Gut dysfunction is defined as the impairment of intestinal parenchyma and(or) intestinal function leading to dyspepsia, malabsorption, and(or) intestinal barrier dysfunction. In the stress state, gastrointestinal tract contributes to the physiopathological change, which is considered as the "central organ after stress". Because of ischemia, anoxia and metabolic disturbance, critical illness is frequently complicated with intestinal dysfunction, which is one of the difficulties to treat critically ill patients. Undoubtedly, nutritional support is one of the indispensable therapies of intestinal dysfunction, which is also difficult to manage. This report was aimed to elaborate the definition, causes of intestinal dysfunction, assessment of nutritional status, and design of nutritional support in these patients.
Critical Illness ; Gastrointestinal Diseases ; etiology ; therapy ; Humans ; Multiple Organ Failure ; complications ; Nutritional Support

Traditional treatments of gastrointestinal fistula include early drainage, maintaining nutrition and then resection of fistula at the proper time,which usually take three to four months or even longer. Rapid treatments of gastrointestinal fistula mean promoting rapid spontaneous closure of tract fistula and early primary resection of fistula within two weeks after fistula occurrence. Early diagnosis is the premise of early management, and fistulography and abdominal CT scan are important early diagnostic methods. Most of fistula could close spontaneously in the maintaining stage. To promote the rapid closure, however, special measures including sufficient drainage, somatostatin and total parenteral nutrition in the early stage should be implemented to avoid intra-abdominal collection of intestinal fluid and infection, control further leakage of intestinal fluid and improve nutritional status. In the late stage,when leakage of intestinal fluid could be controlled, recombine human growth hormone (rhGH) and enteral nutrition should be administered in place of somatostatin and total parenteral nutrition respectively. The fistula can reach rapid spontaneous closure in both stages. Fibrin glue and rhGH used at the same time can improve the curative rate and shorten the treatment time even more. In the 1960s and 1970s, early primary resection of the fistula and re-anastomosis often resulted in anastomosis failure. The reasons for this included poor nutritional status, uncontrolled secretion of intestinal fluid, severe intra-abdominal infection and multiorgan dysfunction syndrome. Such stage management policy has been proposed, developed and persisted since late 1960s. Nowadays, the advance of medical science provided the possibility to change or improve the current policy. Our research proved that early resection of the primary fistula and re-anastomosis of the small bowel could be performed successfully in some selected patients whose general conditions are good and intestinal adhesion were not severe within ten to fourteen days after fistula occurrence. More studies are still needed to define the indications and contradictions for early resection of the primary gastrointestinal fistula, and prove the feasibility and rationality of rapid treatments of gastrointestinal fistula.
Early Diagnosis ; Humans ; Intestinal Fistula ; diagnosis ; therapy ; Parenteral Nutrition, Total

A new flavonone, named as (2R, 3S)-pinobanksin-3-cinnamate(1), together with six known compounds, pinocem-brin (2), pinobanksin (3), 3-O-acetylpinobanksin (4), galangin (5), kumatakenin(6), and 3-methylkaempferol (7), were isolated from a 95% ethanol extract of seeds of Alpinia katsumadai through a combination of various chromatographic techniques, including silica gel and Sephadex LH-20. The structure of compound 1 was elucidated by spectroscopic data analysis. Compound 1 exhibits a potent neuroprotective effect against the corticosterone-damaged PC12 cells, which may be underlying the effect by scavenging intracellular ROS.
Alpinia ; chemistry ; Animals ; Cell Death ; drug effects ; Cholestenones ; chemistry ; isolation & purification ; pharmacology ; Cinnamates ; chemistry ; isolation & purification ; pharmacology ; DNA Fragmentation ; drug effects ; Neuroprotective Agents ; chemistry ; isolation & purification ; pharmacology ; Oxidative Stress ; drug effects ; PC12 Cells ; Rats ; Reactive Oxygen Species ; metabolism ; Seeds ; chemistry

OBJECTIVETo investigate the influence of abdominal cavity infection and hypertension on the function of intestinal dynamic and interstitial cells of Cajal (ICC).

METHODSSprague-Dawley rats were divided into four groups. Group 1 was the sham group. In group 2, infection was induced by cecal puncture and ligation. In group 3, abdominal hypertension was created by placing a catheter into the abdominal cavity, and in group 4, both infection and hypertension were induced simultaneously. Small intestinal transit and in vitro muscle contractions were recorded. Ileum sections stained with hematoxylin and eosin were assessed pathologically. Immunopositivity of c-Kit as markers of ICC and ultrastructures were evaluated by transmission electron microscopy.

RESULTSAbdominal cavity infection, hypertension and infection plus hypertension decreased the intestinal transit ratios by 14%, 25% and 36% respectively as compared to the sham group. In the bowel segment of the above three groups, muscles showed a significant reduction in frequency and amplitude of contraction. Meanwhile, obvious pathological lesions and smaller positive c-Kit area were found in the above three groups. These changes were associated with the lesions of ICC networks and ultrastructure.

CONCLUSIONIntestinal dysmotility and decrease of c-Kit immunopositivity are induced by abdominal cavity infection and hypertension. ICC plays a central role in maintaining and disrupting the normal intestinal motility in the above conditions.

Abdomen ; microbiology ; pathology ; physiopathology ; Animals ; Hypertension ; physiopathology ; Infection ; pathology ; physiopathology ; Interstitial Cells of Cajal ; ultrastructure ; Intestines ; cytology ; pathology ; Male ; Rats ; Rats, Sprague-Dawley

In order to investigate the characteristics of transdermal delivery of ferulic acid under the treated of microneedle arrays and the influence on permeability of rat skin capillaries, improved Franz-cells were used in the transdermal delivery experiment with the rat skin of abdominal wall and the length of microneedle arrays, different insertion forces, retention time were studied in the influence of characteristics of transdermal delivery of FA. The amount of FA was determined by HPLC system. Intravenous injection Evans blue and FA was added after microneedle arrays treated. Established inflammation model was built by daubing dimethylbenzene. The amount of Evans blue in the rat skin was read at 590 nm wavelength with a Multiskan Go microplate reader. Compared with passive diffusion group the skin pretreated with microneedle arrays had a remarkable enhancement of FA transport (P <0.01). The accumulation of FA increased with the enhancement of insertion force as to as the increase of retention time. Microneedle arrays with different length had a remarkable enhancement of FA transport, but was not related to the increase of the length. The research of FA on the reduce of permeability of rat skin capillaries indicated that the skin pretreated with microneedle arrays could reduce the content of Evans blue in the skins of rat significantly compared with the untreated group. The permeation rate of ferulic acid transdermal delivery had remarkable increase under the treated of microneedle arrays and the length of microneedle arrays ,the retention time so as to the insertion force were important to the transdermal delivery of ferulic acid.
Administration, Cutaneous ; Animals ; Coumaric Acids ; administration & dosage ; pharmacokinetics ; Male ; Needles ; Rats ; Rats, Sprague-Dawley ; Skin Absorption

Coagulation dysfunction after major war trauma is conventionally attributed to consumption and dilution of coagulation factors. However, recent studies have identified an acute coagulation dysfunction at the early stage after trauma. This coagulation dysfunction due to endogenous coagulation disturbance at the early stage after trauma is called acute traumatic coagulation dysfunction (ATCD), and the patients with ATCD would have an increased complication rate and mortality. Standard coagulation tests provide only limited information on the underlying coagulation disorder. Viscoelastic haemostatic assays (VHA) such as rotational thromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process. Early goal-directed coagulation therapy guided by VHA could change administration of blood products and improve diagnosis of trauma patients.

OBJECTIVEFor heart functional parameters, we commonly used normal range. The reference values and predict formulas of heart functional parameters and their relationships with individual characteristics are still lack.

METHODSLeft ventricular (LV) volumes (end-diastolic volume and end-systolic volume), stroke volume (SV), ejection fraction (EF) and cardiac output (CO) were measured by cardiac CT angiography (CAT) in 1 200 healthy Caucasian volunteers, men 807 and women 393, and age 20-90yr. The results are analyzed by high-accuracy three-dimensional imaging technology, and then measured the dynamic changes of the volumes of each atriam and ventricule during their contractions and relaxations. The gender, age, height and weight were analyzed by multiple linear regression to predict LV functional parameters.

RESULTSExcept the LVEF was lower in man than in women (P < 0.001), all other LV functional parameters of EDV, ESV, SV, FE and CO were higher in man (P < 0.001). Multiple linear regression indicated that age, gender, height and weight are all independent factors of EDV, ESV and SV (P < 0.001). CO could be significantly predicted by age, gender and weight (P < 0.001), but not height (P > 0.05). The predict equation for CO (L x min(-1)) = 6.963+0.446 (Male) -0.037 x age (yr) +0.013 x weight (kg).

CONCLUSIONAge, gender, height and weight are predictors of heart functions. The reference values and predict equations are important for noninvasive and accurate evaluation of cardiovascular disease and individualized treatment.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Body Height ; Body Weight ; Cardiac Output ; Female ; Heart ; physiology ; Humans ; Male ; Middle Aged ; Reference Values ; Sex Factors ; Stroke Volume ; Ventricular Function, Left ; Young Adult

OBJECTIVETo investigate the potential molecular mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide (LPS) in rat hepatocytes.

METHODSThe albumin mRNA expression and albumin protein levels in the supernatant were observed at 0, 2, 8, 12 and 24 hours after 1 micro g/ml LPS treatment. The albumin mRNA expression was determined by RT-PCR, and albumin protein levels were assayed with EIA in the supernatant of hepatocytes pretreated with specific inhibitors of extracellular signal-regulated kinase (PD98059) and p38 kinase (SB203580).

RESULTSThe albumin mRNA expression was reduced to 70% of baseline value, meanwhile, the albumin protein concentration in the supernatant was reduced by 50% compared with the controls after 24 hours of LPS treatment. Pretreatment with PD98059 and SB203580 did significantly inhibit the reduction of albumin by LPS at the given dose.

CONCLUSIONThe results indicate that LPS can induce the reduction of albumin synthesis by down-regulation of albumin mRNA expression at transcription level, and the process may be related to the signal transducation of extracellular signal-regulated kinase and p38 kinase.

Albumins ; genetics ; metabolism ; Animals ; Calcium-Calmodulin-Dependent Protein Kinases ; antagonists & inhibitors ; Dose-Response Relationship, Drug ; Down-Regulation ; Enzyme Inhibitors ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; Flavonoids ; pharmacology ; Hepatocytes ; drug effects ; metabolism ; Imidazoles ; pharmacology ; Lipopolysaccharides ; toxicity ; Male ; Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; Pyridines ; pharmacology ; RNA, Messenger ; genetics ; metabolism ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors ; p38 Mitogen-Activated Protein Kinases

OBJECTIVETo investigate the significance, effects and precautions of enteral nutritional support in patients with short bowel syndrome (SBS).

METHODSClinical data of 40 SBS patients who were maintained on enteral nutrition (EN) for more than 2 years were retrospectively summarized. The cost of EN and parenteral nutrition (PN), the PN-free duration, and the current nutritional status of these patients were analyzed.

RESULTSThe mean length of the remnant small bowel was (50.8 +/- 29.4) cm. All the patients currently lived on high-carbohydrate low-fat diet supplemented with EN (3284.0 +/- 1408.8) kJ/d, the cost was significantly lower than that of PN (P < 0.01). Mean PN-free duration was (29.1 +/- 9.2) months for these patients. The current defecation frequency and volume were (3.4 +/- 1.7) times/d and (720.2 +/- 350.3) ml/d, respectively. As for the patients' nutritional index, mean BMI, blood hemoglobin and serum albumin level were (17.8 +/- 3.2) kg/m(2), (113.3 +/- 14.8) g/L and (35.0 +/- 4.1) g/L, respectively.

CONCLUSIONSEnteral nutrition is a cost-effective method for maintaining the nutritional status in patients with short bowel syndrome, but proper management in clinical practice to avoid diarrhea or other complications should be ensured.

Adolescent ; Adult ; Enteral Nutrition ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Retrospective Studies ; Short Bowel Syndrome ; therapy ; Treatment Outcome

OBJECTIVETo investigate the effect of thymosin alpha1 on immunological function and protein metabolism in peritoneal sepsis rats.

METHODSWe observed the effect of thymosin alpha1 on T cell subclassification, TNFalpha, IL-6, IL-10, albumin, C-reactive protein (CRP) and mortality in cecal ligation and puncture (CLP) induced septic rats.

RESULTSConcentration of TNFalpha and IL-6 in CLP induced septic rats increased significantly, and concentration of IL-10 decreased significantly compared to control group. Thymosin alpha1 significantly decreased TNFalpha, IL-6, and significantly raised concentration of plasma IL-10, percent of CD(3), CD(4), and CD(4)/CD(8) in septic group. Thymosin alpha1 reduced degressive degree of albumin. Concentration of CRP increased in both septic groups, but was less prominently in thymosin alpha1 treated group. Thymosin alpha1 reduced cumulate 7-day mortality.

CONCLUSIONThymosin alpha1 can improve immunological function, inflammation condition and protein metabolism.

Adjuvants, Immunologic ; pharmacology ; Animals ; C-Reactive Protein ; metabolism ; Disease Models, Animal ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Peritonitis ; drug therapy ; immunology ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sepsis ; drug therapy ; immunology ; metabolism ; T-Lymphocyte Subsets ; immunology ; Thymosin ; analogs & derivatives ; pharmacology ; Tumor Necrosis Factor-alpha ; metabolism