Objective To investigate the effect and mechanism of growth factors on intestinal compensation after massive intestinal resection， and understand the progress of growth factors in nutrition support treatment for short bowel syndrome （SBS）. Method The related literatures about the application and effect of growth factors in the patients with SBS were reviewed. Results Different kinds of growth factors had different effects on intestinal adaptation after massive intestinal resection. The application of growth factors according to the specific circumstances of the patients with SBS could shorten the residual small intestine compensatory time and improve the nutrition status of the patient with SBS. Conclusions Growth factors play important role in promoting the intestinal adaptation after resection. Different kinds of growth factors have their effects and it’s helpful for getting rid of the total parenteral nutrition early. However， much work still remains to be done.
ObjectiveTo explore the risk factors affecting operation treatment selection of acute adhesive small bowel obstruction (ASBO), and establish a prediction model of surgical treatment selection to provide a guidance for clinical decision-making. MethodsThe patients with acute ASBO admitted to this hospital and met the inclusion and exclusion criteria, from January 2019 to December 2022, were retrospectively collected, and the patients were assigned into the surgical treatment and conservative treatment according to the treatment selection. The differences in the clinicopathologic factors between the patients with surgical treatment and conservative treatment were compared. Meanwhile, the factors with statistical differences (P<0.05) or the factors with clinical significance judged based on professional knowledge were included to screen the influencing factors of surgical treatment selection using the multivariate logistic regression analysis, and the selected influencing factors were used to construct the logistic regression prediction model equation. The area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (95%CI) was used to evaluate the prediction efficiency of the prediction model equation. ResultsA total of 231 patients with acute ASBO were included, 117 (50.6%) of whom underwent surgical treatment and 114 (49.4%) underwent conservative treatment. In all 16 clinicopathologic factors between the patients with surgical treatment and conservative treatment had statistical differences (P<0.05) including the body mass index (BMI), preopeative high fever, intestinal type, sign of peritonitis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score excluded age scoring, abdominal surgery history and times of abdominal surgery history, times of pre-admission seek medical advice and preoperative conservative treatment time, the air-liquid level by X-ray plain film, and severe small bowel obstruction and adhesive bands by CT examination, as well as the white blood cell count (WBC), neutrophil percentage, albumin (ALB), and urea nitrogen. The multivariate logistic regression analysis showed that the acute ASBO accompanied by sign of peritonitis (β=1.778, P=0.028), history of abdominal surgery (β=1.394, P=0.022), and adhesive bands (β=1.321, P=0.010) and severe small bowel obstruction (β=1.183, P=0.018) by CT examination, WBC (β=0.524, P＜0.001), APACHEⅡ score excluded age scoring (β=0.291, P＜0.001), and BMI (β=0.191, P=0.011) had positive impacts on adopting surgical treatment, while preoperative ALB (β=–0.101, P=0.023) and conservative treatment time (β=–0.391, P＜0.001) had negative impacts on adopting surgical treatment. The accuracy, specificity, and sensitivity of the logistic regression prediction model equation constructed according to these 9 influencing factors were 84.8%, 71.1%, and 77.7%, respectively. The AUC (95%CI) of the prediction model equation to distinguish selection of surgical treatment from conservative treatment was 0.942 (0.914, 0.970). ConclusionsAccording to the preliminary results of this study, surgical treatment is recommended for patients with acute ASBO accompanied by signs of peritonitis, history of abdominal surgery, adhesive bands and severe small bowel obstruction by CT, increased preoperative WBC, high APACHEⅡ score excluded age scoring, high BMI, preoperative low ALB level, and shorter preoperative conservative treatment time. And the logistic prediction model equation constructed according to these characteristics in this study has a good discrimination for patients with surgical treatment or conservative treatment selection.
Objective To investigate the effect of porcine small intestinal submucosa extracellular matrix (PSISM) on the vitality and gene regulation of hepatocyte so as to lay the experimental foundation for the application of PSISM in liver tissue engineering. Methods The experiment was divided into two parts: ① BRL cells were cultured with 50, 100, and 200 μg/mL PSISM-medium which were prepared by adding PSISM into the H-DMEM-medium containing 10%FBS in groups A1, B1, and C1, and simple H-DMEM-medium served as a control (group D1); ② BRL cells were seeded on 1%, 2%, and 3% PSISM hydrogel which were prepared by dissolving PSISM in sterile PBS solution containing 0.1 mol/L NaOH in groups A2, B2, and C2, and collagen type I gel served as a control (group D2). At 1, 3, and 5 days after culture, the morphology and survival of liver cells were detected by the Live/Dead fluorescent staining. The cell vitality was tested by cell counting kit-8 (CCK-8) assay. And the relative expressions of albumin (ALB), cytokeratin 18 (CK18), and alpha-fetoprotein (AFP) in hepatocytes were determined by real-time fluorescent quantitative PCR (RT-qPCR). Results The Live/Dead fluorescent staining showed the cells survived well in all groups. CCK-8 results displayed that the absorbance (A) value of group C1 was significantly higher than that of group D1 at 5 days after culture with PSISM-medium, and there was no significant difference between groups at other time points (P>0.05). After cultured with PSISM hydrogels, theA values of groups A2, B2, and C2 were significantly higher than those of group D2 at 3 and 5 days (P<0.05), theA value of group A2 was significantly higher than that of groups B2 and C2 at 5 days (P<0.05), but there was no significant difference between groups at other time points (P>0.05). RT-qPCR showed that the relative expressions of ALB and CK18 mRNA significantly increased and the relative expression of AFP mRNA significantly decreased in groups A1, B1, and C1 when compared with group D1 (P<0.05). The relative expression of CK18 mRNA in group C1 was significantly lower than that in groups A1 and B1 (P<0.05). The relative expressions of ALB and CK18 mRNA were significantly higher and the relative expression of AFP mRNA was significantly lower in groups A2, B2, and C2 than group D2 (P<0.05); the relative expression of CK18 mRNA in group A2 was significantly higher than that in group B2 (P<0.05), and the relative expression of AFP mRNA in group A2 was significantly lower than that in group C2 (P<0.05), but no significant difference was found between other groups (P>0.05). Conclusion PSISM has good compatibility with hepatocyte and can promote the vitality and functional gene expression of hepatocyte. PSISM is expected to be used as culture medium supplement or cell carrier for liver tissue engineering.
Objective to determine the modulus of elasticity (E) of small intestinal submucosa (SIS), a new biological graft material. Methods The longitudinal tensile testing was performed on 21 specimens of canine jejunum with the electronic material test machine. Results Stress (σ)strain (ε) data were obtained. It was found that the stress (σ)strain (ε) data fitted the expressionσ＝Kεα very well, the mean correlation coefficients R2 was0.991 6.Then the expression of the modulus of elasticity (E) of SIS was E=K1/ασ1-1/α. The mean values of α and K were 3.966 9 and 374.55，so E=4.3992σ0.75. Conclusion The modulus of elasticity was found to increase with increasing stress. The variations law is similar to that of the vessels. Furthermore when σ is 001333 MPa(100 mmHg),E is about 0.16 MPa, which is similar to that of the vessels.
Objective To explore the bacterial translocation of mesenteric lymph nodes （MLNs） of the ileum and the spectrum of bacteria in patients with small bowel obstruction.Methods Total 84 patients were divided into study group （with small bowel obstruction） and control group （without small bowel obstruction）. MLNs were obtained under sterile conditions intraoperatively， and which were processed for culture of aerobic and anaerobic organisms. The rate of bacterial translocation and postoperative infection were compared between two groups and the species of bacterial translocation was identified. Results The bacterial translocation rate in the study group was higher than that in the control group 〔57.1% （24/42） versus 16.7% （7/42），χ2=14.775， P＜0.01〕. Escherichia coil was the most commonly bacteria （20）. Emergency surgery and age over 70 years were associated with bacterial translocation （P＜0.05）. Postoperative infection complications rate in the bacterial translocation patients was higher than that in the patients without bacterial translocation 〔29.0% （9/31） versus 3.8% （2/53），χ2=10.965，P＜0.05〕. Conclusions Bacterial translocation to MLNs occurres more frequently in patients with small bowel obstruction，non-elective surgery， and elderly.
Objective To evaluate the effect of hepatocyte growth factor(HGF) on intestinal permeability and bacterial translocation after small bowel transplantation in rats. Methods Twenty Wistar rats were as recptors and twenty SD rats as donors. After heterotopic intestinal grafting, cyclosporine A was administered at 6mg/kg·day intramuscularly for inhibiting rejection. The SD rats were divided into 2 groups(n=10). HGF was administered at 150 μg/kg·day (HGF group) and normal saline was administered at 150 μg/kg·day (controlgroup). Intestinal permeability and bacterial translocation to the mesenteric lymph nodes and portal vein were assessed at the 8th postoperative day. Results The lactulose and lactulose/ mannitol of control group (0.0931%±0.008 5% and 0.132± 0.021) were higher than those of normal reference value (0.015 0%±0.002 0% and 0.020±0.005)（Plt;0.05）. The lactulose and lactulose/ mannitol of HGF group (0.039 6%±0.009 0% and 0.056±0.013) were also higher than those of normal reference value（Plt;0.05）.The bacterial culture positive proportion of lymphaden in HGF group and control group were 10% and 60%, showing statistically significant difference（Plt;0.05）. The bacterial culture positive proportion of portal vein in HGF group and control group were 10% and 20% respectively（P＞0.05）. Conclusion HGF can decrease intestinal permeability and bacterial translocation from the lumen of the graft to the mesenteric lymph nodes,thus improve gut barrier function, may be of help to reduce the incidence of septic complications after intestinal grafting.
目的：探讨DSA诊断小肠血管畸形的价值。方法：本文分析21例小肠血管畸形患者的临床及DSA特征，其中男性14例，女性7例，所有患者均行肠系膜上、下动脉造影。结果：临床特征：①急性消化道出血为主症状；②常规检查一般为阴性；③血红蛋白含量短期内降至4～6 g/mL。DSA特征：①动静脉瘘；②局部肠壁染色增浓；③局部血管异常增多，结构紊乱。其中12例进行了动脉导丝栓塞，2例栓塞后出血，进行外科手术切除。结论：DSA是诊断血管畸形所致小肠出血的最有效的方法，动脉导丝栓塞是安全，有效的治疗方法，同时为外科手术切除提供的正确部位。
ObjectiveCapsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. MethodsWe electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. ResultsWe finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusiona) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.
ObjectiveTo prepare the small intestinal submucosa (SIS)-silk composite scaffold for anterior cruciate ligament (ACL) reconstruction, and to evaluate its properties of biomechanics, biocompatibility, and the influence on synovial fluid leaking into tibia tunnel so as to provide a better choice in the clinical application of ACL reconstruction. MethodsThe silk was used to remove sericin and then weaved as silk scaffold, which was surrounded cylindrically by SIS to prepare a composite scaffold. The property of biomechanics was evaluated by biomechanical testing system. The cell biocompatibility of scaffolds was evaluated by live/dead staining and the cell counting kit 8 (CCK- 8). Thirty 6-week-old Sprague Dawley rats were randomly assigned to 2 groups (n=15). The silk scaffold (S group) and composite scaffold (SS group) were subcutaneously implanted. At 2, 4, and 8 weeks after implanted, the specimen were harvested for HE staining to observe the biocompatibility. Another 20 28-week-old New Zealand white rabbits were randomly assigned to the S group and SS group (n=20), and the silk scaffold and composite scaffold were used for ACL reconstruction respectively in 2 groups. Furthermore, a bone window was made on the tibia tunnel. At last, the electric resistance of tendon graft in the bone window was measured and recorded at different time points after 5 mL of 10% NaCl or 5 mL of ink solution was irrigated into the joint cavity recspectively. ResultsThe gross observation showed that the composite scaffold consisted of the helical silk bundle inside which was surrounded by SIS. The maximal load of silk scaffold and composite scaffold was respectively (138.62±11.41) N and (137.05±16.95) N, showing no significant difference (P>0.05); the stiffness was respectively (24.65±2.62) N/mm and (24.21±2.39) N/mm, showing no significant difference (P>0.05). The live/dead staining showed that the cells had good activity on both scaffolds. However, the cells on the composite scaffold had better extensibility. In addition, the cell proliferation curve indicated that no significant difference in the absorbance (A) values was founded between groups at various time points (P>0.05). HE staining showed less inflammatory cells and much more angiogenesis in SS group than in S group at 2, 4, and 8 weeks after subcutaneously implanted (P<0.05), indicating good biocompatibility. Additionally, the starting time points of electric resistance decrease and the ink leakage were both significantly later in SS group than in S group (P<0.05). The duration of ink leakage was significantly longer in SS group than in S group (P<0.05). ConclusionThe SIS-silk composite scaffold has excellent biomechanical properties and biocompatibility and early vacularization after in vivo implantation. Moreover, it can reducing the leakage of synovial fluid into tibia tunnel at the early stage of ACL reconstruction. So it is promising to be an ideal ACL scaffold.