Efficacy evaluation of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis / 中国医师杂志

Objective:To compare the efficacy of conventional Western medicine alone and acupuncture combined with acupoint application in treating intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis.Methods:A retrospective analysis was performed on 111 elderly patients with mechanical ventilation for sepsis admitted to the emergency department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to June 2021. They were divided into two groups according to the time of admission: Western medicine treatment group alone (patients from January 2019 to December 2019, n=47) and acupuncture combined with acupoint application group (patients from January 2020 to June 2021, n=64). Acupuncture combined with acupoint application group was treated with acupuncture combined with acupoint application on the basis of conventional Western medicine. The intestinal dysfunction score, abdominal circumference and mortality after 4 weeks were compared between the two groups. Results:The abdominal circumference and intestinal dysfunction score in acupuncture combined with acupoint application group were significantly lower than those before treatment [(100.56±9.34)cm vs (106.25±9.74)cm; (0.92±0.72)point vs (2.31±0.69)point, all P< 0.05], while there was no significant difference in the above indexes before and after treatment in the Western medicine treatment group (all P>0.05). The abdominal circumference, intestinal dysfunction score and mortality after 4 weeks in the acupuncture combined with acupoint application group were significantly lower than those in the Western medicine treatment group [(100.56±9.34)cm vs (108.09±10.52)cm; (0.92±0.72)point vs (2.43±0.62)point; (29.7%, 19/64) vs (48.9%, 23/47), all P<0.05]. Conclusions:The curative effect of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with sepsis in emergency is better than that of routine treatment of Western medicine alone. The gastrointestinal function and prognosis of patients have been significantly improved, which is worthy of clinical promotion.

Discussion on COPD Intestinal Dysfunction and Treatment with Traditional Chinese Medicine / 中国实验方剂学杂志

In China， about 100 million people currently have chronic obstructive pulmonary disease （COPD）. At the same time， COPD is a multisystem disease， not only affecting the function of musculoskeletal， cardiovascular， kidney and immune systems in patients， but also causing intestinal dysfunction as its extrapulmonary manifestations. From the perspective of traditional Chinese medicine （TCM）， after COPD is formed， deficiency， phlegm stasis and toxicity were accumulated in the lungs， which leads to dysfunction of lung in dispersing and descending， and eventually causes ascending and descending disorder of Qi activities， disorder of fluid supply and distribution， and stagnation of blood stasis. The viscera disease would affect the bowels， and the large intestine is thus affected. Modern medical discovers that， the lungs and intestines have common origins and similar physiological structures， in pathological circumstances， their common mucosal immune system may lead to similar immune factors and inflammatory manifestations in the lungs and intestines. At the same time， the studies have confirmed that there is also a close relationship between intestinal flora and lung， that is "lung-gut axis". These theories partially illustrate the mechanism of COPD in inducing intestinal injury. The specific manifestations of COPD intestinal dysfunction， ① Flora disorder， with increased abundance of intestinal gram-negative bacilli， and inhibited reproduction of Bifidobacterium， Lactobacillus and short-chain fatty acid-producing bacteria. ② Intestinal barrier damage： characterized by the destruction of intestinal epithelium tight connectivity， increased intestinal permeability， and thinning of the mucus layer. ③ Intestinal motility disorder： mostly manifested as weight loss and malnutrition. At present， for the intestinal dysfunction in COPD patients， most of the relevant discussions and targeted treatment methods in TCM are scattered and unsystematic. Guided by the idea of treating different diseases with the same treatment， we summarized the etiology and pathogenesis of COPD intestinal dysfunction by learning from the experience of TCM in treating intestinal flora disorders and inflammatory bowel disease， and proposed preliminary formulation with Tiaoqi Qushi，Tongfu Tongluo as its basic treatment principles in this paper， hoping to provide new ideas for the treatment of COPD.

Adjuvant therapy of acupuncture for elderly patients of primary osteoporosis with intestinal dysfunction: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture on bone mineral density (BMD), bone metabolism and intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.@*METHODS@#A total of 128 elderly patients of primary osteoporosis with intestinal dysfunction were randomly divided into an observation group and a control group, 64 cases in each group. Patients in the control group were treated with oral administration of vitamin D calcium chewable tablets (0.6 g, once a day) and calcitriol capsules (0.25 μg, three times a day); the treatment was given for 6 months. On the basis of the treatment in the control group, patients in the observation group were additionally treated with acupuncture at Shenshu (BL 23), Mingmen (GV 4), Pishu (BL 20), Dachangshu (BL 25), Tianshu (ST 25) and Zusanli (ST 36), etc. for 30 min each time, once a day. After 1-week treatment, the patients took a rest for 2 days; the treatment was given for 6 months. Before and after treatment, the BMD of lumbar spine, femoral neck and femoral trochanter was detected by dual energy X-ray absorptiometry, and the serum levels of bone alkaline phosphatase (NBAP), osteocalcin (OC), matrix metalloproteinase-2 (MMP-2) and calcitonin (CT) were detected by ELISA method. The primary symptom scores of intestinal function, serum diamine oxidase (DAO) and D-lactic acid (D-Lac) levels were compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated.@*RESULTS@#The total effective rate was 85.9% (55/64) in the observation group, which was higher than 71.9% (46/64) in the control group (<0.05). After treatment, BMD were increased (<0.05), and serum bone metabolism indexes were improved in the two groups (<0.05); the BMD and serum bone metabolism indexes in the observation group were better than those in the control group (<0.05). After treatment, the primary symptom scores of intestinal function, serum DAO and D-Lac levels in the observation group were decreased (<0.05), and the indexes in the observation group were lower than those in the control group (<0.05).@*CONCLUSION@#The adjuvant therapy of acupuncture could increase BMD, improve bone metabolism and regulate intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.

Effect of Dahuang Mudan Tang in Triggering Receptor Expressed on Myeloid Cells-1 in Intestinal Tract in Rats with Septic Acute Intestinal Dysfunction / 中国实验方剂学杂志

Objective:To investigate whether the therapeutic effect of Dahuang Mudan Tang on septic acute intestinal dysfunction in sepsis ratsis related to the regulation of expression of triggering receptor expressed on myeloid cells-1(TREM-1). Method:Totally 100 male SD rats were injected intraperitoneally with lipopolysaccharide (LPS) at a dose of 4.5 mg·kg-1 to build sepsis model. The sepsis model rats were randomly divided into five groups:model group, glutamine group (3.75 g·kg-1),low,medium, high-dose Dahuang Mudan Tang group(7.5,15,30 g·kg-1),and another 10 normal rats were selected as normal group. Seven days later,2 mL suspension (100 mg lactulose and 50 mg mannitol) was orally administrated by gavage, and 24 h urinewas collected. The ratio of lactulose to mannitol in urine (L/M) was detected by HPLC with pulsed electrochemical detection (HPLC-PED).Serum citrulline concentrationsin blood and ileum were determined by HPLC.Enzyme linked immunesorbent assay (ELISA) was used to detect the concentrations of triggering receptor expressed on myeloid cells-1(TREM-1),tumor necrosis factor-α(TNF-α),intestinal fatty acid binding protein(iFABP) and D-lactic acid.Real-time PCR was used to detect the mRNA expressions of TREM-1,Toll-like receptors2(TLR2),Toll-like receptors 4(TLR4),myeloid cell differentiation protein(MyD88),nuclear transcription factor-κB(NF-κB).Electron microscopy was used to observe the pathological changes of intestinal mucosa injury. Result:Compared with normal group, the serum concentrations of TREM-1,TNF-α,iFABP, D-lactate; the ratio of lactulose to mannitol in urine (L/M)and the expressions of TREM-1,TLR2,TLR4,MyD88,NF-κB mRNA in model group were increased obviously(PPPPPκB mRNA,and the serum concentrations of TREM-1 and TNF-α in all medication administration groups were decreased obviously(PD-lactate, L/M, the Chiu scorein glutamine group, medium-dose Dahuang Mudan Tang group and high-dose Dahuang Mudan Tang group were decreased obviously(PPPConclusion:Dahuang Mudan Tang can effectively treat SAID in rats, and its mechanism may be realized by regulating the expression of TREM-1 and relieving intestinal inflammation of intestinal tract.

Preventive oral rehydration salts Ⅲ could protect intestinal function in rats with exertional heatstroke / 中华危重病急救医学

Objective To observe the damage of various organs of rats with exertional heatstroke (EHS), and to investigate the protective effect of oral rehydration salts Ⅲ (ORSⅢ) on multi-organ function in rats with EHS. Methods Fifty-one male Sprague-Dawley (SD) rats were randomly divided into four groups by random digit table: normal control group (n = 13), EHS group (n = 13), EHS+water group (n = 12), and EHS+ORSⅢ group (n = 13). All rats in the EHS groups received adaptive training for 7 days before the experiment. On the 8th day, the rats of EHS+water and EHS+ORSⅢ groups were orally given 20 mL/kg water or ORSⅢ 30 minutes before the experiment. No pretreatment was performed in the EHS group. EHS model was reproduced by forcing rats to run under hot environment. The rats which refused to exercise and which core temperature > 40.5 ℃ were considered as the onset of EHS. The rats in the normal control group were exposed to room temperature (25±2) ℃ and humidity (50±5)% without any treatment. Six hours later, blood of inferior vena cava was collected, and the levels of serum MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (SCr), blood urea nitrogen (BUN), serum potassium, serum sodium and serum chloride were determined by automatic chemical analyzer. Serum intestinal fatty acid-binding protein (I-FABP) was determined by enzyme linked immunosorbent assay (ELISA). Results The levels of LDH, ALT, AST, BUN, serum sodium and serum chloride in the EHS group were significantly higher than those in the normal control group [LDH (U/L): 1 220±427 vs. 837±485, ALT (U/L): 138 (97, 164) vs. 37 (33, 42), AST (U/L): 409 (380, 566) vs. 86 (78, 104), BUN (mmol/L): 11.7 (9.6, 13.2) vs. 5.9 (5.5, 6.1), serum sodium (mmol/L): 148.0 (143.5, 154.5) vs. 139.0 (138.0, 140.5), serum chloride (mmol/L): 100.9±2.3 vs. 97.3±1.4, all P < 0.05], but no significant difference in CK-MB, SCr or serum potassium could be found [CK-MB (U/L): 1 280±373 vs. 1 379±480, SCr (μmol/L): 38.2±7.5 vs. 35.5±6.3, serum potassium (mmol/L): 5.5 (4.4, 6.2) vs. 4.7 (4.4, 4.9), all P > 0.05]. In the EHS+ORSⅢ group, only serum potassium level was significantly lower than that in the EHS group [mmol/L: 4.0 (3.7, 4.4) vs. 5.5 (4.4, 6.2), P < 0.01], while no significant difference in other parameters was found between the EHS+ORSⅢ group and the EHS group as well as the EHS+water group. Serum I-FABP level in the EHS group was significantly higher than that in the normal control group [μg/L: 36.90 (29.10, 45.00) vs. 11.39 (0.31, 20.80), P < 0.01]. Serum I-FABP level in the EHS+water and EHS+ORSⅢ groups were notably lower than that in the EHS group [μg/L:24.19 (20.00, 28.36), 0.31 (0.31, 5.58) vs. 36.90 (29.10, 45.00), both P < 0.01], additionally, I-FABP level was much lower in the EHS+ORSⅢ group (P < 0.01). Conclusions EHS could lead to liver, intestinal barrier dysfunction and electrolyte disturbance. Pre-treatment of ORSⅢ could alleviate the intestinal dysfunction and electrolyte disorder caused by EHS in rats. It can lower the serum potassium to some extent. However, ORSⅢ failed to protect liver from EHS.

Meta-analysis of randomized controlled trials on the efficacy of daikenchuto on improving intestinal dysfunction after abdominal surgery

PURPOSE: Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery. METHODS: PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I2 = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I2 = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results. CONCLUSION: These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.

Research progress of early enteral nutrition in acute pancreatitis / 肠外与肠内营养

Nowadays,acute pancreatitis remains a clinical challenge with considerable morbidity and mortality.Acute pancreatitis is associated with systemic and metabolic derangements which may promote hypermetabolism and negative nitrogen balance due to negative energy balance.Therefore,optimal nutritional support intreatmentof acute pancreatitis has been a subject for decades.Originally,the concept of pancreatic rest by fasting was thought to improve outcome as early enteral nutrition was believed to aggravate inflammation or infection through pancreatic stimulation.At present,an increasing number of studieswere performed showing numerousbenefits of enteral nutrition.In this review,intestinal dysfunctionandroute,timing,type and amount of enteralnutritional support in acute pancreatitis will be discussed.

Pay Emphasis to Prevention and Treatment of Intestinal Dysfunction in Severe Acute Pancreatitis / 胃肠病学

Severe acute pancreatitis( SAP),especially with secondary infection of pancreatic necrotic tissue,is clinically a very severe and critical condition. The mortality rate can be as high as 40% . Intestinal barrier dysfunction and translocation of enteric bacteria contribute to the infection of pancreatic necrotic tissue and peripancreatic accumulated fluid,promote systemic inflammatory response syndrome( SIRS)and multiple organ dysfunction syndrome( MODS). Because there is no specific and objective assessment criteria for intestinal function and the function is diversity,intestinal dysfunction is not included in the modified Marshall organ dysfunction scoring system in 2012 revision of the Atlanta International Consensus on Classification and Definitions of Acute Pancreatitis. Paying emphasis to prevention and treatment of intestinal dysfunction may reduce the infection of pancreatic necrotic tissue,preventing the progress of MODS and reducing the mortality rate of SAP. This article reviewed the pathogenic mechanism as well as prevention and treatment of intestinal dysfunction in SAP.

Role of I-FABP in the diagnose of acute intestinal dysfunction rats with sepsis and effect of glutamine on its expression / 中国生化药物杂志

Objective To investigate the role of intestinal fatty acid binding protein(I-FABP)in evaluating intestinal dysfunction of septic rats and the effect of glutamine on I-FABP expression.Methods Rats were divided into 3 groups,control group were only fed with Peptisorb,model group were fed with Peptisorb after intraperitoneal injection with E.coli endotoxin lipopolysaccharidegiven and glutamine group were added glutamine on basis of model group.The correlation between serum I-FABP level and intestinal mucosa damage index were analyzed and the concentrations of serum I-FABP in each group were observed and compared. Results The serum level of I-FABP in rats were correlated with the Chiu’s score of intestinal mucosa,mucosa thickness and villus length(P<0.05 ).Compared with control group,the concentration of serum I-FABP in model group and glutamine group were significantly increased(P<0.05),but which in glutamine group was lower than that in model group(P<0.05).Conclusions Serum I-FABP could be an non-invasive diagnosis index for evaluating acute intestinal dysfunction in septic rats.In addition,dietary glutamine supplementation may ameliorate sepsis-induced intestinal epithelial injury in rats.

Intestinal rehabilitation in the management of acute gastrointestinal injury / 中华消化外科杂志

Acute gastrointestinal injury (AGI) is a malfunctioning of the gastrointestinal tract in intensive care patients due to their acute illness.AGI could be divided into 4 types,including AGI grade Ⅰ:increased risk of developing gastrointestinal dysfunction or failure; AGI grade Ⅱ:gastrointestinal dysfunction; AGI grade Ⅲ:gastrointestinal failure; AGI grade Ⅳ:gastrointestinal failure complicated with distal organ dysfunction.The symptoms of AGI include vomiting and regurgitation,gastric retention,diarrhea,gastrointestinal bleeding,paralytic intestinal obstruction,bowel dilatation and abnormal bowel sounds.Intestinal rehabilitation therapy was used to promote the patients with short bowel syndrome to restore enteral or oral feeding,and it could be used to improve the gastrointestinal function in patients with AGI.The procedure of intestinal rehabilitation therapy include total parenteral nutrition,parenteral and enteral nutrition,total enteral nutrition and oral feeding.The specific therapy could be implemented according to the severity of AGI and early enteral nutrition should be tried frequently.Intestinal tissue specific nutrients should also be provided either through enteral or parenteral approaches.

Level and clinical significance of 5-HT and iFABP in severe acute pancreatitis patients with intestinal dysfunction / 中华胰腺病杂志

Objective To determine the level and clinical significance of 5-hydroxytryptamine (5-HT) and intestinal fatty acid binding protein (iFABP) in patients of severe acute pancreatitis (SAP) with intestinal dysfunction. Methods The serum and urine in 42 cases of SAP with intestinal dysfunction were collected at day 1, 3 and 7 after admission, respectively. The numbers of bowel sounds were recorded. 20 health subjects were selected as the control. Results The numbers of bowel sounds in health subjects were 5.6 ± 2.3/min. The numbers of bowel sounds in SAP patients at day 1,3 and 7 were 2.3 ± 0.7/min, 1.7 ± 0.2/min and 3.1 ± 1.1/min, respectively;which were significantly lower than that in the control group (P < 0.01). The level of 5-HT in the control group was(86.7 ± 9.5)ng/ml, while the levels of 5-HT in the SAP patients at day 1, 3 and 7 were (112.0 ± 17.8) ng/ml, (130.5 ± 19.7) ng/ml, (107.9 ± 16.3) ng/ml. The level of urine iFABP in the control group was (90.5 ± 19.8) pg/ml, while the levels of urine iFABP in the SAP patients were (1250.2 ± 425.3) pg/ml, (1586.9 ± 523.4) pg/ml, (1154.6 ± 394.0) pg/ml. The levels of 5-HT and urine iFABP in the SAP patients all were significantly higher than those in the control group (P <0.01). The levels of 5-HT and urine iFABP in the SAP patients at day 3 were significantly higher than those in the day 1 and day 7, while there was no significant difference between the two groups. Conclusions Determination of serum 5-HT and urine iFABP in patients with early SAP could effectively evaluate the intestinal function, and it may have potential clinical significance.

Enteral feeding intolerance in patients with severe acute pancreatitis: causes and management / 肠外与肠内营养

Objective: To investigate the causes and management of enteral feeding intolerance in patients with severe acute pancreatitis (SAP). Methods: The clinical data were retrospectively analyzed of 128 SAP patients who underwent enteral feeding treatment during the period from January 2006 to January 2008. Results: The rate of enteral feeding intolerance was significantly higher in the group of patients who didn' t use Flocare 800 pump, single-use enteral feeding tube and heater (10/50 or 20.0%) than that in the group of patients who used Flocare 800 pump, single-use enteral feeding tube and heater (5/78 or 6.4%). Conclusion: The possible risk factors of enteral feeding intolerance may be transfusional speed, temperature and concentration of nutritional fluid. Severity of acute pancreatitis is another important factor. Intestinal dysfunction should be noticed during the enteral nutritional support.

Change of the plasma ghrelin level in patients with severe sepsis and its clinical significance / 中国实用内科杂志

Objective To observe the changes of plasma ghrelin in patients with severe sepsis and to explore the correlation of the plasma ghrelin and cytokines with sepsis.Methods Choose the healthy volunteer(n=10)as control group,and measure the plasma ghrelin(by ELISA),TNF-?,IL-1?,PCT(procalcitonin)and CRP at the 1st day,3rd day and 10th day in sepsis group(n=26).Results The plasma ghrelin level in sepsis group increased significantly compared with control group(P