【Abstract】ObjectiveTo explore the effect of glutamine on immune function of rat with obstructive jaundice and its possible mechanism. MethodsFifty male Wistar rats were randomly divided into three groups: Control group (n=10)， obstructive jaundice group (n=20) and glutamine treatment group (n=20). The serum concentration of TNF-α, IL-10 was detected by using radioimmune method. Liver function was measured through automated biochemistry analyzer. The animal model of obstructive jaundice was established by ligating the rat’s common bile duct. Bacteria cultures were performed with the rat’s tissues of lung, spleen, liver and kidney respectively. ResultsCompared with control group, obstructive jaundice group showed statistically lower serum level of TNF-α, and statistically higher serum level of IL-10, TBIL, ALT and AST during the first and the second week after ligation of common bile duct. During the first and second week after administration of glutamine, the serum TNF-α of glutamine treatment group was statistically higher than that in control group and obstructive jaundice group. Meanwhile, glutamine treatment group showed statistically lower serum level of IL-10, TBIL, ALT and AST than obstructive jaundice group. There were statistically less bacteria translocations in glutamine treatment group than those in obstructive jaundice group. Conclusion Glutamine can increase the immune function by changing serum concentration of TNF-α, IL-10 and decrease the bacteria translocation.
Objective To discuss the cause and prevention of bacterial translocation after small bowel transplantation (SBT). MethodsMost of the existing literatures concerning bacterial translocation and SBT were reviewed. ResultsThe ischemia/reperfusion injury, graft rejection, graft versus host disease (GVHD) and administration of immunosuppressive drugs were associated with the gut barrier damage, intestinal mobility and transmit dysfunction and luminal potentially pathogenic bacterial overgrowth after SBT which caused the germs and toxin to translocate into recipient tissues, and posed a major threat on the development of sepsis. Conclusion The rate of bacterial translocation after SBT is higher than that of other types of solid organ transplantation,which is the main cause of recipient sepsis affecting the outcome of SBT. Improving the surgical techniques, shortening ischemia preservation time, selective bowel decontamination and improving the methods of nutritional support and immunosuppression would decrease the incidence of bacterial translocation and sepsis, and improve the outcome of SBT.
Objective To investigate the effect of recombinant human growth hormone (rhGH) on intestinal bacteria and endotoxin translocation in experimental obstructive jaundice. MethodsObstructive jaundice rat models were made and divided into three groups: sham operation (SO) group, obstructive jaundice (OJ) group and obstructive with rhGH (OG) group. The number in each group was 20. The mice in rhGH group underwent subcutaneous injection each day of Saizen, with the dose of 0.75 u/kg, while SO group and OJ group received nitric sodium injection. All these maitained for 2 weeks, then the animals were killed and the endotoxin were determined by limulus test, and bacterial cultures of ascites, blood, mesenchymal lymph node, kidney, spleen and liver were made, and the height of villi and the thickness of intestinal walls were examined.ResultsThe value of endotoxin in OJ group was (0.77±0.03) u/ml, higher than that in OG group and SO group, while it was (0.40±0.02) u/ml and (0.33±0.03) u/ml (Plt;0.01). The bacteria translocation rate in OJ group was 58.8%, much higher than that in OG group, which was 10.0% (Plt;0.01). There was no difference between OG group and SO group (Pgt;0.05). Villi height in OJ group was (183.39±11.09) μm, and thickness was (255.62±16.58) μm. While in OG group was (237.52±13.65) μm, and (320.81±14.34) μm (Plt;0.01) respectively.Conclusion rhGH has significant effect on protecting the injuried mucosa barrier in obstructive jaundice, and can decrease endotoxemia and bacteria translocation.
ObjectiveTo evaluate the effect of the early enteral nutrition（EEN） on the natural course in dogs with severe acute pancreatitis（SAP）.MethodsSAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000-10 000 BAEE units trypsin/ml into pancrease via pancreatic duct.Fifteen dogs were divided into parenteral nutrition(PN) group and EEN group.Two groups were isonitrogenous and isocaloric.EEN was used at postoperative 24 h.Systemic plasma endotoxin level was quantified by the chromogenic limulus amebocyte lysate technique.Both portal and systemic blood sample were obtained before and 1，4，7 d following SAP, and cultured for aerobic as well as anaerobic bacterial.Serum glucose, calcium,amylase and lysosomal enzymes were determined.All dogs were injected with 1.85×106 Bq 125IBSA 4 h before sacrificed.The 125IBSA index of the pancreas/muscle and pancreas/blood was measured,and pancreas pathology was observed.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenata were cultured as blood mentioned above.The thickness of mucosa,the whole gut layer,the height of intestinal villi and their protein and DNA contents in the intestinal and transverse colon were determined.ResultsThe study showed that EEN significantly reduced the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ,serum glucose in PN group was higher than that in EEN after SAP 4 d.There were no difference between two groups in the data of serum calcium,amylase and lysosomal enzymes,pathologic index and 125IBSA index of pancreas/muscle and pancreas/blood.EEN improved the gut barrier function by increasing the thickness of mucosa,the whole gut layer and the height of intestinal villi,increasing its protein and DNA contents in the bowel.ConclusionOur results suggest that EEN is safe and effective,and can decrease the rate of intestinal bacterial translocation.
ObjectiveThe changes of intestinal permeability and relationship of intestinal mucosa and bacterial translocation were studied in rat acute necrotizing pancreatitis (ANP) models.MethodsThe ANP models were made by injection of 5% sodium taurocholate 1.0 ml into pancreatic subcapsula.Then wistar rats were divided into four groups,control group (n=20),ANP group(n=22),treatment model group fed with lactose (n=22) and treatment model group fed with MgSO4 and antibiotic (n=22).After 72 hours,the experimental models were sacrificed.Tissues of pancreas,mesenteric lymph node, ascites were collected for microbiological study.The intestinal permeability was observed by lanthanum tracer.The blood samples were obtained from portal vein and ascites in order to assay the amount of amylase in serum.The pathologic lesions were found in the intestinal villus of the model group, including acute necrosis of intestinal mucosa,necrotichaemorrhage as well as enteroparalysis and a mass of haemorrhagic ascites.ResultsBacterial translocation of model group were markedly elevated than that of control (P＜0.05).There were statistically significant differences in bacterial translocation among three model groups （P＜0.05）.The pathologic lesions were found in the intestinal villus of the model group,including acute necrosis of intestinal mucosa,necrotichaemorrhage as well as enteroparalysis and a mass of haemorrhagic ascites.The lanthanum grain in clearance of intestinal cell of model group can be observed by eletron microscope.ConclusionThere is a severe gut barrier damage and injury in the intestinal mucosa,which lead to bacterial translocation from intestine as the source of pancreatic infection.Cleaning out enteric bacteria,improving intestinal movement and feeding with lactose could decrease bacterial translocation to treat and prevent acute necrotizing pancreatitis.
This study based on two serial animal experiments: ①caerulein-induced edematous pancreatitis with gut motility inhibited by administration of lopemin (an opium antidiarrheal agent) and ②deoxycholate intraductal-injection induced pancreatitis with gut motility improved by administration of rhubarb solution. The results of these experiments indicated that inhibition of gut motility will increase the incidence of bacterial translocation and endotoxemia during acute pancreatitis; and acceleration of gut motility will significantly decrease the incidence of bacterial translocation and endotoxemia during severe type of acute pancreatitis. The authors conclude that promotion of gut motility may protect the inflammatory pancreas from infection and prevent the multiple organ failure during acute pancreatitis, and eventualy improve the prognosis of pancreatitis.
In order to investigate the mechanism of enterogenous infection, sixty SD rats were randomly allocated into four groups∶ group of intestinal obstruction; group of cyclophosphamide+intestinal obstruction; group of cyclophosphamide and group of sham-operation. Each group included 15 rats. Twenty four hours after obstruction of the terminal ileum, the bacteria in blood of portal vein, blood of heart, peritoneal fluid, mesenteric lymph node (MLN) and content of gut were determined quantitatively, the concentration of endotoxin in portal system were measured. The results showed that early (24 hours) intestinal obstruction led to endotoxemia in portal vein, overgrowth of enteric G－bacili and bacterial translocation into the MLN. The immunosuppressive agent cyclophosphamide not only increased the rate of bacterial translocation into MLN and the number of living bacteria in MLN, but also promoted bacteria to spread into the systemic circulation. The authors conclude that under immunosuppression the bacterial translocation from gut by way of lymphatic channel plays an important role in enterogenous infection.
Objective To evaluate the effectiveness of bridging fixation with long locking plate for displaced midshaft clavicular fractures. Methods Between October 2010 and December 2011, 18 patients with displaced midshaft clavicular fracture were treated with reduction and bridging fixation with 9 or 10 holes locking plate. There were 17 males and 1 female with an average age of 47 years (range, 23-82 years). Fracture was caused by traffic accident in 6 cases, by falling in 10 cases, by crushing in 1 case, and by crashing object in 1 case. All fractures were closed and displaced or shortened (range, 2.1-3.4 cm; mean, 2.62 cm) with angulation deformity. According to Robinson classification criteria, 5 cases were rated as type 2B1 and 13 as type 2B2. The duration from injury to surgery was 5 hours to 19 days (mean, 5 days). The fracture healing time and complication were recorded; the effectiveness evaluation was performed with Constant-Murley score and satisfaction to appearance. Results No neurologic or vascular complication occurred with primary healing of incision. All patients were followed up 12-22 months (mean, 14.7 months). The fracture healing time was 9-14 weeks (mean, 11.4 weeks). During follow-up, no loosening or breakage of internal fixator was observed. The Constant-Murley score was 82-98 (mean, 92.4) at last follow-up; the satisfaction rate of appearance was 88.9% (16/18). Conclusion Bridging fixation with long locking plate is an effective method for treatment of displaced midshaft clavicular fractures. Preserved blood supply and stable angle are important to fracture healing.
【Abstract】 Objective To investigate the feasibil ity of contralateral C7 nerve transfer via posterior spinal route fortreatment of brachial plexus root avulsion injury by anatomical study. Methods Ten cadaveric specimens of 7 men and3 women were selected, who had no obvious deformity and no tissue defect in neck neutral position. By simulating surgical exploration of brachial plexus injury, the length of contralateral C7 nerve root was elongated by dissecting its anterior and posterior divisions to the distal end, while the length of C7 nerve from the intervertebral foramen to the branching point and the length of the anterior and posterior divisions were measured. By simulating cervical posterior approach, the C7 vertebral plate and T1 spinous process were fully exposed; the hole was made near vertebral body; and the C7 nerve root lengths by posterior vertebra path to the contralateral upper trunk and lower trunk were measured. Results C7 nerve root length was (58.62 ± 8.70) mm; the length of C7 nerve root plus posterior or anterior division was (65.15 ± 9.11) mm and (70.03 ± 10.79) mm, respectively. By posterior spinal route, the distance was (72.12 ± 10.22) mm from the end of C7 nerve to the contralateral upper trunk of brachial plexus, and was (95.21 ± 12.50) mm to the contralateral lower trunk of brachial plexus. Conclusion Contralateral C7 nerve can be transferred to the contralateral side through posterior spinal route and it only needs short bridge nerve or no. The posterior spinal route can effectively prevent from neurovascular injury, so it might be the best surgery approach for the treatment of brachial plexus root avulsion injury.