Implementation of gastrointestinal function protection in severe acute pancreatitis

Severe acute pancreatitis(SAP)is a serious systemic disease associated with strong local inflammatory reactions and serious systemic pathophysiological disorders caused by trypsin spillover.Patients with SAP are prone to exhibit gastrointestinal dysfunction.Meanwhile,gastrointestinal dysfunction further aggravates the systemic inflammatory response and metabolic abnormalities,resulting in a more critical condition of SAP.Gastrointestinal dysfunction is considered to be the“trigger”of multiple organ dysfunction syndrome[1].Thus,it is important to maintain gastrointestinal homeostasis in the treatment of SAP.

Antibiotics management in severe acute pancreatitis

Severe acute pancreatitis(SAP)is a common and critical disease.It is life-threatening at any time if multiple organ dysfunction occurs.SAP may develop secondary infection,often iatrogenic[1].To treat infected SAP,appropriate antibiotic use and nosocomial management is critical,along with adequate drainage of the infected foci and optimizing the immune function.Not only is the use of powerful antibiotics necessary to minimize mortality,but early use is also necessary to reduce the occurrence of drug-resistant bacteria.Therefore,antibiotic management is clinically important and requires careful attention.

Magnolol protects against acute gastrointestinal injury in sepsis by down-regulating regulated on activation,normal T-cell expressed and secreted

BACKGROUND Sepsis is a major medical challenge.Magnolol is an active constituent of Houpu that improves tissue function and exerts strong anti-endotoxin and anti-inflammatory effects,but the mechanism by which it reduces intestinal inflammation in sepsis is yet unclear.AIM To assess the protective effect of magnolol on intestinal mucosal epithelial cells in sepsis and elucidate the underlying mechanisms.METHODS Enzyme-linked immunosorbent assay was used to measure tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-6,and regulated on activation,normal T-cell expressed and secreted(RANTES)levels in serum and ileal tissue in animal studies.The histopathological changes of the ileal mucosa in different groups were observed under a microscope.Cell Counting Kit-8 and cell permeability assays were used to determine the concentration of drug-containing serum that did not affect the activity of Caco2 cells but inhibited lipopolysaccharide(LPS)-induced decrease in permeability.Immunofluorescence and Western blot assays were used to detect the levels of RANTES,inhibitor of nuclear factor kappa-B kinaseβ(IKKβ),phosphorylated IKKβ(p-IKKβ),inhibitor of nuclear factor kappa-B kinaseα(IκBα),p65,and p-p65 proteins in different groups in vitro.RESULTS In rats treated with LPS by intravenous tail injection in the presence or absence of magnolol,magnolol inhibited the expression of proinflammatory cytokines,IL-1β,IL-6,and TNF-αin a dose-dependent manner.In addition,magnolol suppressed the production of RANTES in LPS-stimulated sepsis rats.Moreover,in vitro studies suggested that magnolol inhibited the increase of p65 nucleation,thereby markedly downregulating the production of the phosphorylated form of IKKβin LPS-treated Caco2 cells.Specifically,magnolol inhibited the translocation of the transcription factor nuclear factor-kappa B(NF-κB)from the cytosol into the nucleus and down-regulated the expression level of the chemokine RANTES in LPS-stimulated Caco2 cells.CONCLUSION Magnolol down-regulates RANTES levels by inhibiting the LPS/NF-κB signaling pathways,thereby suppressing IL-1β,IL-6,and TNF-αexpression to alleviate the mucosal barrier dysfunction in sepsis.

Nutritional management of severe acute pancreatitis

Severe acute pancreatitis(SAP)is a common clinical emergency and critical illness.The increases of hyperlipidemic pancreatitis and alcoholic pancreatitis result in the increase of SAP.The SAP mortality is as high as 30%[1].During the resuscitation and treat-ment of SAP,the metabolism changes require nutritional support.The individual metabolic status need personalized nutrition ap-proach.

Detailed analysis of fan-shaped jets in three dimensional numerical simulation

We performed three dimensional resistive magnetohydrodynamic simulations to study the magnetic reconnection using an initially shearing magnetic field configuration（force free field with a current sheet in the middle of the computational box）.It is shown that there are two types of reconnection jets：the ordinary reconnection jets and fan-shaped jets,which are formed along the guide magnetic field.The fan-shaped jets are significantly different from the ordinary reconnection jets which are ejected by magnetic tension force.There are two driving forces for accelerating the fan-shaped jets.One is the Lorentz force which initially dominates the motion of fluid elements,and then the gas pressure gradient force accelerates the fluid elements in the later stage.The dependence on magnetic reconnection angle and resistivity value has also been studied.The formation and evolution of these jets provide a new understanding of dynamic magnetohydrodynamic jets.

Effects of aspirin on the expression of nuclear factor-κB in a rat model of acute pulmonary embolism

BACKGROUND:Acute pulmonary embolism(APE) is a disorder involving the pulmonary circulation resulting from a blockage of the pulmonary artery. The present study aimed to investigate the effects of aspirin on the nuclear factor-κB(NF-κB) activity in a rat model of APE.METHODS:A total of 108 healthy male Sprague-Dawley rats were randomly assigned into six groups(n=18 rats per group):control group,sham operation group,APE model group,and low-,medium- and high-dose aspirin groups. Six,24,and 72 hours after the induction of APE,rats in the low-,medium- and high-dose aspirin groups were given aspirin at a respective daily dose of 150,300,and 600 mg/kg by gavage for three consecutive days. Rats in the other groups were treated with equal volumes of normal saline. Six rats in each group were anesthetized with 10% chloral hydrate solution at each time point,and then the lung tissues were collected and analyzed using immunohistochemical staining.RESULTS:Positive immunohistochemical staining was present in the bronchial epithelial cells,alveolar cells,macrophages,and surrounding bronchial smooth muscle cells. When compared with the APE model group,the number of positive cells was signif icantly lower in the other groups at each time point(P<0.001). Statistically signif icant differences were also observed among the aspirin-treated groups at 6 hours(P<0.05,P<0.001). Compared with the APE model group,NF-κB protein expression was reduced in the other groups at each time point(P<0.05,P<0.001). Rats from the APE model group had thrombosis,damaged alveolar walls,and pulmonary hemorrhage,along with different degrees of inf lammatory cellular inf iltration at each time point. However,pathological changes such as pulmonary hemorrhage and inf iltration of inf lammatory cells were attenuated after the aspirin treatment.CONCLUSION:Aspirin can signifi cantly inhibit NF-κB activity in the lung of rats with APE in a dose-dependent manner,and can alleviate lung injury after APE.

Intestinal microecology: A crucial strategy for targeted therapy of liver diseases

Intestinal microecology is an important part of human internal environment and is an extremely complex ecosystem consisting of gut microbiota, intestinal mucosa and intestinal immune system [1]. Gut is highly specialized for the digestion and absorption of different nutrients. The gut microbiota is the largest and most complex, which not only affects the local function of the intestine, but also plays an important role in the maturation and maintenance of the whole immune system.

Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

Objective: To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support. Methods: Clinical trials were searched in PubMed, EMBASE, and the Cochrane Central Registry of Clinical Trials, as well as Web of Science. Studies were included if they compared levosimendan with dobutamine in critically ill patients requiring inotropic support, and provided at least one outcome of interest. Outcomes of interest included mortality, incidence of hypotension, supraventricular arrhythmias, and ventricular arrhythmias. Results: Data from a total of 3052 patients from 22 randomized controlled trials (RCTs) were included in the analysis. Overall analysis showed that the use of levosimendan was associated with a significant reduction in mortality (269 of 1373 [19.6%] in the levosimendan group, versus 328 of 1278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence interval (CI) 0.70-0.92, P for effect=0.002). Subgroup analysis indicated that the benefit from levosimendan could be found in the subpopulations of cardiac surgery, ischemic heart failure, and concomitant β-blocker therapy in comparison with dobutamine. There was no significant difference in the incidence of hypotension, supraventricular arrhythmias, or ventricular arrhythmias between the two drugs. Conclusions: In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant β-blocker therapy may benefit from levosimendan. More RCTs are required to address the questions about no positive outcomes in the subpopulation in a cardiology setting, and to confirm the advantages in long-term prognosis.