occurred early.In patients with early trophic feeding,the intestinal mucous membrane barrier function can be improved,thus decreasing ICU associated infection complications and incidence of feeding intolerance.

Early enteral trophic feeding for improvement of intestinal mucosa barrier in seriously traumatic patients / 中华急诊医学杂志

Objective To investigate the value of early trophic feeding on maintenance of the integrity of intestinal mucosa barrier in severe traumatic patients.Methods The seriously traumatic patients were eligible for enrollment to this study from January 1st,2014 to March 31st,2015 in the intensive care unit of Xiangcheng People's Hospital.All patients were randomly divided into early enteral nutrition (EEN)group and the control group.Within 12 to 24 hours after ICU admission,all patients were fed on enteral nutrition.In the EEN group,the nutrient was reached to 25％ of target nutrient amount [104.6 kJ/ (kg · d)],and in the control group,the nutrition was reached to 60％ of the target nutrient amount.Comparisons of feeding intolerance,incidence of newly developed lung infection,the total length of hospital stay,ICU medical costs,and the markers of mucosa barrier function including lactulose/mannitol ratios (L/M),serum lactic acid level,and diamine oxidase (the first day,the third day and the seventh day) between two groups were carried out.Results Of them,56 patients were treated with early enteral nutrition.Early enteral feeding intolerance and ICU associated infection complications were significantly lower in EEN group than those in control group (P =0.012,P =0.046).There were no significant differences in ICU associated infection complications,the length of ICU stay,the length of hospital stay,ICU medical costs,L/M ratios,D-lactic acid level and diamine oxidase concentration between the two groups (P=0.135,P=0.126,P =0.223,P =0.235).Conclusions Under the seriously traumatic stress,the significantly increased intestinal mucosal permeability will be occurred early.In patients with early trophic feeding,the intestinal mucous membrane barrier function can be improved,thus decreasing ICU associated infection complications and incidence of feeding intolerance.

Curcumin protects against the intestinal ischemia-reperfusion injury: involvement of the tight junction protein ZO-1 and TNF-alpha related mechanism

Present study aimed to investigate the eff ect of curcumin-pretreatment on intestinal I/R injury and on intestinal mucosa barrier. Thirty Wistar rats were randomly divided into: sham, I/R, and curcumin groups (n=10). Animals in curcumin group were pretreated with curcumin by gastric gavage (200 mg/kg) for 2 days before I/R. Small intestine tissues were prepared for Haematoxylin & Eosin (H&E) staining. Serum diamine oxidase (DAO) and tumor necrosis factor (TNF)-alpha levels were measured. Expression of intestinal TNF-alpha and tight junction protein (ZO-1) proteins was detected by Western blot and/or immunohistochemistry. Serum DAO level and serum and intestinal TNF-alpha leves were signifi cantly increased after I/R, and the values were markedly reduced by curcumin pretreatment although still higher than that of sham group (p<0.05 or p<0.001). H&E staining showed the significant injury to intestinal mucosa following I/R, and curcumin pretreatment signifi cantly improved the histological structure of intestinal mucosa. I/R insult also induced significantly down-regulated expression of ZO-1, and the eff ect was dramatically attenuated by curcumin-pretreatment. Curcumin may protect the intestine from I/R injury through restoration of the epithelial structure, promotion of the recovery of intestinal permeability, as well as enhancement of ZO-1 protein expression, and this eff ect may be partly attributed to the TNF-alpha related pathway.

Effect of TREM-1 expression on the apoptosis of intestinal macrophages of rats / 中华急诊医学杂志

Objective To investigate the effect of triggering receptor expression in myeloid cells-1 (TREM-1) on intestinal macrophage apoptosis in rat.Methods In vitro,the achieved rat intestinal macrophages were divided into 3 groups:control group,LPS (Lipopolysaccharides) group and LPS + LP17 group (n =6 holes of culture plate in each).The concentrations of LPS and LP17 were 1 mg/L and 0.1 mg/L,respectively.The intestinal macrophage apoptosis was measured by using TUNEL kit and flow cytometry after culture for 6 h.All data were statistically analyzed using SPSS 18.0 software.Results The shape and growth of rat intestinal macrophages were quite favorable after culture.The membrane marker of intestinal macrophages,CD14 was clearly observed under immunofluorescence.After macrophage was treated with specific procedure,the cell apoptosis found in LPS group (44.33 ± 7.74)％ was significantly higher than that in control group (19.17 ± 6.01) ％ (P=0.000) measured by TUNEL;the cell apoptosis in LPS +LP17 group (28.33 ± 6.53)％ apparently reduced compared with LPS group (44.33 ±7.74) ％ (P =0.004);there was no significant difference in cell apoptosis between control group (19.17 ± 6.01) ％ and LPS + LP17 group (28.33 ± 6.53) ％ (P =0.050).By flow cytometry,the apoptotic cells in LPS group (16.47 ± 1.66) ％ was significantly increased compared with control group (7.70 ± 1.52) ％ (P =0.000);apoptotic cells in LPS + LP17 group (11.47 ± 3.12) ％ was significantly reduced in comparison with LPS group (16.47 ± 1.66) ％ (P =0.018).There was no significant difference in apoptotic cells between control group (7.70±1.52)％ and LPS + LP17 group (11.47±3.12) ％ (P =0.061).Conclusion LP17 can inhibit TREM-1 expression in intestinal macrophages and reduce intestinal macrophage apoptosis.

Effect of early enteral nutrition on mechanically ventilated patients / 中华临床营养杂志

Objective To observe the effectiveness of early enteral nutrition (EEN) in managing ICU mechanically ventilated patients.Methods Totally 47 patients who had been ventilated for more than one week were randomly divided into EEN group and control group.The EEN group was supplied with enteral nutrition (EN) 12-24 hours after ICU admission,whereas the control group received EN 72 hours-5 days later.The function of intestinal mucosal barrier was evaluated by the reabsorb concentration of disaccharides lactulose/mannitol (L/M).In addition,the body mass index (BMI),body temperature,urine L/M ratio,serum albumin,pre-albumin,and ventilation days were recorded or calculated.Results On the seventh day,the L/M ratio was (0.036 ±0.004) in the EEN group,which was significantly lower than that (0.108 ±0.020) in the control group (t =2.746,P ＜0.01) ; the average body temperature was significantly lower in the EEN group than in the control group [(38.25 ± 1.20) ℃ vs (38.92 ± 1.40) ℃ ; t =2.683,P ＜ 0.05)] ; the incidences of adverse reactions such as constipation and diarrhea were significantly lower in the EEN group [16.7％ (4/23) vs 27.3％ (6/22),P＜0.05].The weaning rate within 2 weeks also favoured the EEN group [90％ (18/20) vs 80％ (16/20),P ＜ 0.05].Compared with the control group,the nutritional status of serum albumin and pre-albumin also showed a favourbale trends in the EEN group.Conclusions EEN can improve intestinal mucosal barrier and increase the weaning possibility in patients with mechanical ventilation.

Effect of Protease Activated Receptor-2 Agonist on Intestinal SIgA in Rats with Acute Necrotizing Pancreatitis / 医药导报

Objective To discuss the effects of proteinase-activated receptor-2( PAR-2 )agonists on intestinal SIgA levels in rats with severe acute necrotizing pancreatitis( SAP). Methods This study established SAP rat model and observed the levels of TNF-α and IL-6 in intestinal mucosa,SIgA content in intestinal mucus and histopathological changes of intestinal mucosa 6,12,and 24 h after establishment of model. The univariate analysis was used to compare the difference among groups. Linear correlation analysis was used to compare correlation between inflammatory mediators( TNF-α,IL-6 )and SIgA content in intestinal mucus,as well as the histopathological scores of intestinal mucosa. Results The level of TNF-α and IL-6 in intestinal mucosa and histopathological scores of intestinal mucosa were all significantly increased but SIgA content was decreased in model group at each time point after establishment of model,as compared with the sham-operated group(P﹤0. 05). The level of TNF-α and IL-6 in intestinal mucosa and histopathological scores of intestinal mucosa were all significantly decreased while SIgA content in intestinal mucus increased in pretreatment group at each time point after establishment of model,as compared with the model group(P﹤0. 05). There was a positive relationship between inflammatory mediators(TNF-α,IL-6)in intestinal mucosa and histopathological scores of intestinal mucosa(P﹤0. 01). There was a negative relationship between inflammatory mediators(TNF-α,IL-6)and SIgA content in intestinal mucus(P﹤0. 05). Conclusion Intestinal mucosa immune barrier was impaired in the early stage of SAP in rats. PAR-2 agonist has therapeutic effects on intestinal mucosa immune barrier,which is related to the inhibition of excessive release of inflammatory mediators( TNF-α and IL-6)in rats with SAP.

Protective effect of epigallocatechin-3-gallate in the intestinal mucosal barrier injury of severe acute pancreatitis in rats / 国际中医中药杂志

Objective The study was designed to investigate the intestinal mucosa barrier function changes in rats with severe acute pancreatitis (SAP),and the intervention effect of epigallocatechin-3-gallate(EGCG) injection and its mechanisms of protection on intestinal mucosa barrier function injury of SAP with the purpose of providing evidence for preventing and curing intestinal mucosa barrier function injury of SAP in clinical practice.Methods A total of 80 healthy male Sprauge-Dawley (SD) rats were randomly divided into a normal group (Normal),a sham-operation group (Sham),a SAP model group (Model),and a EGCG treated group (EGCG),with 24 rats (except 8 rats in the normal group) in each group.The latter three groups each had three subgroups at three time points:6,12,24hours.Rats with SAP were prepared with retrograde cholangiopancreatic duct infusion in 5％ sodium taurocholate.The dynamic changes of the indexes of intestinal mucosa barrier function injury and Pancreas injury were observed at various time points in each group,including the levels of Plasma diamine oxidase (DAO) and serum amylase and malondialdehyde (MDA),nitric oxide(NO),inducible nitric oxide synthase(iNOS)in gut.Results 1.The levels of serum amylase [(3158.64 ± 218.25)μ/L,(4277.24 ± 231.35)μ/L,(5842.76 ± 248.18)μ/L] and plasma DAO concentration [(4.23 ± 0.51) μ/L,(5.13 ± 0.32)μ/L,(7.83 ± 0.76) μ/L] in the Model group were significantly higher at 6 h,12 h,24 h postoperation than the Normal group[serum amylase:(2074.11 ± 101.56)μ/L,DAO:(2.32 ± 0.48) μ/L] and Sham group [serum amylase:(1885.27 ± 103.89) μ/L,(1778.57 ± 98.94) μ/L,(1935.24 ± 105.87) μ/L].The levels of serum amylase [(2576.70 ± 123.43) μ/L,(2783.77 ± 155.53) μ/L,(2902.32 ±176.25) μ/L] and plasma DAO concentration (3.59 ± 0.57) μ/L,(3.98 ± 0.67) μ/L,(6.44 ± 0.71) μ/L in the EGCG group were lower than the Model group,but higher than the Normal group and the Sham group.Compared with the Normal group and the Sham group,the concentration of MDA and NO [MDA:(2.28±0.35) μmol/g,(3.02 ± 0.41) μmol/g,(3.78 ± 0.48) μmol/g ; NO:(16.80 ± 0.60) μmol/g,(18.23 ± 0.78) μmol/g,(20.14±0.82) μ,mol/g] significantly increased in the Model group at 6h,12 h,and 24 h postoperation.The concentration of MDA and NO (1.67±0.14) μmol/g,(1.75±0.16) μmol/g,(1.84±0.22) μmol/g; NO:(9.09±0.31) μmol/g,(9.32±0.44)μmol/g,(10.15±0.52)μmol/g were lower in the EGCG group in all times than the Model group.Compared with the Normal group (0.10) and the Sham group (0.25).The expression ofiNOS was significantly increased in the Model group(1.86).The expression of iNOS was lower in the EGCG group (0.66) in all times than the Model group,but higher than the Normal group and the sham group (P＜0.05).Conclusion Conclusion EGCG can protect the damages of intestinal mucosa barrier function in SAP rats,probably through reducing free radicals,and the iNOS expression.

The role of apoptosis in the stress-related changes of intestinal mucosa barrier following traumatic brain injury / 中华内科杂志

Objective To investigate the role of epithelial cell apoptosis in the stress-related changes of intestinal mucosa barrier following traumatic brain injury. Methods Sixty-four health male Wistar rats were divided randomly into two groups: (1) traumatic brain injury model group (n =32) ,in which rats suffered from traumatic brain injury by Feeney's method; (2) control group ( n = 32) , rats suffered from sham operation. Each group were divided into four subgroups according 6 h, 12 h,24 h, and 48 h after operation ( n = 8, for each subgroup ). Ileum tissue were taken to observed the damage of the intestinal mucosa under microscope and electronmicroscope. The early apoptosis rate of intestinal mucosal cells were analyzed with Annexin Ⅴ-PI double stained and detected by flow cytometry. Results The intestinal mucosa were damaged and the intercellular space of intestinal mucosal were found increased in traumatic brain injury group. The early apoptosis rate of intestinal mucosal epithelial cells was significant increased in traumatic brain injury group than that in control group [6 h: (13.5 ±3.7)% vs (6.1 ± 1.7)%, P＜0.05; 12 h:(66.1±6.0)% vs (5.2±1.1)%, P＜0.05; 24 h:(39.8±4.8)% vs (8.4±2.6)%, P＜0.05;48 h: (7.5 ±1.3)% vs (6.6 ±0.5)%]. Conclusion The increased early apoptosis rate of intestinal mucosal epithelial cells might contribute to the stress-damage of the intestinal mucosa barrier in early stage of traumatic brain injury.

The effects of Xuebijing injection on intestinal tract mucosa barrier and on the expression of macrophage antibody in rats with sepsis / 中华急诊医学杂志

Objective To study the effect of Xuebijing injection on the change of intestinal tract mucosa barriers and the expression of macrophage antihody in rats with sepsis. Method Totally 150 Wistar rats were ran-domly divided into three groups: sham group, sepsis group, and Xuebijing group. Sepsis models were estabhshed in rats by cecal ligation and puncture. The success standards of sepsis included fever, the increase of respiration rate,increased heart rate and change in leukocyte count. At 12 hours before operation, and after operation the rats in the Xuebijing group were injected with 4 mL/kg Xuebijing (once every 12 hours for 3 days), and the rats in the others two groups were injected with the same volume of saline, the image analytical system were used to detect the pathological change of intestinal tract mucosa harriers and the expression of macrophage antibody in three groups. All the data were analyzed by rank-sum test and variance analysis(F test). Results Almost all the mucous mem-brahe of small intestine in sham groups were normal. The mucous membrane lesions of small intestine developed in sepsis and Xuebijing groups after 12,24,48,72 hours, and the lesion was severer in sepsis group than that in the Xuebijing group (H=19.732, P<0.01). There were no significant differences on the expression of macrophage antibody in mucous membrane of small intestine between three groups at 3 hours. But at 12, 24, 48 and 72 hours, the expression of macmphage antibody of sepsis and Xnebijing groups increased with time (F=560.13, P< 0.05). Conclusions At the early period of sepsis, intestinal tract mucosa barriers develops varying degrees of damage, and Xnebijing can partly protect intestinal tract mucosa barriers.

Protective effects of Glutamine on intestinal mucosa barrier dysfunction following traumatic brain injury in rats / 中华创伤杂志

Objective To observe the effect of Glutsmine on intestinal barrier function after traumatic brain injury in rats. Methods A total of 54 adult male Wistar rats were divided randomly into 3 groups, ie, normal group (Group N, 6 rats), TBI group (Group T, 24 rats) and Giutamine intervention group (Group G, 24 rats). Group T and Group G were subdivided into 4 groups according to detection time at days 1,3, 5 and 7 respectively. Meanwhile, 6 rats were enlisted in each group. The intestinal mucosa structure was detected by histopathological examination and electron microscopy. Apoptosis was detected by in situ immunohistochemical staining (TUNEL). Results Glutamine could relieve the pathological lesion of gut mucosa and decrease intestinal mucosa cell apoptosis after traumatic brain injury. Conclusion Glutamine can protect intestinal mucosa barrier function following traumatic brain injury.

Beneficial effect of recombinant human growth hormone on the intestinal mucosa barrier of septic rats

The objective of the present study was to investigate the effects of recombinant human growth hormone (rhGH) on the intestinal mucosa barrier of septic rats and explore its possible mechanism. Female Sprague-Dawley rats were randomized into three groups: control, Escherichia coli-induced sepsis (S) and treatment (T) groups. Groups S and T were subdivided into subgroups 1d and 3d, respectively. Expression of liver insulin-like growth factor-1 (IGF-1) mRNA, Bcl-2 and Bax protein levels and the intestinal Bax/Bcl-2 ratio, and plasma GH and IGF-1 levels were determined. Histological examination of the intestine was performed and bacterial translocation was determined. rhGH significantly attenuated intestinal mucosal injuries and bacterial translocation in septic rats, markedly decreased Bax protein levels, inhibited the decrease of Bcl-2 protein expression and maintained the Bax/Bcl-2 ratio in the intestine. rhGH given after sepsis significantly improved levels of plasma GH (T1d: 1.28 ± 0.24; T3d: 2.14 ± 0.48 æg/L vs S1d: 0.74 ± 0.12; S3d: 0.60 ± 0.18 æg/L; P < 0.05) and IGF-1 (T1d: 168.94 ± 65.67; T3d: 201.56 ± 64.98 æg/L vs S1d: 116.72 ± 13.96; S3d: 107.50 ± 23.53 æg/L; P < 0.05) and expression of liver IGF-1 mRNA (T1d: 0.98 ± 0.20; T3d: 1.76 ± 0.17 vs S1d: 0.38 ± 0.09; S3d: 0.46 ± 0.10; P < 0.05). These findings indicate that treatment with rhGH had beneficial effects on the maintenance of the integrity of the intestinal mucosa barrier in septic rats.

Effect of Human Growth Hormone on Diamine Oxidase and Endotoxemia in Systemic Inflammatory Response Syndrome / 中国普外基础与临床杂志

Objective To investigate the changes of diamine oxidase(DAO) and endotoxin(ET) during the treatment of systemic inflammatory response syndrome with human growth hormone and the relationship between human growth hormone and intestinal mucosal barrier injury. Methods One hundred and forty six patients with systemic inflammatory response syndrome were randomly divided into operative group and non operative group, which were again randomly divided into the study group and control group.Plasma concentration of DAO and ET were determined before the treatment and 1 week after the treatment.Results Plasma concentration of DAO and ET in study group decreased after treatment with significant difference ( P

Effects of glutamine and recombinant human growth hormone on intestinal mucosal barrier and proliferating cell nuclear antigen in postoperative portal hypertension patients / 中国病理生理杂志

AIM:To investigate morphologic and functional changes of small intestinal mucosa and proliferating cell nuclear antigen in postoperative portal hypertension patients with single or combined administration of Gln and rhGH.METHODS:Twenty-nine portal hypertension patients with surgical treatment were prospectively randomized to four groups as follows:① Gln group(n=6);② rhGH group(n=8);③ Gln+rhGH group(n=7)and ④ control group(n=8).A standard solution for TPN was given three days after operation for a week.The concentration ratio of urinary lactulose and mannitol(L/M),the villus height and crypt depth and PCNA index of small intestinal mucosa were compared.RESULTS:A week after TPN postoperation,the increased ratios of L/M in Gln+rhGH group were less than those in control group(P0.05).CONCLUSION:This study suggest that Gln together with rhGH reduce the intestinal permeability and protect the mucosa integrality in postoperative portal hypertension patients,but not in single treatment.

The effect of enteral nutrition on gut barrier in patients with hepatic dysfunction / 肠外与肠内营养

Objectives:To determine if enteral nutrition can protect the gut barrier in patients with damaged hepatic function and draw the clinical significance from it. Methods:76 patients whose hepatic function was in Child B or C grade were randomly assigned in enteral nutrition group(EN,30 cases),total parenteral nutrition group(TPN,26 cases) and control group(CON,20 cases).They were given with different nutritional support. Nutritional parameter and hepatic function indexes were massured at the day before operation,5th day and 10th day after the operation respectively.The concentrations of lactulose(L) and Mannitl(M) were detected in the urines with pulsed electrochemical detection(HPLC PED) and the L/M ratio was calculated. Results:No significant differences of hepatic function changes were observed between EN group and TPN group.It was the earlist that EN group reached the positive nitrogon equilibrium among the 3 groups and the loss of body weight after operation was the lowest in EN group There wes no change in L/M ratio in EN group, but the change was significant in TPN group( P

The study on tight junction proteins and myosin light chain kinase in obstructive jaundice in rats / 中国普通外科杂志

Objective To elucidate the mechanisms of disruption of intestinal mucosa barrier in obstructive jaundice.Methods The obstructive jaundice model of rats was set up.At 10 d and 20 d after operation,immunohistochemistry and Western-blot techniques were used to examine the distribution and expression of tight junction proteins(ZO-1,Occludin) and myosin light chain kinase(MLCK)in intestinal mucosa.Results In normal control groups,the staining of ZO-1 and occludin was predominantly localized to the margins of the epithelial cells and the apex of the cell membrane,and displayed a continuous and uniform distribution along the under surface of the villae.MLCK was distributed mainly in cytoplasm.In obstructive jaundice groups,ZO-1 and occludin staining appeared discontinuous and vague,with rough edges and spiculate processes.The staining of MLCK was also discontinuous and scanty.The strong positive express ratio of ZO-1,Occludin and MLCK were obviously lower in two experiment group than those in the control group all P