Objective:To explore the protective effect and related mechanism of rebamipide on non-steroid anti-inflammatory drug (NSAID) related small intestinal mucosal injury.Methods:A total of 21 C57BL/6 mice were selected and by random number table method, they were divided into negative control group (0.9% NaCl gavage for four days), indomethacin modeling group (20 mg/kg indomethacin gavage for four days) and rebamipide intervention group (20 mg/kg indomethacin gavage for four hours and then 320 mg·kg -1·d -1 rebamipide gavage for four days), seven mice in each group. After modeling, the injury of mice intestinal mucosa of indomethacin modeling group and rebamipide intervention group was evaluated by gross observation as well as pathological analysis. The serum levels of interleukin (IL)-6, IL-10, trefoil factor 3 (TFF3), prostaglandin E2 (PGE2) and epidermal growth factor (EGF) in mice were detected by enzyme-linked immunosorbent assay (ELISA). The expression of IL-6, IL-10, TFF3, cyclooxygenase 2( COX2) and EGF at mRNA level of mice small intestinal tissues were examined by real-time quantitative polymerase chain reaction (qRT-PCR). And the relative expression of TFF3, COX2 and EGF at protein level of mice small intestinal tissues were determined by Western blotting. Levene test and independent sample t test were used for statistical analysis. Results:The scores of gross observation and histopathology of mice small intestinal mucosa injury of rebamipide intervention group were both lower than those of indomethacin modeling group (2.80±0.45 vs. 4.60±1.14, 1.67±0.52 vs. 3.00±0.71), and the differences were statistically significant ( t=2.667 and 3.618, P=0.029 and 0.006). The mouse serum level of IL-6 and the expression of IL-6 at mRNA level in intestinal tissues of indomethacin modeling group were both higher than those of the negative control group, however the serum level of IL-10 was lower than that of the negative control group ((48.83±5.40) ng/L vs. (40.96±5.92) ng/L, 5.23±2.36 vs. 1.12±0.56, (168.50±10.57) ng/L vs. (186.30±7.77) ng/L), and the differences were statistically significant ( t=2.307, 3.372 and 3.366; P=0.047, 0.007 and 0.012). The expression of IL-6 at mRNA level in mice small intestinal tissues of rebamipide intervention group was lower than that of indomethacin modeling group (1.74±0.82 vs. 5.23±2.36), however, the expression of IL-10 at mRNA level was higher than that of indomethacin modeling group (6.44±3.46 vs. 1.22±0.83), and the differences were statistically significant ( t=3.409 and 3.025, P=0.008 and 0.014). The serum levels of TFF3, PGE2 and EGF, the expression of TFF3 at mRNA level of small intestinal tissues, the relative expression of COX2 and EGF at protein level of small intestinal tissues of indomethacin modeling group were all lower than those of the negative control group ((131.20±16.37) ng/L vs. (150.30±9.66) ng/L, (32.68±6.88) ng/L vs. (41.51±3.20) ng/L, (112.70±17.17) ng/L vs. (138.20±10.10) ng/L, 0.43±0.22 vs. 1.20±0.50, 0.33±0.25 vs. 1.30±0.43, 0.28±0.19 vs. 1.15±0.10), and the differences were statistically significant ( t=2.290, 2.645, 2.867, 3.097, 3.405 and 7.106; P=0.048, 0.021, 0.025, 0.017, 0.027 and 0.002). The mice serum levels of PGE2 and EGF, expression of TFF3, COX2 and EGF at mRNA level of small intestinal tissues, as well as the expression of TFF3 and EGF at protein level of small intestinal tissues of rebamipide intervention group were all higher than those of indomethacin modeling group ((43.55±5.28) ng/L vs. (32.68±6.88) ng/L, (153.30±15.66) ng/L vs. (112.70±17.17) ng/L, 2.48±1.70 vs. 0.43±0.22, 2.95±1.56 vs. 0.88±0.45, 3.97±2.54 vs. 0.98±0.76, 1.47±0.26 vs. 0.72±0.35, 1.08±0.36 vs. 0.28±0.19), and the differences were statistically significant ( t= 2.711, 3.658, 2.656, 2.856, 2.524, 3.013 and 3.435; P=0.024, 0.008, 0.026, 0.019, 0.033, 0.039 and 0.026). Conclusions:Rebamipide alleviates small intestinal mucosal injury induced by indomethacin by inhibiting the expression of inflammatory factors and promoting the expression of intestinal mucosal protective factors suggesting that rebamipide plays a protective role in NSAID related small intestinal injury by maintaining the chemical barrier of the intestinal mucosal.

BACKGROUND:Slow growth of peripheral nerve, muscle denervation atrophy and fossilization of motor end plate fol owing sciatic nerve injury cause irreversible limb function disorders. Umbilical cord mesenchymal stem cells have been widely used in multi-disciplinary research, but studies concerning umbilical cord mesenchymal stem cells delaying denervated muscle atrophy in rats fol owing peripheral nerve injury are rarely reported.
OBJECTIVE:To observe the value of human umbilical cord mesenchymal stem cells transplantation to delay denervated muscle atrophy of rats after sciatic nerve injury.
METHODS:Umbilical cord blood was col ected from healthy parturient woman after ful-term delivery. In the experimental group, the rat’s Sunderland IV degree sciatic nerve injury model was established by 5 mm denervation, epineurial repair, and 5 mm smal gap transplantation of umbilical cord mesenchymal stem cells. In the control group, after modeling, the same volume of normal saline was injected into the smal gap. The main outcome measures included the sciatic nerve function index, the wet weight of triceps surae,sciatic nerve latency, action potential conduction velocity and amplitude,and skeletal muscle fiber cross section area maintenance rate.
RESULTS AND CONCLUSION:After 4, 8 and 12 weeks of modeling, the sciatic nerve function index values, the wet weight of triceps surae and skeletal muscle fiber cross section area maintenance rates in the experimental group were significantly higher than those in the control group (P<0.05). After 12 weeks of modeling, electromyography results showed sciatic nerve latency was significantly lower, but action potential conduction velocity and amplitude were dramatical y higher in the experimental group than the control group (P<0.05, P<0.001). Human umbilical cord mesenchymal stem cells transplantation in denervated muscle atrophy rats after sciatic nerve promotes nerve growth, delays denervated muscle atrophy, maintains the denervatied neuromusle’s morphology and function.

Objective:To evaluate the surgical effect of repairing soft tissue defect of hand and foot with medial gastrocnemius fascia flap combined with skin graft.Methods:From January, 2018 to June, 2019, 10 patients were treated with transfers of free medial gastrocnemius fascia flaps combined with skin graft to repair soft tissue defect of hand and foot. The size of free fascial flap was 5.0 cm×8.0 cm-12.0 cm×15.0 cm. After successful transfer on the wound, the skin was grafted onto the fascial flap, and the donor site was sutured directly. The appearance and function of the recipient and donor sites were observed and the effect of the operation was evaluated. Sensory recovery was assessed by the standard set by British Medical Research Council (BMRC) at the last follow-up.Results:All the free medial gastrocnemius fascia flap survived. After 6-10 days of granulation tissue growing, the skin grafts were transferred and all survived. All patients entered follow-up for 3-9 months, with an average of 7.5 months. The tissue at the recipient sites were soft and wear-resistant without swelling or ulceration. According to the self-designed evaluation system of soft tissue defect reconstruction, 10 patients had score from 68 to 92 (average, 75.2) . At the last follow-up, sensory recovery was assessed by BMRC, 7 cases were excellent and 3 cases were good.Conclusion:The repair of hand and foot soft tissue defect by the free medial gastrocnemius fascia flap combined with skin graft has advantages in constancy of vascular anatomy of free fascia tissue, long vascular pedicle and for repair of various types of hand and foot defects. Skin of the recipient area is soft with good appearance without swelling after the reconstruction of fascia flap. It is a method of treatment in repair of soft tissue defect of hand and foot by avoiding the thinning of a flap in the second procedure.

Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor.Methods From August 2012 to August 2017,hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled.The data of clinical manifestations,laboratory examinations,imaging,endoscopy examination,pathological findings and treatment were collected and analyzed.Results A total of 180 patients with primary small intestinal tumor were enrolled.The common clinical manifestations included abdominal pain (76 cases,42.2 ％),gastrointestinal bleeding (64 cases,35.6％),and abdominal distension (30 cases,16.7％),and 22 (12.2％) patients had no overt clinical symptoms.The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1％ (12/21).The diagnostic rates of computed tomography enterodysis (CTE),positron-emission computed tomography (PET)/computed tomography (CT),and abdominopelvic enhanced CT were 96.5％ (83/86),100.0％ (29/29),and 91.5％ (43/47),respectively.The diagnostic small intestinal tumor patients of barium radiography (14 cases),abdominopelvic magnetic resonance imaging (MRI) (eight cases),small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven,six,fifteen and six cases,respectively.Among 180 patients,14 (7.8％) patients were considered gynecological tumors by imaging examination before surgery,seven (3.9％) patients underwent emergency operation because of intestinal obstruction,four (2.2％) patients underwent emergency surgery due to gastrointestinal bleeding,and four (2.2％) patients underwent emergency surgery because of intestinal perforation.Histopathological type included gastrointestinal stromal tumor (117 cases,65.0％),lymphoma (25 cases,13.9％) and adenocarcinomas (21 cases,11.7％).Except seven patients with intestinal lymphoma who received chemotherapy,the rest 173 patients underwent surgical resection.Conclusions Primary small bowel tumor has no specific clinical manifestations.It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain,gastrointestinal bleeding and intestinal obstruction.CTE should be the first choice for patients with symptoms but unclear diagnosis.

Objective: To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. Methods: This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. Results: A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.

Objective:To explore the effects and underlying mechanisms of azintamide on gastric emptying and gastrointestinal hormone secretion in proton pump inhibitor related low gastric acid environment.Methods:A total of 60 rats were selected and randomly divided into low gastric acid control group, low gastric acid model group, low gastric acid and azintamide intervention group, high gastric acid control group, high gastric acid model group and high gastric acid and azintamide intervention group by random number table, with 10 rats in each group. The rats of low gastric acid control group and high gastric acid control group were all treated with 0.9% sodium chloride solution. The rats of low gastric acid model group and high gastric acid model group were established by intraperitoneal injection of 20 mg/kg omeprazole once per day for seven days, and subcutaneous injection of 2 mg/kg penta gastrin once per day for three days, respectively. The rats of low gastric acid and azintamide intervention group and high gastric acid and azintamide intervention group were gavaged with azintamide 50 mg/kg once per day for three days on the basis of low gastric acid model group and high gastric acid model group, respectively. Only the rats in three low gastric acid groups were analyzed. At Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats were compared. After modeling, the weight of gastric contents and pH of gastric fluid was measured and compared, and the peripheral blood levels of pepsinogen A (PGA), gastrin and cholecystokinin (CCK) were detected by enzyme linked immunosorbent assay. One-way analysis of variance and Tukey′s honestly significant difference post-hoc test were used for statistical analysis.Results:The pH value of gastric fluid in low gastric acid model group and low gastric acid and azintamide intervention group were both higher than that in the low gastric acid control group (2.17±0.53, 2.03±0.69 vs. 1.32±0.17), and the differences were statistically significant ( P=0.026 and 0.041, respectively). While there was no significant difference in pH value between the low gastric acid model group and low gastric acid and azintamide intervention group ( P>0.05). On the Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats of low gastric acid control group, low gastric acid model group and low gastric acid and azintamide intervention group was (285.40±10.86), (283.40±6.38), (282.00±5.04) g; (287.10±10.73), (283.20±5.83), (284.00±5.72) g; (292.20±11.18), (281.90±6.23), (289.00±5.82) g; (296.40±11.12), (277.70±6.96), (292.00±6.82) g; (300.80±11.29), (274.30±8.84), (297.00±4.17) g, respectively. On the Day 6th and 8th after modeling, the body weight of rats of low gastric acid model group was lower than that of the low gastric acid control group; and the body weight of rats of low gastric acid and azintamide intervention group was higher than that of low gastric acid model group, and the differences were statistically significant (both P<0.01). On the Day 0, 2nd, 4th, 6th and 8th, there was no statistically significant difference in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid control group ( P>0.05). On the Day 0, 2nd, 4th, there were no statistically significant differences in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid model group, and between low gastric acid model group and low gastric acid control group (both P>0.05). The weight of gastric contents of low gastric acid model group was heavier than that of low gastric acid control group ((2.36±0.11) g vs. (1.85±0.20) g), the weight of gastric contents of low gastric acid and azintamide intervention group was lighter than that of low gastric acid model group ((1.87±0.42) g vs. (2.36±0.11) g), and the differences were statistically significant ( P=0.019 and 0.016, respectively), and there was no statistically significant difference in weight of gastric contents between the low gastric acid and azintamide intervention group and the low gastric acid control group ( P>0.05). The peripheral blood level of PGA of rats of low gastric acid model group was lower than that of low gastric acid control group ((551.80±190.00) ng/L vs. (857.00±164.80) ng/L), while the peripheral blood level of PGA of the low gastric acid and azintamide intervention group was higher than that of the low gastric acid model group ((799.90±97.80) ng/L vs. (551.80±190.00) ng/L), and the differences were statistically significant ( P=0.011 and 0.037, respectively). There was no significant difference in peripheral blood level of PGA between the low gastric acid control group and the low gastric acid and azintamide intervention group ( P>0.05). The peripheral blood level of gastrin of the low gastric acid model group was higher than that of the low gastric acid control group ((49.31±11.93) ng/L vs. (35.59±5.29) ng/L), and the CCK level of the low gastric acid model group was lower than that of low gastric acid control group ((10.26±5.32) ng/L vs. (25.55±11.62) ng/L), and the differences were statistically significant ( P=0.037 and 0.035, respectively). The peripheral blood level of gastrin of the low gastric acid and azintamide intervention group was lower than that of low gastric acid model group ((35.65±6.49) ng/L vs. (49.31±11.93) ng/L), the level of CCK of the low gastric acid and azintamide intervention group was higher than that of low gastric acid model group ((27.59±11.22) ng/L vs. (10.26±5.32) ng/L), and the differences were statistically significant ( P=0.048 and 0.021, respectively). There were no significant differences in CCK and gastrin between low gastric acid and azintamide intervention group and low gastric acid control group (both P>0.05). Conclusion:Azintamide regulates the levels of gastrointestinal hormones CCK and gastrin under the condition of low gastric acid and affects the expression of pepsinogen A, thereby promoting gastric emptying in a low gastric acid environment.