Comparative effects of Roux-en-Y gastric bypass procedures preserving different gastric volume on blood glucose in Goto-Kakizaki rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the effects of Roux-en-Y gastric bypass (RYGBP)procedures preserving different gastric volume on blood glucose of rats with non-obese type 2 diabetes.</p><p><b>METHODS</b>A total of 36 Goto-Kakizaki rats randomly underwent one of the following procedures: gastric bypass with different types of anastomosis including the Roux-en-Y of total stomach excision(n=12), the Roux-en-Y of partial stomach excision(n=12) and the Roux-en-Y of stomach preservation(n=12). Rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0(preoperative), 1, 3, 6, 12, 24 weeks. Hemoglobin A1c(HbA1c) level was measured at 0, 12, 24 weeks and glucose tolerance test (OGTT) was performed in conscious rats before (baseline) and then 30, 60, 120, and 180 minutes. Change of blood glucose over time was depicted. Area under curve(AUC) of glucose tolerance were calculated.</p><p><b>RESULTS</b>Compared with preoperative levels, the weight and food intake of all the rats were significantly decreased at 1 week after surgery(P<0.01). At 3 weeks after operation, the weight and food intake were significantly increased compared with 1 week after operation in the Roux-en-Y of partial stomach excision and the Roux-en-Y of stomach retention(P<0.01). In the Roux-en-Y of total stomach excision, the weight and food intake were significantly lower compared with other two groups(P<0.05). At 24 weeks after operation, the levels of fasting blood glucose were (7.3 ± 1.5), (7.5 ± 2.0) and (8.3 ± 1.3) mmol/L, which were lower than the preoperative levels [(13.2 ± 1.6), (13.6 ± 2.5) and (12.9 ± 2.0) mmol/L, P<0.01] in the three groups. There were no significant differences among the three groups(P>0.05). At 24 weeks after operation, the HbA1c levels were(6.3 ± 1.3)%, (6.4 ± 2.0)% and (7.0 ± 1.3)%, which were lower than the preoperative level[(10.2 ± 2.6)%, (9.6 ± 2.5) and (9.9 ± 2.0)%, P<0.01]. There were no significant differences among the three groups(P>0.05). The trend of the glucose tolerance test and AUC were similar in the three groups after operation.</p><p><b>CONCLUSION</b>Roux-en-Y gastric bypass in non-obese diabetic rats is effective in terms of glucose control and the efficacy of gastric bypass has no obvious association with the stomach volume.</p>

Early treatment with high-volume hemofiltration combined with rhubarb for patients with severe acute pancreatitis / 第二军医大学学报

Objective: To investigate the effect of early treatment with a combination of rhubarb and high volume hemofiltration for patients with severe acute pancreatitis(SAP). Methods: We retrospectively analyzed the 31 SAP patients, who were treated in our department between June 2005 and December 2007. Twelve patients (control group) received high-volume hemofiltration only and the other 19 patients(treatment group)received both hemofiltration and rhubarb-enchyma infused via a gastric tube for three days. The vital signs and recovery of gastrointestinal functions were observed in the two groups. The serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and plasma endotoxin were measured in the two groups. Results: The vital signs of all the patients were stable during the treatment. The APACHE II score and serum cytokine concentrations were significantly decreased in the two groups after treatment(P0.05). Gastrointestinal function of the treatment group recovered earlier, with an effective rate significantly higher than that of the control group(P<0.05). The plasma endotoxin of the control group were gradually elevated during the treatment; that of the treatment group increased first and then gradually decreased; and there was significant difference between the two groups (P<0.05). Conclusion: High-volume hemofiltration can clear the plasma inflammatory mediators and cytokines. Rhubarb can improve the gastrointestinal function and decrease the plasma endotoxin level of SAP patients; early treatment with a combination of both can improve the clinical outcomes of patients.

Protective effect of Shen fu injection against intestinal barrier dysfunction and second hit in rats with severe acute pancreatitis / 第二军医大学学报

Objective: To evaluate the protective effect of Shenfu injection (SFI) against intestinal barrier dysfunction and second hit in rats with severe acute pancreatitis (SAP). Methods: Fifty-four male Wistar rats were randomly divided into sham operation group (n = 6), SAP group (n = 24), and SAP + SFI group (10 ml/kg body wt, n = 24). Sham operation group underwent laparotomy only. SAP model was established by retrograde injection of 5% sodium taurocholate into the bilipancreatic duct of Wistar rats. SAP+SFI group was given SFI (10 ml/kg) intaperitoneally 2 h before SAP establishment. Rats were sacrificed at 3,6,12 and 24 hours after operation. The samples of pancreas, lung and liver were collected for measuring the levels of myeloperoxidase (MPO) at 3,6,12, and 24 h after injection of sodium taurocholate. The pathological changes of the terminal ilea were observed under light microscopy, and the blood levels of diamine oxidase (DAO), tumor necrosis factor alpha (TNF-α) and interleukin-6(IL-6) were also measured at different time points. Results: The blood levels of TNF-α, IL-6 and DAO in SAP group were significantly higher than those in the sham operation group at all time points (P<0.01). The levels of intrapulmonary, intrapancreatic and intrahepatic MPO in SAP group were significantly than those in the sham operation group at 6,12, and 24 hours (P<0.01). The contents of DAO, TNF-α and IL-6 were significantly decreased in SAP + SFI group compared with in SAP group at all time points (P<0.05 or P<0.01). The contents of intrapulmonary, intrapancreatic and intrahepatic MPO were significantly decreased in SAP+SFI group compared with SAP group at 6,12, and 24 h after operation (P<0.05 or P<0.01). Intestinal pathological damages were obviously milder in SAP+SFI group than that in SAP group at 24 h after operation. Conclusion: SFI can protect the small intestine mucosal barrier and other organs from second hit by reducing the polymorphonuclear leucocyte detaining and inhibiting TNF-α and IL-6.

Protective effect of N-acetylcysteine on the intestinal barrier dysfunction after radiation injury in rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the protective effect of N-acetylcysteine (NAC) on the intestinal barrier dysfunction in rats after extensive abdominal radiation with X ray.</p><p><b>METHODS</b>Twenty-four Spraque-Dawley male rats were divided into normal control group (n=8), radiation group (n=8), and radiation+NAC group (300 mg/kg) (n=8). Radiation injury was induced by X ray with a single dose of 10 Gy. NAC was administered from 4 days before irradiation to 3 days after radiation. Three days after radiation, all the rats were euthanized. The terminal ileum was collected for crypt survival assay and ileal villi count. The tissue samples from mesenteric lymph nodes (MLN), spleen, and liver were harvested under sterile conditions for microbiological analysis and ileum samples were harvested for biochemical analysis. The blood levels of D-lactate, endotoxin and diamine oxidase (DAO) and the ileum samples levels of nitric oxide(NO) were also measured.</p><p><b>RESULTS</b>Rats in radiation+NAC group had a higher survival rate of intestinal crypt [(76.84+/-4.82)% vs (49.64+/-5.48)%, P<0.01], higher intestinal villus count [(8.56+/-0.68)/mm vs (4.02+/-0.54)/mm, P<0.01], lower NO concentration [(0.48+/-0.12) mumol/g vs (0.88+/-0.16) mumol/g, P<0.01], lower levels of D-lactate, endotoxin and DAO (P<0.05 or P<0.01), and significantly decreased enteric bacteria cultured from mesenteric lymph nodes and other tissues as compared with the radiation group (P<0.05 or P<0.01).</p><p><b>CONCLUSION</b>NAC protects the small intestine from radiation-induced injury maybe through the inhibition of NO in rats.</p>

Safety and efficacy of Qingre Buyi Decoction in the treatment of acute radiation proctitis: a prospective, randomized and controlled trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the efficiency, safety, and possible mechanisms of Qingre Buyi Decoction (QBD) in the treatment of acute radiation proctitis (ARP).</p><p><b>METHODS</b>This study was a single center, prospective, single blind, randomized, and placebo-controlled clinical trial. A total of 60 patients with ARP was equally and randomly distributed into the control group (conventional treatment) and the combination group (conventional treatment plus QBD). The changes of main Chinese medicine clinical symptoms and signs, including stomachache, diarrhea, mucous or bloody stool before and after treatment, and their adverse reactions were observed after the two-week treatment. Also, D-lactate and diamine oxidase (DAO) levels, hepatic and renal function were measured. Cure rates, effective rates, and recurrence rates were compared between the two groups.</p><p><b>RESULTS</b>The blood levels of both DAO and D-lactate were significantly decreased in the combination group as compared with those in the control group (P<0.05 or P<0.01). All main clinical symptoms and signs were alleviated more significantly in the combination group (P<0.01). The main symptom scores also were significantly decreased after treatment in the control group (P<0.01), except those for mucous or bloody stool (P>0.05). Compared to the control group, the improvements of stomachache, diarrhea, defecation dysfunction, and stool blood in the combination group were significantly better (P<0.05 or P<0.01). For the combination group, the curative rate, effective rate, and recurrence rate was 76.67%, 16.67%, and 6.67%, respectively. On the other hand, for the control group, the rate was 53.33%, 16.67%, and 30.00%, respectively. The total curative effect was significantly better in the combination group than in the control group (P<0.05). However, the recurrence rate was similar between the two groups (P>0.05). The hepatic and renal function remained normal in both groups (P>0.05). In addition, no severe adverse event was found in both groups.</p><p><b>CONCLUSIONS</b>Addition of QBD to the conventional treatment can effectively alleviate the damage of intestinal mucosal barrier function and improve all main clinical symptoms and signs of the ARP. The combination of conventional treatment with Chinese herbal medicine QBD is effective and safe for ARP.</p>

Evaluation of endoscopy-assisted laparoscopic surgery in the treatment of early colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the endoscopy-assisted laparoscopic surgery in the treatment of early colon carcinoma.</p><p><b>METHODS</b>The data of 55 early colon cancer patients, including 30 male, 25 female with mean age of 54 years(ranged 42 to 68), undergone endoscopy-assisted laparoscopic surgery at the colon were reviewed retrospectively.</p><p><b>RESULTS</b>From March 2002 to December 2007, 55 early colon cancer patients were treated with endoscopy-assisted laparoscopic surgery in our institute. In 53 cases, a laparoscopic and endoscopic cooperative bowel segment resection was performed at first. Of these 53 patients, 11 cases then received laparoscopic and endoscopic cooperative radical anatomical resection according to the result of frozen section. Two cases were transferred to open surgery because of small intestinal inflation after endoscopic location. The mean operative time of cooperation was 90 min (55-240 min), and the mean blood loss was 50 ml(10-200 ml). In 51 cases(92.7%), the time for flatus passage was 2 to 3 days. The mean postoperative hospital stay was 5 d(2-15 d). No postoperative complications were found. Follow-up data were obtained by clinical examination and personal communication via telephone. The median follow-up was 42 months(ranged 3-72). Most of the patients were alive except one case died of myocardial infarction during the follow-up period. None of the patients with early colon cancer treated by the cooperative surgery had relapse or metastasis. Two cases of T1N1Mx underwent adjuvant chemotherapy.</p><p><b>CONCLUSIONS</b>Endoscopy-assisted laparoscopic surgery offers a minimal-invasive and safe therapeutic approach for early colon cancer. The early colon cancer may be a good indication for endoscopy-assisted laparoscopic surgery when the endoscopic mucosal resection is inadequate.</p>

Effect of different position and CO(2) pneumoperitoneum on deep vein hemodynamics of lower limb / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effect of laparoscopic surgery position and CO(2) pneumoperitoneum on deep vein hemodynamics of lower limb.</p><p><b>METHODS</b>Color Doppler ultrasound was adopted to evaluate the diameter, blood velocity and the amount of the blood flow in the lower extremity of 37 gastric cancer patients undergone laparoscopic surgery from November 2007 to August 2008 in our hospital. Three kinds of position(prostration, head-down tilt position and feet-down tilt position) before the establishment of pneumoperitoneum and three different pressure of CO(2) pneumoperitoneum( 8 mm Hg, 12 mm Hg, 16 mm Hg ) after the establishment of pneumoperitoneum were applied during laparoscopic surgery.</p><p><b>RESULTS</b>Compared with the stage of prostration before the pneumoperitoneum, the femoral vein diameter decreased (P<0.05), the velocity and the amount of blood flow increased (P<0.01, P<0.05) in head-down tilt position; the femoral vein diameter increased(P<0.01), the velocity and the amount of blood flow decreased(P<0.01, P<0.05) in feet-down tilt position or the establishment of pneumoperitoneum. Furthermore, with the increase of pneumoperitoneum pressure, the femoral vein diameter increased, the velocity and the amount of blood flow decreased(P<0.05).</p><p><b>CONCLUSIONS</b>The head-down tilt position is conducive for the blood to recirculate, which will degrade the risk of deep vein thrombosis after the laparoscopy. The feet-down tilt position and CO(2) pneumoperitoneum can interfere the recirculation of blood, and increase the risk of deep vein thrombosis after the laparoscopy.</p>

Effect of diabetes control after small intestine exclusion surgery in Goto-Kakizaki rat with non-obese type 2 diabetes mellitus / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect and possible mechanisms of diabetes control after small intestine exclusion surgery in Goto-Kakizaki (GK) rat with non-obese type 2 diabetes mellitus.</p><p><b>METHODS</b>Forty GK rats with non-obese type 2 diabetes mellitus underwent duodenal bypass (Group A, n = 8), which creates a shortcut for ingested nutrients bypassing duodenum alone; duodenal-jejunal bypass (Group B, n = 8), a stomach-preserving RYGB that excludes the duodenum and proximal jejunum; duodenum and total jejunum exclusion (Group C, n = 8); sub-total small intestine exclusion (Group D, n = 8), which creates a shortcut for ingested nutrients bypassing duodenum, jejunum and sub-total ileum; controls were pair-fed (PF) sham-operated and untreated GK rats (Group SO, n = 8). The rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0, 1, 3, 6, 12, 24 weeks after the operation in those groups. The concentrations of insulin and glucagon-like peptide-1 (GLP-1) concentrations were measured before (baseline) and then 30, 60, 120, and 180 minutes after OGTT at 0, 12, 24 weeks after the operation.</p><p><b>RESULTS</b>Mean operating time of all groups was similar. The mean body weight and food intake decreased significantly at 1 week after surgery (P < 0.01) and with no differences among the groups. Fasting blood glucose level decreased significantly after surgery in all the operation groups through the entire follow-up period (P < 0.05). No significant changes in fasting blood glucose level in SO group was found in 12 weeks after the operation, and it increased at 12 and 24 weeks after. Fasting blood glucose levels in group B decreased significantly compared with group A (P < 0.05), but no difference was found among group B, C and D (P > 0.05). Oral glucose-stimulated peak (30 min) levels of blood insulin and GLP-1 increased markedly in operation groups (A, B, C and D) after surgery (P < 0.01). Compared with group A, peak levels of blood insulin and GLP-1 in group B were strikingly higher (P < 0.05), but no difference was found when compared with group C or D (P > 0.05).</p><p><b>CONCLUSIONS</b>In spontaneously non-obese type 2 diabetes mellitus rats, small intestinal exclusion including proximal gut is effective in terms of glucose control and has no direct relation with body weight and food intake loss. Restoration of the first-phase insulin secretion and high secretion of GLP-1 in type 2 diabetic subjects after gastrointestinal bypass surgery seem to be helpful to diabetes control. Taking intestinal nutrient absorption into consideration, duodenal-jejunal bypass may be a better surgery for diabetes control.</p>