Enhanced recovery after surgery protocol enhances early postoperative recovery after pancreaticoduodenectomy

Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.

Pseudomonas fluorescens-like bacteria from the stomach:A microbiological and molecular study

AIM:To characterize oxidase-and urease-producing bacterial isolates,grown aerobically,that originated from antral biopsies of patients suffering from acid peptic diseases.METHODS:A total of 258 antral biopsy specimens were subjected to isolation of bacteria followed by tests for oxidase and urease production,acid tolerance and aerobic growth.The selected isolates were further characterized by molecular techniques viz.amplifications for 16S rRNA using universal eubacterial and HSP60 gene specific primers.The amplicons were subjected to restriction analysis and partial sequencing.A phylogenetic tree was generated using unweighted pair group method with arithmetic mean(UPGMA) from evolutionary distance computed with bootstrap test of phylogeny.Assessment of acidity tolerance of bacteria isolated from antrum was performed using hydrochloric acid from 10-7 mol/L to 10-1 mol/L.RESULTS:Of the 258 antral biopsy specimens collected from patients,179(69.4%) were positive for urease production by rapid urease test and 31%(80/258) yielded typical Helicobacter pylori(H.pylori) after 5-7 d of incubation under a microaerophilic environment.A total of 240(93%) antral biopsies yielded homogeneous semi-translucent and small colonies after overnight incubation.The partial 16S rRNA sequences revealed that the isolates had 99% similarity with Pseudomonas species.A phylogenetic tree on the basis of 16S rRNA sequences denoted that JQ927226 and JQ927227 were likely to be related to Pseudomonas fluorescens(P.fluorescens).On the basis ofHSP60 sequences applied to the UPGMA phylogenetic tree,it was observed that isolated strains in an aerobic environment were likely to be P.fluorescens,and HSP60 sequences had more discriminatory potential rather than 16S rRNA sequences.Interestingly,this bacterium was acid tolerant for hours at low pH.Further,a total of 250(96.9%) genomic DNA samples of 258 biopsy specimens and DNA from 240 bacterial isolates were positive for the 613 bp amplicons by targeting P.fluorescens-specific conserved putative outer membrane protein gene sequences.CONCLUSION:This study indicates that bacterial isolates from antral biopsies grown aerobically were P.fluorescens,and thus acid-tolerant bacteria other than H.pylori can also colonize the stomach and may be implicated in pathogenesis/protection.

仙茅:对健康有众多益处的黑金(英文)

仙茅(石蒜科)是一种濒临灭绝的多年生草本植物,是印度本土药,作为强有力的适应原和春药在印度传统药物中占有重要位置。它也是多种印度传统药物处方的重要组成部分,被认为具有促进性欲、刺激免疫、保护肝脏、抗氧化、抗癌和治疗糖尿病等作用。已有报道,从仙茅中提取出多种化学成分,如植物黏胶,酚苷、皂苷和脂肪族化合物等。仙茅也是中医和日本汉方医学中各种草药处方的重要成分。本文对仙茅的多种生物活性和其不同化学成分的作用进行了综述。

南欧派利吞草石油醚提取物对雄性大鼠性行为的影响(英文)

目的:检测南欧派利吞草石油醚提取物(petroleum ether extract,PEE)对雄性大鼠性行为的影响。方法:制备南欧派利吞草PEE。32只雄性Wistar大鼠分成对照组、睾酮组、低剂量PEE组和高剂量PEE组,每组8只。对照组大鼠灌胃花生油(溶剂对照),睾酮组大鼠肌肉注射0.5mg/kg睾酮,每周2次,低剂量和高剂量PEE组大鼠分别灌胃50和100mg/kgPEE,治疗持续28d。于治疗前,治疗第15天、第28天和治疗后第7天、第15天,检测大鼠体质量,治疗结束后,取4只大鼠性器官(睾丸、附睾、精囊、前列腺)称取质量,其余4只大鼠用于检测大鼠的性取向行为和性功能。结果:与对照组大鼠比较,PEE治疗28d可明显增加雄性大鼠的体质量和性器官质量,雄性大鼠易于接受雌性大鼠和对雌性大鼠趋向性增加,雄性大鼠性能力增加,表现为舔、嗅雌性大鼠肛门和生殖器,阴茎勃起指数增加,交配潜伏期缩短,交配频率增加。在PEE治疗结束后7和15d仍观察到以上行为和性指标的变化。结论:与睾酮不同的是,PEE治疗结束后7和15d仍可见明显治疗效果,提示南欧派利吞草能提高大鼠性潜能,并有延迟效应。

提高认知能力的印度传统草药土丁桂(英文)

土丁桂属草药是作用于中枢神经系统的印度传统药物,特别是对促进记忆和改善智力有较好疗效。从印度传统医学和梵语文献中提取的大量信息提示,冠以土丁桂属草药名称的植物类别共4种:旋花科田旋花、旋花科土丁桂、蝶形花科蝴蝶花豆和龙胆科穿心草。这些草药名称均在古代文献中有所记载,可单独使用或与其他药材组合成各种草药处方。本文就现有的科学信息,如土丁桂属不同植物来源物种的生药学特征、化学成分、药理作用、临床前及临床应用等方面进行述评,以期为科学地应用土丁桂提供依据。此外,还可根据不同植物来源土丁桂属草药的不同功效进行鉴别应用。