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Objective:To investigate the effect of early postoperative enteral nutrition(EN)on postoperative rehabilitation and inflammation after laparoscopic radical gastrectomy for gastric cancer,in order to provide reference for postoperative rehabilitation of such patients.Methods:Patients who received laparoscopic assisted radical gastrectomy in Department of Gastrointestinal Surgery of The First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2022 were included in the analysis.According to the different ways of postoperative nutritional treatment,patients were divided into the observation group(early postoperative EN group)and the control group(parenteral nutrition group),and indexes such as postoperative rehabilitation,abdominal drainage flow and the level of inflammatory mediators in drainage fluid were compared between the two groups.Results:A total of 81 patients were included,including 41 in the observation group and 40 in the control group.Interval of the first postoperative exhaust(t=3.806;P<0.001)and resuming diet day(t=5.510;P<0.001),and length of postoperative hospital stay(t=2.401;P=0.019)in the observation group were shorter than those in the control group.Levels of peripheral blood albumin(t=14.040;P<0.001)and prealbumin(t=9.832;P<0.001)of the observation group at postoperative day(POD)5 were significantly higher than those of the control group,but there was no significant difference in hemoglobin level(t=1.477;P=0.144).The level of CRP in peripheral blood of the observation group at POD 5(t=7.758;P<0.001)and the incidence of postoperative SIRS[(12.2%,5/41)vs(32.5%,13/40),x2=4.830;P=0.028)]were significantly lower than those in the control group.The average drainage volume(t=6.858;P<0.001),drainage removal time(t=5.016;P<0.001),and TNF-α level(t=4.993;P<0.001)and IL-6 level(t=20.640;P<0.001)in postoperative drainage at POD 5 were significantly lower in the observation group than those in the control group.Conclusion:Early postoperative EN could accelerate the rehabilitation process after laparoscopic radical gastrectomy,improve postoperative nutritional status,and reduce abdominal inflammation.
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OBJECTIVE@#To assess the value of m7G-lncRNAs in predicting the prognosis and microenvironment of colorectal cancer (CRC).@*METHODS@#We screened m7G-lncRNAs from TCGA to construct an m7G-lncRNAs risk model using multivariate Cox analysis, which was validated using ROC and C-index curves. Calibration and nomogram were used to predict the prognosis of CRC patients. Point-bar charts and K-M survival curves were used to assess the correlation of risk scores with the patients' clinical staging and prognosis. CIBERSORT and ESTIMATE were used to explore the association between the tumor microenvironment and immune cell infiltration in patients in high and low risk groups and the correlation of risk scores with microsatellite instability, stem cell index and immune checkpoint expression. A protein-protein interaction network was constructed, and the key targets regulated by m7G-lncRNAs were identified and validated in paired samples of CRC and adjacent tissues by immunoblotting.@*RESULTS@#We identified a total of 1722 m7G-lncRNAs from TCGA database, from which 12 lncRNAs were screened to construct the risk model. The AUCs of the risk model for predicting survival outcomes at 1, 3 and 5 years were 0.727, 0.747 and 0.794, respectively. The AUC of the nomogram for predicting prognosis was 0.794, and the predicted results were consistent with actual survival outcomes of the patients. The patients in the high-risk group showed more advanced tumor stages and a greater likelihood of high microsatellite instability than those in the low-risk group (P < 0.05). The tumor stemness index was negatively correlated with the risk score (r=-0.19; P=7.3e-05). Patients in the high-risk group had higher stromal cell scores (P=0.0028) and higher total scores (P=0.007) with lowered expressions of activated mast cells (r=-0.11; P=0.045) and resting CD4+ T cells (r=-0.14; P=0.01) and increased expressions of most immune checkpoints (P < 0.05). ATXN2 (P= 0.006) and G3BP1 (P=0.007) were identified as the key targets regulated by m7G-lncRNAs, and their expressions were both higher in CRC than in adjacent tissues.@*CONCLUSION@#The risk model based on 12 m7G-lncRNAs has important prognostic value for CRC and can reflect the microenvironment and the efficacy of immunotherapy in the patients.
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Humanos , Biomarcadores Tumorais/metabolismo , Neoplasias do Colo , DNA Helicases/metabolismo , Regulação Neoplásica da Expressão Gênica , Instabilidade de Microssatélites , Proteínas de Ligação a Poli-ADP-Ribose/metabolismo , Prognóstico , RNA Helicases/metabolismo , Proteínas com Motivo de Reconhecimento de RNA/metabolismo , RNA Longo não Codificante/metabolismo , Microambiente TumoralRESUMO
Objective:Our study was aimed to analyze the therapeutic effect of early sequential enteral nutrition on postoperative rehabilitation in patients with gastric cancer.Methods:Patients with gastric cancer receiving surgery at our hospital from 2016 to 2017 included and the clinical information was prospective collected and analyzed.Patients were randomly divided into two groups using random number table.Patients in group A were sequentially given amino acid type,short peptide type and then whole protein type,while those in group B received whole protein formulation only.The recovery of gastrointestinal function,postoperative systemic inflammatory response,six-minutes walking test,and enteral nutrition-related complications were compared between the two groups.Results:A total of 71 patients were included in this study (Group A 36 cases,Group B 35 cases).There was no significant difference in terms of the restart anal exhaust between the two groups (P > 0.05).Patients in group A had a significantly shorter postoperative hospitalization (t =4.070;P < 0.01) and the earlier restoration of oral intake than that of Group B (t =3.400;P =0.001).One week after surgery,the levels of CRP (t =2.547;P =0.013) and IL-6 (t =3.172;P =0.002) were significant lower in group A when compared with group B.In addition,patients in group A had a significant higher six minutes walk steps than those in Group B [(416.1 + 36.7) m vs (358.9 ± 32.7) m;t =6.927,P < 0.01].However,no significant difference in enteral nutrition-related complications was found between the two groups (P > 0.05).Conclusion:In patients with gastric cancer,early sequential enteral nutrition can effectively accelerate the postoperative rehabilitation.
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OBJECTIVE: To observe the effect of excretory/secretory products from Trichinella spiralis adult worms (AES) on cecal ligation and puncture (CLP) -induced sepsis in mice. METHODS: Forty-eight BALB/c mice were randomly divided into 3 groupsï¼a sham operation group (PBS + sham group, Group A), a CLP-induced sepsis group (PBS+CLP group, Group B) and an AES treatment group (AES+CLP group, Group C). The mice of each group were intraperitoneally injected with 25 µg of AES or PBS only as a control in a total volume of 200 µl. Eight mice from each group were selected randomly for survival analysis of 96 hours. The other 8 mice in each group were observed for pathological changes in the lung, liver and kidney tissues by HE staining 12 h after CLP, and then determined for the detection of cytokines including TNF-α, IL-1ß, IL-6, IL-10 and TGF-ß in the sera by ELISA. RESULTS: The difference among the survival rates of mice in the 3 groups was statistically significant (χ2 = 21.16, P < 0.05). Compared to Group A (100%), the survival rate of mice in Group B (0) decreased significantly (P < 0.05), and also the pathological damage degrees in the lung, liver and kidney tissues of the mice in Group B increased significantly after CLP. Compared with the mice in group B, the survival rate of those in Group C (70%) increased significantly (P < 0.05), and the pathological damage degrees in the lung, liver and kidney tissues of the mice in Group C decreased significantly after the treatment with AES. The differences among the levels of pro-inflammatory cytokines TNF-α (F = 27.11, P < 0.05), IL1ß (F = 18.75, P < 0.05) and IL-6 (F = 100.93, P < 0.05) in the sera of the mice in the three groups were statistically significant. Compared with the mice in Group A, the levels of the 3 cytokines of those in Group B increased significantly (all P < 0.05). However, after the treatment with AES, the levels of the pro-inflammatory cytokines of those in Group C decreased significantly (all P < 0.05). The differences among the levels of immunoregulatory cytokines IL-10 (F = 10.88, P < 0.05) and TGF-ß (F = 11.37, P < 0.05) in the sera of the mice in the three groups were also statistically significant. Compared with the mice in Group B, the levels of IL-10 and TGF-ß of those in Group C were higher after treatment with AES (both P < 0.05). CONCLUSIONS: T. spiralis AES has a therapeutic potential for alleviating sepsis induced by CLP in mice.
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Ceco/cirurgia , Proteínas de Helminto/farmacologia , Ligadura/efeitos adversos , Sepse/tratamento farmacológico , Trichinella spiralis/metabolismo , Animais , Citocinas/sangue , Feminino , Proteínas de Helminto/uso terapêutico , Camundongos , Sepse/sangue , Sepse/etiologia , Sepse/patologia , Análise de SobrevidaRESUMO
BACKGROUND: The gut is capable of inducing multiple organ dysfunction syndrome (MODS). In the diagnosis and treatment of critical ill patients, doctors should pay particular attention to the protection or recovery of intestinal barrier function. However, no reliable diagnostic criteria are available clinically. This study aimed to assess the changes of intestinal mucosal barrier function in surgically critical ill patients as well as their significance. METHODS: Thirty-eight surgically critical ill patients were enrolled as a study group (APACHE II>8 scores), and 15 non-critical ill patients without intestinal dysfunction were selected as a control group (APACHE II<6). General information, symptoms, physical signs, and APACHE II scores of the patients were recorded. The patients in the study group were subdivided into an intestinal dysfunction group (n=26) and a non-intestinal dysfunction group (n=12). Three ml venous blood was collected from the control group on admission and the same volume of plasma was collected from the study group both on admission and in the period of recovery. The plasma concentrations of endotoxin, diamine oxidase (DAO), D-lactate, and intestinal fatty-acid binding protein (iFABP) were detected respectively. The data collected were analyzed by the SPSS 17.0 software for Windows. RESULTS: The levels of variables were significantly higher in the study group than in the control group (P<0.01). They were higher in the intestinal dysfunction group than in the non-intestinal dysfunction group (DAO P<0.05, endotoxin, D-lactate, iFABP P<0.01). In the non-intestinal dysfunction group compared with the control group, the level of endotoxin was not significant (P>0.05), but the levels of DAO, D-lactate and iFABP were statistically significant (P<0.05). The levels of variables in acute stage were higher than those in recovery stage (P<0.01).The death group showed higher levels of variables than the survival group (endotoxin and D-lactate P<0.01, DAO and iFABP P<0.05). CONCLUSION: The plasma concentrations of endotoxin, DAO, D-lactate, and intestinal fatty-acid binding protein (iFABP) could reflect a better function of the intestinal mucosa barrier in surgically critical ill patients.
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Objective To explore the early diagnostic marker and mechanism of the injury of in- testinal mucosal barrier induced by intestinal ischemia-reperfusion in rats.Methods Sixty male Wistar rats were randomly divided into six groups:the sham operation group(SO),the ischemia 15 minutes group(A),the ischemia 45 minutes group(B),the ischemia 45 minutes plus reperfusion 2 hours group (C),the ischemia 45 minutes plus reperfusion 6 hours group(D),and the ischemia 45 minutes plus reperfusion 12 hours group(E).Using clamping and then releasing superior mesenteric artery the model of intestinal ischemia-reperfusion in rats was made.The sham operation group only underwent laparotomy. At different time points after ischemia and reperfusion the levels of serum CK,LDH,D-lactate and intes- tinal fatty acid binding protein(IFABP)in each group were examined.The morphological changes of in- testinal tissues were observed with light microscopy.Results Compared with group SO,the level of se- rum IFABP in group A was(374.74?48.85)pg/ml,significantly higher(P<0.01),but the level of CK,LDH and D-lactate had no significant difference(all P>0.05).In group B,the level of CK was (1090.40?187.51)u/L,peaking at 45 minutes after ischemia,meanwhile,D-lactate and IFABP levels were significantly increased(P<0.01,respectively).In group C,D-lactate and IFABP were (2.51?0.19)?g/ml and (1601.42?286.81 )pg/ml,respectively,peaking at 2 hours after reperfusion (P<0.01).At 6 hours after reperfusion,compared with ischemia 45 minutes,CK level was significantly de- creased(P<0.01),LDH had no significant difference(P>0.05),but the levels of D-lactate and IF- ABP were(2.03?0.24)?g/ml and(1443.76?174.52)pg/ml,respectively,all sustained a high lev- el(P<0.01 ).At 12 hours after reperfusion,D-lactate and IFABP levels were gradually decreased(P<0.01).At 45 minutes after ischemia the morphological changes of intestinal mucosa could be observed. At 6 hours after reperfusion part of the mucous layer appeared necrotic,some intestinal mucosal cells shed to enteric cavity,and submucous layer had hyperemia and edema obviously.Injury scores of intestinal mucosa were significantly correlated to the serum level of D-lactate and IFABP,correlation coefficients were 0.456,0.612(P<0.01).Conclusion The monitoring of serum IFABP combined with D-lac- tate is a early,sensitive and specific biochemical marker in the diagnosis of intestinal mucosal barrier in- jury after ischemia-reperfusion.