The Effects of the Laparoscopic and Open Surgery on the Postoperative Intestinal Function Recovery Time in Elderly Patients with Colorectal Cancer / 昆明医科大学学报

Objective To investigate the effects of the laparoscopic surgery and open surgery on the postoperative intestinal function recovery time in elderly patients with colorectal cancer(CRC).Methods 66 elderly patients with CRC and treated in the 2nd People's Hospital of Kunming from January 2021to July 2022 were chosen and divided into the control group(n = 33)and the study group(n = 33)according to different operation ways.And the postoperative bowel function recovery time,radical,complications and surgical index were compared between the two groups.Results The recovery time of intestinal function in the study group was significantly shorter than that in the control group(P<0.05),but there was no significant difference in radical indicators between the two groups(P>0.05).The incidence of complications in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).The operation time of the study group was longer than that of the control group and there was the statistically significant difference(P<0.05),while the bleeding was less than that of the control group and there was the statistically significant difference(P<0.05).Conclusion Compared with the open surgery,laparoscopic surgery can more effectively shorten the recovery time of postoperative intestinal function,reduce the incidence of complications and intraoperative blood loss in elderly patients with CRC.Although there is no significant difference between two kinds of operation mode in terms of radical,it should be considered when it is applied in the specific operation time and other factors.

The effect of Astragalus membranaceus (Fisch.) Bge. on intestinal function and gut microbiota homeostasis in aging mice / 药学学报

Aging can cause degenerative changes in the function of multiple tissues and organs in the body. Gastrointestinal diseases and intestinal dysfunction are very common in the elderly people. The purpose of this study is to explore the effect of the total extract of Astragalus membranaceus (Fisch.) Bge. on intestinal function and gut microbiota homeostasis in natural aging mice, which will provide clues for further mechanism study. The natural aging mice model is established and animal experiments follow the regulations of the Animal Ethics Committee of Nanjing University of Traditional Chinese Medicine. The overall health of the mice was evaluated by the "frailty index" scoring method. The intestinal absorption and transport function were measured by detecting intestinal glucose absorption capacity, transport time, lipase and amylase activities of aging mice. Intestinal inflammation was assessed by detecting inflammatory cytokines by enzyme-linked immunosorbent assay (ELISA). The pathological changes in the intestines of aging mice were tested by hematoxylin-eosin (H&E) staining and alizarin blue (AB) staining. The qRT-PCR method was used to explore the gene transcription level related with the proliferation and differentiation of intestinal stem cells. Microbiota analysis based on 16S rDNA were used to evaluate the composition of gut microbiota. The results showed that Astragalus had a tendency to reduce the "frailty index" of aging mice, but did not show a significant difference. In some indicators of aging phenotype, Astragalus has the most significant effect on hair loss and physical fitness. In terms of intestinal function, Astragalus could increase intestinal glucose absorption capacity, shorten intestinal transportation time and promote lipase secretion in aging mice. The levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-‍α) in the aging intestinal tissue were reduced after Astragalus administration. Astragalus also ameliorated the pathological degeneration of the intestinal tissue of aging mice by increasing the length of small intestinal villi, the thickness of colonic mucosa and goblet cell number. In addition, Astragalus elevated the expression of genes associated with the proliferation and differentiation in jejunum and modulated gut microbiota, especially restoring the abundance of Lachnospiraceae. Taken together, the above research results demonstrate the total extract of Astragalus as a key factor improving the intestinal function and gut microbiota homeostasis of aging mice.

Chronic radiation-induced rectal injury after adjuvant radiotherapy for pelvic malignant tumors: report based on a phase 3 randomized clinical trial / 中华胃肠外科杂志

Objective: Radiotherapy is one of the standard treatments for pelvic malignant tumors. However, researches associated with intestinal radiation injury and the quality of life (QoL) of patients receiving radiotherapy were lacking in the past. This study aims to analyze the occurrence of radiation-induced rectal injury after adjuvant radiotherapy for pelvic malignant tumors and call for more attention on this issne. Methods: A retrospectively observational study was conducted. Case data of cervical cancer patients from the database of STARS phase 3 randomized clinical trial (NCT00806117) in Sun Yat-sen University Cancer Center were analyzed. A total of 848 cervical cancer patients who received adjuvant radiation following hysterectomy and pelvic lymphadenectomy in Sun Yat-sen University Cancer Center from February 2008 to August 2015 were recruited. The pelvic radiation dosage was 1.8 Gy/day or 2.0 Gy/day, five times every week, and the total dosage was 40-50 Gy. Among 848 patients, 563 patients received radiation six weeks after surgery, of whom 282 received adjuvant radiation alone and 281 received concurrent chemoradiotherapy (weekly cisplatin); other 285 patients received sequential chemoradiotherapy (paclitaxel and cisplatin). Acute adverse events, chronic radiation damage of rectum, and QoL were collected and analyed. The digestive tract symptoms and QoL were evaluated based on EORTC QLQ-C30 questionnaires at one week after surgery (M0), during adjuvant therapy period (M1), and at 12 months and 24 months after the completion of treatments (M12 and M24), respectively. Higher scores in the functional catalog and overall quality of life indicated better quality of life, while higher scores in the symptom catalog indicated severe symptoms and worse QoL. Chronic radiation rectal injury was defined as digestive symptoms that were not improved within three months after radiotherapy. Grading standard of acute adverse events and chronic radiation rectal injury was according to the gastrointestinal part of National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0 (NCI-CTCAE Version 4.0). Results: The mean total radiation dosage of 848 patients was (47.8±4.6) Gy. During adjuvant therapy, the common symptoms of acute intestinal dysfunction were nausea (46.0%, 390/848), vomiting (33.8%, 287/848), constipation (16.3%, 138/848) and abdominal pain (10.3%, 87/848). At M12 and M24, the number of 0 QLQ-C30 questionnaires collected was 346 and 250, respectively. QLQ-C30 questionnaires showed that the scores of nausea or vomiting, appetite decrease, diarrhea, constipation, etc. were improved obviously at M12 or M24 compared with those at M0 or during M1 (all P<0.05). As the extension of the follow-up time, the score of the overall QoL of patients gradually increased [M0: 59.7 (0.0-100.0); M1: 63.1 (0.0-100.0); M12: 75.2 (0.0-100.0); M24: 94.1 (20.0-120.0); H=253.800, P<0.001]. Twelve months after the completion of treatments, the incidence of chronic radiation rectal injury was 9.8% (34/346), mainly presenting as abdominal pain, constipation, stool blood, diarrhea, mostly at level 1 to 2 toxicity (33/34, 97.1%). One patient (0.3%) developed frequent diarrhea (>8 times/d), which was level 3 toxicity. Twenty-four months after all treatments, the incidence of chronic radiation rectal injury was 9.6% (24/250), which was not decreased significantly compared to that in the previous period (χ(2)=0.008, P=0.927). The symotoms of one patient with level 3 toxicity was not relieved. Conclusions: The common symptoms of patients with pelvic maligant tumors during postoperative adjuvant radiotherapy include nausea, vomiting, constipation, abdominal pain and diarrhea. These symptoms are alleviated obviously at 12 and 24 months after adjuvant radiotherapy, and the QoL is significantly improved. However, a few patients may develop chronic radiation rectal injury which is not improved for years or even decades, and deserves attention in clinical practice.

Intestinal dysfunction of spinal cord injury treated with moxibustion: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect on intestinal dysfunction of spinal cord injury (SCI) between the comprehensive therapy of moxibustion (moxibustion for opening the governor vessel and regulating the spirit) and rehabilitation training and the simple treatment with rehabilitation training.@*METHODS@#A total of 60 patients with intestinal dysfunction of SCI were randomized into a comprehensive therapy group and a rehabilitation group, 30 cases in each one (3 cases were dropped out in each group). On the base of the routine western medicine treatment and rehabilitation training, the bowel training and rectal function training were provided, once a day in the rehabilitation group. In the comprehensive therapy group, on the base of the treatment as the rehabilitation group, the moxibustion was exerted at Yaoyangguan (GV 3), Mingmen (GV 4), Zhiyang (GV 9), Dazhui (GV 14) and Baihui (GV 20), etc, once a day, 30 min each time. In both groups, the treatment for 4 weeks was as one course and 3 courses of treatment were required. Separately, before treatment, after 4, 8 and 12 weeks of treatment, the scores of neurogenic bowel dysfunction (NBD) and World Health Organization quality of life scale (WHOQOL-BREF) were observed and the clinical effect was evaluated after 12 weeks of treatment.@*RESULTS@#After treatment, the total effective rate was 88.9% (24/27) in the comprehensive therapy group, which was higher than 74.1% (20/27) in the rehabilitation group (<0.05). After 4, 8 and 12 weeks of treatment, NBD scores were all reduced obviously as compared with those before treatment in the two groups (all <0.01). After 8 and 12 weeks of treatment, NBD scores in the comprehensive therapy group were lower than the rehabilitation group (both <0.05). After 4, 8 and 12 weeks of treatment, the scores of all of the domains (psychology, physiology, social relations and environment) in WHOQOL-BREF were higher than those before treatment in the two groups (all <0.01). After 4 weeks of treatment, the scores in the psychology and physiology domains in the comprehensive therapy group were higher than the rehabilitation group (all <0.05). After 8 and 12 weeks of treatment, the scores of all of the domains in the comprehensive therapy group were higher than the rehabilitation group (all <0.05).@*CONCLUSION@#The comprehensive treatment of moxibustion and rehabilitation training achieves the better effect on intestinal dysfunction of SCI than the simple rehabilitation training and greatly improves the quality of life in SCI patients.

Progress research of neutrophil extracellular traps in sepsis and intestinal barrier function / 医学研究生学报

Sepsis is one of the most important factors leading to death in critically ill patients. Neutrophils are the main effector cells that play an immune response during sepsis. In addition to exerting chemotaxis and phagocytosis, neutrophils are also capable of releasing neutrophil extracellular traps (NETs) composed of double-stranded DNA and antibacterial proteins embedded in DNA. The persistent over-formation of NETs in sepsis will cause thrombosis and multiple organ dysfunction (MOD). Gut as the initial organ of MOD, sepsis and intestinal barrier damage is an important cause of MOD. Studies have confirmed that NETs are closely related to intestinal barrier damage, and excessive formation of NETs in the intestine can cause persistent inflammation of the intestinal mucosa, leading to intestinal dysfunction. This article outlines the latest advances in NETs in sepsis and intestinal function, providing new directions for the early diagnosis and treatment of sepsis.

Effect of Modified Chaihu Guizhi Ganjiang Tang in Treating Chronic Cholecystitis of Gallbladder Heat / 中国实验方剂学杂志

Objective: To explore the clinical effect of modified Chaihu Guizhi Ganjiang Tang in the treatment of chronic cholecystitis with gallbladder heat and spleen cold syndrome. Method: Totally 129 cases with chronic cholecystitis treated in our hospital from March 2017 to July 2018 were selected as study objectives and randomly divided into observation group (65 cases)and control group (64 cases). After the shedding and exclusion cases were subtracted, 61 patients in observation group and 61 patients in control group actually completed this study. The routine treatment was provided to both groups, and modified Chaihu Guizhi Ganjiang Tang was additionally given to observation group. All of the cases received treatments for 3 weeks. The two groups' clinical effect, traditional Chinese medicine(TCM)syndrome scores, inflammatory factors[interleukin (IL)-6, tumor necrosis factor (TNF)-α] levels in serum, gallbladder function, gastrointestinal function indicators[motilin (MTL), vasoactive intestinal peptide (VIP)] before and after treatments, as well as toxic side reaction were compared. Result: Totally 7 cases were lost during the study period. The overall effective rate of the observation group was 95.08%(58/61), which was significantly higher than 80.33%(49/61)of the control group (Pα concentrations after treatment were significantly lower than those before treatment (PPPConclusion: Modified Chaihu Guizhi Ganjiang Tang treats patients with chronic cholecystitis with bile heat and spleen cold syndrome by effectively relieving inflammatory response and accelerating the recovery of gastrointestinal function and gallbladder systolic function, with an exact curative effect and high patient tolerance.

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients / 中华物理医学与康复杂志

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group ( n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages:adaptation, training and con-solidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure ( FIM) scale respective-ly. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32％ of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury.

Criteria for Safe Use of Plant Ingredients in Diets for Aquacultured Fish

The Norwegian Food Safety Authority (Mattilsynet) asked the Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet) to assess if the criteria for safe use of plant ingredients in diets for aquacultured fish fulfil the Feed regulative §7 to “not induce negative health effects in the animal”, and in this context aquacultured fish. The use of feed ingredients of both plant and animal origin is set by the regulation “Forskrift 7. November 2002 nr 1290”, and amendments. The objective of the regulation is to protect animals, consumers and the environment. For animals, the feed shall not pose a risk, or danger, to their health. Aspects to be assessed were whether the changes in fish diet ingredient composition seen in recent years with high levels of plant ingredients, plus additions of immunostimulants, would in any manner challenge fish health and if any ingredient should be limited due to its negative effect, or induce any long-term negative effect. “Long-term” here extends beyond normal production time for consumption, e.g. when substances that might affect fish health are included in broodstock diets. Atlantic salmon (Salmo salar), rainbow trout (Onchorhyncus mykiss), Atlantic halibut (Hippoglossus hippoglossus) and Atlantic cod (Gadus morhua) should especially be addressed. However, since all life stages should be included, especially broodstock, and also possible long-term effects, and literature on these for the requested species is scarce, the assessment mentions studies on other species when relevant. With the exception of full-fat and extracted soybean meal for salmonids, substituting at least part of the fishmeal fraction of aquafeeds with individual plant ingredients is promising, at least in the short to medium term. Indeed in some cases, diets containing up to 20% inclusion level of high-quality plant protein sources have resulted in better nutrient digestibility and growth parameters than the fishmeal-based control diets. When substituting fishmeal with plant ingredients, however, it is necessary to balance the diets regarding limiting amino acids and minerals. Adding plant proteins to fish diets result in the introduction of anti-nutritional factors. There is an urgent need to investigate consequences of various anti-nutritional factors, individually and in combinations, to nutrient digestibility, utilization and metabolism as well as to intestinal function, structure, defence mechanisms and microbiota. Long-term effects also merit investigation. This will aid in the ability to predict how a newly introduced plant ingredient as well as combinations of plant ingredients may affect the fish and identify steps needed to avoid adverse health effects. As many of the potential disadvantages of using plant oils in salmonid diets are related to either very high levels of n-6 PUFA (most available oils) or very high levels of linseed oil, it would be recommended that mixtures of plant oils should be used as feed inclusions. By adjusting the ratio of n-6 and n-3 the level of eicosanoids can be controlled. By including palm oil, potential problems in lipid digestibility and transport can be controlled. A standard inclusion of soybean lecithin may also be advisory. These and other variants of mixtures of oil sources have been explored in recent years with some success in salmonid fish. Such mixtures do not seem to be necessary for marine fish. Modern finfish aquaculture faces problems such as bone and skeletal deformities, cataracts, heart disorders, unspecific ulceration and various digestive disorders including intestinal colic in Atlantic cod, gastric dilatation (bloat) in rainbow trout, and intestinal tumours, at low incidence, in Atlantic salmon broodstock. Most of the mentioned problems have been related to malnutrition, feed, intensive growth and/or unfavourable environmental conditions. The disorders are often not lethal, but may imply a fish welfare problem and increase the susceptibility to secondary disorders and infectious diseases. Major changes in feed composition and feed ingredients may increase the risk for such production-related disorders in intensive fish farming. Care should be taken when choosing plant alternatives, both types and qualities, to prevent nutrition-related diseases such as skeletal deformities, cataracts, heart conditions, and other, unspecific symptoms. The change from marine- to plant-based diet ingredients, results in changed profile and content of undesirable substances. The list of undesirable substances included in the feed legislation is, in general, sufficient, but it should be considered to include pesticides in use today and more of the mycotoxins. Currently only aflatoxin B1 is included, while only recommendations exist for other mycotoxins. Studies of dietary exposure to undesirable substances, e.g. pesticides and mycotoxins, and their toxic effects and toxicokinetics in fish are scarce. To date, the application of pre- and probiotics for the improvement of aquatic environmental quality and for disease control in aquaculture seems promising; however, the information is limited and sometimes contradictory. Currently there are numerous gaps in existing knowledge about exogenous nucleotide application to fish including various aspects of digestion, absorption, metabolism, and influences on various physiological responses, especially expression of immunogenes and modulation of immunoglobulin production. As limited information is available about the effect of immunostimulants, prebiotics and nucleotides on gut morphology, this topic should be given high priority in future studies. Heat processing of raw materials and of the complete fish diets may potentially alter nutritional properties of plant materials. However, the negative effects appear to be modest under practical conditions.

Electroacupuncture Treatment Conduced Before and After Surgery Is Better in Promoting Reco-very of Gastrointestinal Function in Colorectal Cancer Patients Undergoing Radical Resection / 针刺研究

OBJECTIVE: To investigate the effect of electroacupuncture (EA) at different time-points on postoperative gastrointestinal function in patients undergoing colorectal cancer surgery. METHODS: Eighty patients with colorectal cancer undergoing laparotomy were randomly assigned to intravenous anesthesia, EA A, EA B, and EA C groups (n＝20 cases in each group). All the patients in the four groups received intravenous anesthesia with midazolam, sufentanil, cisatracurium besylate and Propofol, postoperative gastrointestinal decompression and drug analgesia. EA (2－3 mA, 2 Hz) was applied to Zhongwan (CV 12) and Tianshu (ST 25), Neiguan (PC 6), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39) on the right side for 30 min, once (one day before surgery) in the EA A group, twice (one day and 30 min before surgery) in the EA B group, and 3 times (one day, 30 min before and one day after surgery) in the EA C group. The acupoints used after surgery were PC 6, ST 36, ST 37 and ST 39. The time of postoperative ventilation, defecation, food-intake and water drinking, stomach tube removal and abdominal drainage tube removal, the volumes of stomach tube drainage and abdominal drainage, and postoperative adverse reactions were recorded. RESULTS: The first ventilation time, after surgery in the EA C group was significantly earlier than those in the intravenous anesthesia, EA A and EA B groups (P0.05)．. CONCLUSION: EA treatment combined with intravenous anesthesia conducted before and after surgery is effective in promoting the recovery of gastrointestinal function in patients undergoing colorectal cancer laparotomy, and is obviously better than simple pre-operative EA.

Effect of Taohe Chengqi Decoction on Intestinal Function of Rats with Severe Acute Pancreatitis / 广州中医药大学学报

Objective To investigate the effect and mechanism of Taohe Chengqi Decoction(TCD)on intestinal function of severe acute pancreatitis (SAP) rats. Methods Fifty SD rats were randomly divided into blank control group, SAP model group, TCD group (in the dosage of 23.5 mL·kg -1·d -1 by gastric gavage), Octreotide group(in the dosage of 10 μg·kg-1·d-1 by intraperitoneal injection),combined treatment group(TCD in the dosage of 23.5 mL·kg -1·d -1 by gastric gavage, Octreotide in the dosage of 10 μg·kg -1·d -1 by intraperitoneal injection). Except for the blank control group,the rats in the other groups were injected with L-arginine intraperitoneally to establish SAP model. The rats were sacrificed 24 h after the model was successfully established. The serum level of amylase(AMY) in rats was detected by biochemical method. The serum levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α in the fecal flora of rats were measured by enzyme-linked immunosorbent assay (ELISA),and the pathological changes of colorectal tissues and pancreas tissues were observed by hematoxylin-eosin (HE)staining. Results Compared with the blank control group,the levels of serum AMY,TNF-α,IL-6 and IL-10 in SAP model group were significantly increased (P < 0.05), enterococcus and enterobacteria count were increased, while lactobacillus and bifidobacteria count were decreased;the histological structure of pancreas tissues and large intestinal tissues was destroyed, and the proliferation of large amount of inflammatory cells was present. Compared with the SAP model group, serum AMY,TNF-α,and IL-6 levels were decreased and IL-10 level was increased in the three medication groups (P<0.05);enterococcus and enterobacteria count were decreased,while lactobacillus and bifidobacteria count were increased;the pathological features of pancreas tissues and large intestinal tissues were improved;the effect of the combined treatment group was the strongest. Conclusion TCD can improve the intestinal function and intestinal flora of SAP rats,reduce the inflammatory reaction,and prevent SAP from deterioration.

Influence of electroacupuncture pretreatment on intestinal function in the patients of colorectal cancer surgery / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) pretreatment on the intestinal function, inflammatory reaction and blood lactic acid in the patients of colorectal cancer surgery.</p><p><b>METHODS</b>Sixty patients of colorectal cancer laparotomy at selective period, aged from 18 to 59 years old were selected. According toⅠ-Ⅲ grade of American Society of Anesthesiologists (ASA), the patients were randomized into group A (total intravenous anesthesia), group B[total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side] and group C[total intravenous anesthesia combined with EA pretreatment at Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side], 20 cases in each one. The total intravenous anesthesia was applied to all of the three groups. EA pretreatment was used one day before surgery and 30 min before surgery at corresponding acupoints in the group B and group C separately, 30 min each time. After surgery, the recovery time of bowel sound, the recovery time of flatus, the recovery time of defecation, the duration of diet fasting, the time of peritoneal drainage tube withdrawal and the total peritoneal drainage volume were observed in the three groups. The venous blood was collected to determine white blood cell count (WBC) and neutrophil count (NEUT) before surgery (T), 24 h after surgery (T) and on the 5th day after surgery (T) separately. The arterial blood was collected to determine the level of lactic acid before surgery (T), after peritoneal douching (T) and 24 h after surgery (T)separately.</p><p><b>RESULTS</b>The recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal in the group C were apparently earlier than those in the group A (all<0.05). WBC and NEUT at Tin the group C were apparently less than those in the group A (both<0.05). The differences in lactic acid at T, Tand Twere not significant statistically in comparison of the three groups (all>0.05).</p><p><b>CONCLUSIONS</b>The total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25) and Zhongwan (CV 12) reduce the recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal so as to improve the recovery of intestinal function, reduce WBC in 24 h after surgery and alleviate inflammatory reaction. This therapy has no influence on blood lactic acid.</p>

Influence of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients undergoing laparoscopic radical gastrectomy / 中国现代普通外科进展

Objective:To evaluate the influence of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients undergoing laparoscopic radical gastrectomy.Methods:A total of 120 patients undergoing laparoscopic radical gastrectomy were randomly divided into group A,B and C.Each group included 40 patients.CO2 pneumoperitoneum pressure ingroup A,B and C were 8～10 mmHg,11～13 mmHg and 14～16 mmHg,respectively.The degree of intestinal mucosa damage,plasma D-lactate(2,24 and 48 hours after the treat-ment),intestinal function recovery and complication ration were compared between the three groups.Results:Damage degree of intestinal mucosa after operation in A,B and C groups were 0～1,1～2 and 2～3 respectively.There was significant change in intestinal mucosa injury after operation in both B and C groups.The level of D-lactic acid in group C (2,24 and 48 hours after the treat-ment) were significantly higher those in group A and group B (P＜0.05).The bowel sounds appeared time,exhaust time and intake time in group C were significantly longer than group A and group B (P＜0.05).The incidence of complications were not significantly difference during the three groups.Conclusion:The high pressure of CO2 pneumoperitoneum will cause intestinal mucosa damaged,and not conducive to the patients' intestinal rehabilitation.We suggest that the CO2 pneumoperitoneum pressure should be as low as possible under clear visualization during operation.

Impacto do uso de simbiótico na evolução de pacientes com neoplasia de vias aéreas e digestivas superiores submetidos a tratamento cirúrgico / Impact of the use of symbiotic on the evolution of patients with upper airway and upper digestive tract undergoing surgical treatment

Trata-se de estudo clinico randomizado duplo-cego, no qual foram incluídos indivíduos com câncer de vias aéreas e digestivas superiores submetidos a tratamento cirúrgico. Os participantes foram randomizados para o tratamento com simbiótico ou placebo. 0 objetivo foi avaliar se o tratamento com simbi6tico durante o pré-operatório seria capaz de interferir na evolução dos pacientes. Trinta e seis pacientes foram incluídos, sendo 18 no grupo simbiótico e 18 no placebo. Os pacientes foram avaliados no pre-operatório imediato, e realizada Avaliação Global Subjetiva, avaliação antropométrica e funcional. Foram também, coletadas amostras de sangue para mensuração da citocina TNF-a e de diamina oxidase. A intervenção consistiu em administração de simbiótico ou placebo duas vezes por dia, por no mínimo cinco e no máximo sete dias. Ao longo da internação os pacientes foram acompanhados, especialmente, quanto ao desenvolvimento de complicações e a função intestinal. lnicialmente os grupos foram semelhantes quanto ao sexo, ao estado nutricional, as medidas antropométricas, a capacidade funcional por dinamometria, e a presença de comorbidades, assim como ao tempo de diagnóstico do câncer, ao procedimento cirúrqico realizado, a localização e ao estadiamento T do tumor primário (p> 0,05). Após inicio da intervenção os grupos permaneceram semelhantes quanto as variáveis: , tempo de internação, utilização de antibiótico como profilaxia e tratamento, níveis plasmáticos de TNF-a e de diamina oxidase, além de incidência de complicações infecciosas e não-infecciosas (p>0,05). Contudo, mesmo que sem diferença estatística, quando comparado ao grupo controle, o grupo simbiótico apresentou o primeiro episódio de fezes mais cedo, maior incidência de diarreia e consistência das fezes mais amolecidas segundo...

This is a double-blind clinical randomized study that included individuals with upper air and digestive tract cancer who underwent surgical treatment. Participants were randomized into a treatment with symbiotic or placebo. The aim was to evaluate if the postoperative treatment with symbiotics would be able to interfere with the postoperative outcome of the participants. Thirty-six patients were included, 18 in the symbiotic group and 18 in the placebo. Patients were evaluated by Subjective Global Assessment, anthropometric measurements, and had blood samples drawn to assess TNF-a and intestinal permeability by diamine oxidase. The interventionconsisted of symbiotic or placebo administration twice a day, for at least five up toseven days postoperatively. During hospitalization, patients were followed to assess postoperative complications and intestinal function. At beginning, the groups were similar regarding the nutritional status, comorbidities, sex, functional capacity byhandgrip strength, anthropometric measurements, as well as T stage, time since cancer diagnosis, location of primary tumor and surgical procedure (p> 0.05). After the beginning of the intervention, the groups were still similar, now concerning the variables: time of hospitalization, antibiotic prophylaxis and therapy and incidence of infectious and non-infectious complications (p> 0.05). There were no differences forTNF-a neither for diamine oxidase (p> 0.05). Nevertheless, although not significant, the symbiotic group presented the first stool evacuation earlier, had a higher incidence of diarrhea and softer consistency of stools according to the Bristol Stool Scale (p> 0.05). In conclusion, the symbiotic use was not effective to prevent the development of surgical complications, the modulation of the intestinal function and the inflammatory response, in elective surgical head and neck cancer patients.

Effects of early enteral feeding on clinical outcomes and immune function in patients after colorectal cancer surgery / 中华普通外科杂志

Objective To observe the effect of early enteral feeding on clinical outcomes and immune function in patients after colorectal cancer surgery.Methods 90 cases of colorectal cancer patients were randomly divided into early enteral feeding group (43 cases) and control group (45 cases).Patients in early feeding group were given small amount of water several times and enteral nutrition early after surgery,while patients in the control group were administrated according to conventional postoperative care protocol.Data were collected on serum IgA,IgG,IgM,CD4 +,CD4 +/CD8 + and CRP on the postoperative first,third and seventh days,postoperative length of stay,complications and quality of life.Results The postoperative fever time [(54 ±6) h vs.(65 ±6) h,t =8.688,P ＜0.01],time to flatus [(58 ±8) h vs.(72±7) h,t=8.573,P＜0.01],postoperative length of stay [(6.9±1.4) dvs.(8.5 ±1.9) d,t=4.277,P ＜ 0.01] and health care cost [(41 868 ± 3 168) RMB vs.(45 950 ± 3 714) RMB,t =5.536,P ＜ 0.01] were significantly in favour of early enteral feeding group than those in control group.Further,the score of quality of life at discharge were significantly higher in early enteral feeding group [(18.4 ± 1.7) vs.(16.4 ± 1.9),t =5.235,P ＜ 0.01],while the complication incidence showed no difference between the two groups [18.6％ (8/43) vs.22.2％ (10/45),t=0.177,P＞0.05].The CD4+,CD4+/CD8+ and IgM on the seventh postoperative day and the IgA and IgG on the third and seventh postoperative day were significantly better in early enteral feeding group while the CRP was significantly lower as compared to the control group (t =3.639,t =2.255,t =2.119,t =2.035,t =2.961,t =2.060,t =2.108,t =7.308,t =3.435,P ＜ 0.05).Conclusions Early oral enteral feeding after elective colorectal cancer surgery can improve patient's immune function,reduce the stress and accelerate rehabilitation.

Effects of Flurbiprofen on Morphine Doses and Intestinal Function Recovery after Radical Gastrectomy for Gastric Cancer / 中国药房

OBJECTIVE:To investigate the effect of flurbiprofen on morphine doses and intestinal function recovery after radi-cal gastrectomy for gastric cancer. METHODS:102 patients underwent radical gastrectomy of gastric cancer were randomly divided into control group and observation group,with 51 cases in each group. Control group was treated with routine morphine analgesia pump,and observation group was additionally given intravenous injection of flurbiprofen 50 mg before operation and 24 h after op-eration on the basis of control group. VAS,comfort score(BCS),the amount of morphine and intestinal function recovery were ob-served and recorded in 2 groups. RESULTS:48 h after operation,there was no statistical significance in VAS and BCS scores be-tween both groups(P>0.05),but the dose of morphine in observation group was significantly less than in control group,with sta-tistical significance (P<0.05);the postoperative recovery time of bowel sounds and the first anal exhaust time in observation group were significantly shorter than control group,and the incidence of nausea and vomiting in observation group was significant-ly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:The application of flurbiprofen combined with morphine in gastrectomy can reduce the dose and ADR of morphine based on the same analgesic effect,and it is good for the recovery of intestinal function.

Protective Effects of Proanthocyanidins on Intestinal Function after Cerebral Ischemia-reperfusion Injury / 中国康复理论与实践

Objective To explore the protective effects of proanthocyanidins pretreatment on intestinal function after cerebral isch-emia-reperfusion injury. Methods 24 Sprague-Dawley rats were randomly divided into sham group (group A, n=8), ischemia-reperfusion group (group B, n=8) and proanthocyanidins pretreatment group (group C, n=8). The model of cerebral ischemia-reperfusion injury in rats was established according to Longa's method. Group C was intraperitoneally injected with proanthocyanidins 10 mg/(kg?d), group A and group B were injected with normal saline for 5 consecutive days. 1 and 3 days after cerebral ischemia-reperfusion, ileum myoelectric slow wave and smooth muscle contractility, the activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were measured, the content of the serum TNF-αwas tested with ELISA kit, ileum tissues were tested with hematoxylin eosin (HE) staining and used for mea-suring the moisture content. Results Compared with group B 1 and 3 days after cerebral ischemia-reperfusion, the intestinal mucosa injury relieved, the intestinal mucosa score decreased (P0.05), and the amplitude increased (P<0.05) in group C;the serum SOD activity in-creased (P<0.05), and the content of MDA and TNF-αdecreased (P<0.01) in group C;the intestinal moisture content reduced (P<0.01) in group C. Conclusion Proanthocyanidins pretreatment can protect intestinal function from injury after cerebral ischemia-reperfusion.

Protective Effects of Proanthocyanidins on Intestinal Function after Cerebral Ischemia-reperfusion Injury / 中国康复理论与实践

@#Objective To explore the protective effects of proanthocyanidins pretreatment on intestinal function after cerebral ischemia-reperfusion injury. Methods 24 Sprague-Dawley rats were randomly divided into sham group (group A, n=8), ischemia-reperfusion group (group B, n=8) and proanthocyanidins pretreatment group (group C, n=8). The model of cerebral ischemia-reperfusion injury in rats was established according to Longa's method. Group C was intraperitoneally injected with proanthocyanidins 10 mg/(kg ⋅ d), group A and group B were injected with normal saline for 5 consecutive days. 1 and 3 days after cerebral ischemia-reperfusion, ileum myoelectric slow wave and smooth muscle contractility, the activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were measured, the content of the serum TNF-α was tested with ELISA kit, ileum tissues were tested with hematoxylin eosin (HE) staining and used for measuring the moisture content. Results Compared with group B 1 and 3 days after cerebral ischemia-reperfusion, the intestinal mucosa injury relieved, the intestinal mucosa score decreased (P<0.05) and the number of infiltrated inflammatory cell decreased in group C; the frequency of slow wave and contraction trended to increase (P>0.05), and the amplitude increased (P<0.05) in group C; the serum SOD activity increased (P<0.05), and the content of MDA and TNF-α decreased (P<0.01) in group C; the intestinal moisture content reduced (P<0.01) in group C. Conclusion Proanthocyanidins pretreatment can protect intestinal function from injury after cerebral ischemia-reperfusion.

Experimental study of the influence of Sini decoction on the inflammatory response and the immune function in septic rats / 中华危重病急救医学

Objective To observe the effect of Sini decoction on inflammatory response and immune function in septic rats and to discuss its possible mechanism.Methods 66 Sprague-Dawley (SD) rats were randomly divided into normal control group (n=6),model group (n=30),and Sini decoction group (n=30).Septic model was reproduced by intraperitoneal injection of lipopolysaccharide (LPS,5 mg/kg).After the reproduction of sepsis,rats in Sini decoction group received Sini decoction (5 g/kg) by gavage,while those in model group were given equal dose of normal saline in the same way.Rats in normal control group did not receive any treatment.Blood was collected via eye sockets at 2,12,24,48,72 hours after LPS administration,then the rats were sacrificed.The concentrations of inflammatory mediators,such as interleukin (IL-1,IL-6,IL-10),tumor necrosis factor-α (TNF-α),and the expression level of monocyte human leukocyte antigen-DR (HLA-DR) were determined with enzyme linked immunosorbent assay (ELISA),and the pathological changes in intestinal mucosa were observed under electron microscope.Results The concentration of IL-1 (ng/L) at 2 hours in model group was gradually increased and peaked at 48 hours (4.07 ± 0.10),and then gradually decreased,while the IL-1 level in Sini decoction group peaked at 12 hours (2.98 ± 0.12) followed by a gradual decrease.IL-6 (ng/L) in model and Sini decoction groups peaked twice at 12 hours (91.39 ± 1.55,73.00 ± 2.38) and 48 hours (82.51 ± 1.49,64.68 ± 1.68) respectively.IL-10 (ng/L) in model group gradually decreased after peaking at 2 hours (86.66 ± 6.12),and that in Sini decoction decreased at 12 hours (71.61 ± 2.35) followed by an increasing tendency,and approached normal level at 48 hours (109.09 ±4.77 vs.124.01 ± 7.89,P＞0.05).TNF-α (ng/L) in model group was gradually increased and peaked at 48 hours (83.37 ±3.79),and that in Sini decoction peaked at 12 hours (48.52 ± 1.21),and decreased to normal level at 72 hours (18.59 ± 1.97 vs.15.50 ± 2.68,P＞0.05).During the course of the experiment,as compared with those of the model group,level of IL-1,IL-6,and TNF-α were significantly lower at all time points in Sini decoction group,and IL-10was significantly higher.The expression level of HLA-DR (μg/L) in model and Sini decoction groups peaked at 2 hours (4.86 ± 0.15,4.85 ± 0.17),and then gradually lowered.HLA-DR expression μg/L) at 48 hours and 72 hours in Sini decoction group was significantly lower than that in model group (48 hours:4.21 ± 0.12 vs.2.74 ± 0.16,72 hours:3.80 ± 0.09 vs.2.27 ± 0.12,both P＜0.01).Pathological study of intestinal mucosa showed that the intestinal mucosa were infiltrated significandy by inflammatory cells,and villi were damaged severely in both model group and Sini decoction group at 2 hours after LPS challenge.Infiltration of inflammatory cells in Sini decoction group was less intense after 12 hours,and the intestine villi repair was more obvious compared with model group.Conclusion Sini decoction could regulate systemic inflammatory response,and promote the repair of intestinal mucosa,the intestinal function and the immune status of septic rats.

Effects of Jianpisanjie pills on the gastro-intestinal functions / 中国药学杂志

OBJECTIVE: To investigate the effects of Jianpisanjie (JPSJ) pills on the gastro-intestinal functions by animal experiment. METHODS: With gastric evacuation and gastrointestinal propulsion movement of mice obstructed by atropine sulphate, and the emesis of pigeon resulted by copper sulfate, the effects of JPSJ on gastrointestinal function was investigated, the effects on vomit latent period and emesis times were also studied. The model of hepatoma H22 bearing mice was established. After weighting, the mice were randomized into 5 groups, they were the control group, the high, middle, low dosages of JPSJ, and the positive-control group. Then they were treated with chemotherapy and administrated with subject drugs. When the trial ended, the weight and food intake of H22 bearing tumor were determined. RESULTS: Different dosage of JPSJ could increase the gastric evacuation rate and gastrointestinal propulsion rate, prolong the vomit latent period and emesis times of pigeon. And the pills also could reduce the side-effects of chemotherapy, such as weight of mice and food intake. CONCLUSION: JPSJ could promote the gastro-intestinal function, improve the weight loss and less food intake resulted by chemotherapy, and may be adjuvant drug for tumor.

Effect of intestinal function-recovering decoction on treatment of multiple organ dysfunction syndrome in rats

OBJECTIVE@#To analyze the effect of intestinal function-recovering decoction on multiple organ dysfunction syndrome in rats, and to investigate a novel solution to multiple organ dysfunction syndrome.@*METHODS@#Multiple organ dysfunction syndrome was induced in 60 Sprague-Dawley rats by intestinal ischemia-reperfusion combined with cecal ligation and puncture. Then these rats were intragastrically administered physiological saline (group I, n=20), ampicillin (group II, n=20) or intestinal function-recovering decoction (group III, n=20). After treatment, serum malondialdehyde and superoxide dismutase levels were compared among three groups. Simultaneously, bacterial culture of various organ tissues was performed and bacterial and endotoxin translocation were observed.@*RESULTS@#Compared with group I, serum malondialdehyde, alanine aminotransferase and aspartate aminotransferase levels were significantly decreased (all P0.05). The rate of bacterial translocation in the groups II and III was significantly lower than in the group I (P0.05).@*CONCLUSIONS@#Intestinal function-recovering decoction can significantly reduce endotoxin and bacterial translocation and stabilize enteral oxidative-antioxidative balance.