Two intestinal microbiota-derived metabolites, deoxycholic acid and butyrate, synergize to enhance host defense peptide synthesis and alleviate necrotic enteritis

Background Necrotic enteritis(NE)is a major enteric disease in poultry,yet effective mitigation strategies remain elusive.Deoxycholic acid(DCA)and butyrate,two major metabolites derived from the intestinal microbiota,have independently been shown to induce host defense peptide(HDP)synthesis.However,the potential synergy between these two compounds remains unexplored.Methods To investigate the possible synergistic effect between DCA and butyrate in regulating HDP synthesis and barrier function,we treated chicken HD11 macrophage cells and jejunal explants with DCA and sodium butyrate(NaB),either individually or in combination,for 24 h.Subsequently,we performed RNA isolation and reverse transcrip-tion-quantitative PCR to analyze HDP genes as well as the major genes associated with barrier function.To further determine the synergy between DCA and NaB in enhancing NE resistance,we conducted two independent trials with Cobb broiler chicks.In each trial,the diet was supplemented with DCA or NaB on the day-of-hatch,followed by NE induction through sequential challenges with Eimeria maxima and Clostridium perfringens on d 10 and 14,respectively.We recorded animal mortality after infection and assessed intestinal lesions on d 17.The impact of DCA and NaB on the microbiota in the ileum and cecum was evaluated through bacterial 16S rRNA gene sequencing.Results We found that the combination of DCA and NaB synergistically induced multiple HDP genes in both chicken HD11 cells and jejunal explants.Additionally,the gene for claudin-1,a major tight junction protein,also exhibited synergistic induction in response to DCA and NaB.Furthermore,dietary supplementation with a combination of 0.75 g/kg DCA and 1 g/kg NaB led to a significant improvement in animal survival and a reduction in intestinal lesions compared to either compound alone in a chicken model of NE.Notably,the cecal microbiota of NE-infected chickens showed a marked decrease in SCFA-producing bacteria such as Bacteroides,Faecalibacterium,and Cuneatibacter,with lactobacilli becoming the most dominant species.However,supplementation with DCA and NaB largely restored the intestinal microbiota to healthy levels.Conclusions DCA synergizes with NaB to induce HDP and claudin-1 expression and enhance NE resistance,with potential for further development as cost-effective antibiotic alternatives.

Dietary Macleaya cordata extract supplementation improves the growth performance and gut health of broiler chickens with necrotic enteritis

Background The poultry industry needs effective antibiotic alternatives to control outbreaks of necrotic enteritis(NE)caused by Clostridium perfringens.Methods The aim of this study was to investigate the effects of dietary supplementation with Macleaya cordata extract(MCE)on the immune function and gut microbiota of broilers with NE.A total of 2881-day-old broiler chicks were randomly assigned to a 2×2 factorial arrangement with two concentrations of dietary MCE supplementation(0 or 350 mg/kg of diet)and two disease challenge statuses(control or NE).Results The results revealed that NE significantly increased the feed conversion rate(FCR),mortality,intestinal lesion score,the levels of IL-1β,IL-17 and IFN-γ/IL-4 in serum and IL-17/IL-10 in the jejunal mucosa,m RNA levels of TLR2,IFN-γand p Ig R in the jejunum,and Clostridium perfringens concentrations in the cecum.NE significantly decreased the body weight(BW),body weight gain(BWG),jejunal villus height,V/C,m RNA level of AMPK-α1 in jejunum,IL-4 level in the jejunal mucosa and lactic acid bacteria abundance in the cecum.MCE significantly increased BW,BWG,jejunal villus height,V/C,m RNA levels of occludin,ZO-1 and AMPK-α1 in the jejunum,the levels of Ig A and Ig G in serum and IL-10 in the jejunal mucosa and m RNA levels of NF-κB,IL-10 and MHC-II in the jejunum.Additionally,MCE significantly decreased the FCR,mortality,intestinal lesion score,jejunal crypt depth,the levels of IFN-γand IL-17 in serum and IL-17/IL-10 in the jejunal mucosa,Clostridium perfringens concentrations in the cecum,and m RNA levels of IL-17/IL-10 in the jejunum.Moreover,NE significantly increased the abundance of bacteria that are associated with inflammation,obesity and depression(Alistipes,Barnesiella,Intestinimonas,RF39 and UCG-005)and significantly decreased the abundance of short-chain fatty acid(SCFA)-producing bacteria(Anaerotruncus,Butyricicoccus and Bacteroides)in the cecum.MCE significantly increased the abundance of SCFA-producing bacteria(Streptococcus,Ruminococcus_torques_group and Lachnospiraceae_NK4A136_group)and significantly reduced the abundance of bacteria that are associated with inflammation and obesity(Alistipes,Barnesiella and UCG-010)in the cecum.In the cecum of broilers with NE,the relative abundance of Barnesiella and Alistipes was higher and that of Lachnoclostridium and Shuttleworthia was lower.Interestingly,these trends were reversed by the addition of MCE to the diet.Spearman correlation analysis showed that Barnesiella and Alistipes were associated with enhanced intestinal inflammation and inhibited growth performance,whereas Lachnoclostridium and Shuttleworthia were associated with anti-inflammatory effects.Conclusions MCE ameliorated the loss of growth performance in broiler chickens with NE,probably by regulating the intestinal barrier,immune function,and gut microbiota.

Intestinal microecological transplantation for a patient with chronic radiation enteritis:A case report

BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.

Potential pharmacological mechanisms of digallate in the treatment of enteritis based on network pharmacology and molecular docking

Background:In order to investigate the possible pharmacological mechanism of digallate in Galla Chinensis for treating enteritis,providing reference for the search and exploration of effective drugs for treating enteritis.Method:Traditional Chinese Medicines Systems Pharmacology Database and Analysis Platform,PharmMapper,DisGeNET,DrugBank,and GeneCards databases were used to obtain drug and disease-related target information.Gene ontology functional annotation and Kyoto Encyclopedia of Genes and Genomes pathway enrichment were performed,and the main therapeutic pathways and targets were identified by combining protein-protein interaction networks and cytoHubba plug-in.Molecular docking was used to validate the results.Result:297 drug related targets,2436 disease related targets,and 66 target points related to digallate were predicted to be associated with enteritis.10 related signal pathways and 10 key genes were identified.Conclusion:Digallate may be utilized to treat enteritis by acting on similar pathways,such those related to pathways in cancer,lipid and atherosclerosis,proteoglycans in cancer,Rap1 signaling pathway,PI3K-Akt signaling pathway and other targets such as IGF1,EGFR,SRC,IGF1R,PPARG.

Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and disease activity index(DAI)score(OR:53.928,95%CI:3.822-760.948,P=0.003)as independent predictors of SARE.CONCLUSION Anal bulge rating(>0.500 grade)and DAI score(>2.165 points)can predict SARE.The nomogram shows potential value in clinical practice.

Effects of tannic acid on the immunity and intestinal health of broiler chickens with necrotic enteritis infection

Background In broiler chickens,necrotic enteritis(NE)infection can reduce production performance.Tannic acid has shown great potential as a treatment of NE in broilers.However,the appropriate dosage of tannic acid in NE of broilers and the improvement effect on intestinal health are not very clear.In this study,we aimed to investigate the effects of different doses of tannic acid on the production performance,immunity,and intestinal health of broilers by constructing an NE model with C.perfringens infection and determining the appropriate dosage of tannic acid with regard to NE.Results Challenged birds showed significant reduction in body weight,villus height,and the ratio of villus height to crypt depth(P<0.05)and increase in the feed consumption gain ratio,intestinal lesion score,and crypt depth(P<0.05).The infection significantly reduced the relative Bacteroidota and Ligilactobacillus abundance(P<0.05)and increased the ratio of Firmicutes/Bacteroidota and cecal content of C.perfringens(P<0.05).Challenged birds fed diets supplemented with tannic acid showed significantly increased mRNA expression of nutrient transport carriers and intestinal barrier genes and growth performance and reduced serum zonulin and endotoxin levels(P<0.05).Addi-tion of tannic acid to the diet inhibited the inflammatory response by reducing the number of coccidia oocysts in feces and the content of C.perfringens in the cecum.Specifically,tannic acid reduced the serum levels of C reactive protein,myeloperoxidase,and specific IgY and ileal mucosal secretory immunoglobulin A levels in the ileal mucosa compared with those in the NE-infected birds.NE-infected birds fed diets supplemented with tannic acid also showed significantly increased relative Anaerocolumna,Thermoanaerobacterium,and Thermosinus abundance(P<0.05);their microbial composition and functional predictions were similar to those of the NC group.Conclusions Tannic acid in the diet alleviated NE by enhancing the intestinal barrier and absorption function.The recommended dietary tannic acid additive level is 500–750 mg/kg.Our study findings would be useful in reducing related economic losses in the broiler industry.

Essential Oils as an Alternative to Antibiotics to Reduce the Incidence and Severity of Necrotic Enteritis in Broiler Chickens: A Short Review

Due to the removal of antibiotic growth promoters (AGPs) and consumer pressure for antibiotic-free (ABF) or no antibiotics ever (NAE) poultry production, there is a need for sustainable alternatives to prevent disease in commercial poultry operations. Without AGPs, there has been a rise in diseases that were traditionally controlled by subtherapeutic levels of antibiotics in the diet. This has impacted the health of commercial poultry and has been a significant cost to poultry producers. To mitigate this, the industry has started to investigate alternatives to antibiotics to treat these forthcoming health issues, such as necrotic enteritis (NE). NE is an enteric disease caused by an over proliferation of toxigenic Clostridium perfringens (CP) in the gastrointestinal tract. Although CP is a commensal in the avian intestinal tract, dysbiosis caused by inflammation and impaired intestinal integrity facilitates uncontrolled replication of CP. Infectious agents, such as Eimeria maxima, appear to be a predominant predisposing factor that promotes NE. However, non-infectious stressors, including dietary changes, have also been associated with NE to some degree. As a result of increased pressure to restrict the use of antibiotics, there is a need for research evaluating the efficacy of alternatives, such as plant-derived essential oils, as potential tools to mitigate NE in commercial poultry flocks. The aim of this study is to review the effects of essential oils as an alternative to antibiotics to reduce the incidence and severity of necrotic enteritis in broiler chickens.

Stimbiotic supplementation modulated intestinal inflammatory response and improved broilers performance in an experimentally-induced necrotic enteritis infection model

Background:Two experiments were conducted to establish an optimal NE challenge model and evaluate the efficacy of stimbiotic(STB)supplementation in necrotic enteritis(NE)challenged broilers.In Exp.1,a total of 120 Arbor Acres(AA)broilers(45.0±0.21 g)were randomly assigned to 6 treatments in a 3×2 factorial arrangement.Vaccine treatments included non-challenge(0),×10 the recommended dose(×10)or×20 the recommended dose(×20)by the manufacturer.Clostridium perfringens(CP)treatments were non-challenge(No)or 3 mL of 2.2×10^(7)CFU CP challenge(Yes).In Exp.2,a total of 72 AA broilers(40.17±0.27 g)were randomly assigned to 6 treatments in a 3×2 factorial arrangement.Dietary treatments included non-additive(CON),100 mg/kg STB(STB)and 100 mg/kg STB on top of a typical commercial blend including an essential oil,probiotics,and enzyme(CB).Challenge treatments included non-NE challenge(No)and NE challenge(Yes)as established in Exp.1.Results:In Exp.1,CP and vaccine challenge decreased(P<0.05)body weight(BW),body weight gain(BWG)and feed intake(FI),and increased(P<0.05)the number of broilers with diarrhea and intestinal lesions.The oral administration of×20 recommended dose of vaccines coupled with 3 mL of 2.2×10^(7)CFU CP resulted in(P<0.01)a significantly increased incidence of wet litter and intestinal lesions.Thus,this treatment was chosen as the challenge model for the successful inducement of NE in Exp.2.In Exp.2,the NE challenge negatively affected(P<0.01)growth performance,ileal morphology,immunoglobulin contents in blood,caecal microbiota in the caecum,footpad dermatitis,intestinal lesion scores,tumour necrosis factor(TNF-α)and endotoxin in the serum compared with the non-NE challenged birds.The supplementation of STB and CB in diets enhanced(P<0.05)growth performance,intestinal microbiota,and blood profiles by stimulating ileal morphology(VH and VH:CD)and propionate production in the cecum,and there were no differences in measured variables between STB and CB supplemented birds.Conclusion:Overall,these results indicate that STB supplementation was able to reduce the inflammatory response and improve the performance of NE challenged birds,and the supplementation of STB alone was as effective as a typical commercial blend containing a number of other additives.

Rare case of lupus enteritis presenting as colorectum involvement:A case report and review of literature

BACKGROUND Systemic lupus erythematosus(SLE)is a multisystem autoimmune disease that can affect the gastrointestinal tract.Most cases of lupus enteritis(LE)involve the small intestine,while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare.CASE SUMMARY A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months.She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications,which may have contributed to the onset of LE and led to her current hospital admission.According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology,this case scored 14.Additionally,abdominal computed tomography revealed significant wall edema of the colon and rectum,ischemia and hyperemia of the ascending colon intestinal wall,mesenteric vessel engorgement,increased mesangial fat attenuation,ascites,and bilateral ureter-hydronephrosis,all indicative of colon and rectum LE.Laboratory tests also showed lower levels of complement C3 and C4,with an antinuclear antibody titer of 1:100.Overall,it was clear that this case involved the colon and rectum without affecting the small intestine,representing a rare manifestation of SLE.The patient received treatment with 10 mg of methylprednisolone sodium succinate,100 mL of 0.9%sodium chloride,hydroxychloroquine(100 mg),and nutrition support.After one week of methylprednisolone and hydroxychloroquine therapy,her SLE symptoms and disease activity improved significantly.CONCLUSION Although colorectal LE without small intestine involvement is very rare,early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention.Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.

宫颈癌同步放化疗急性放射性肠炎的剂量学参数分析

目的 探索宫颈癌放疗患者肠道剂量与急性放射性肠炎(ARE)的相关性。方法 回顾性分析2014-2019年间158例宫颈癌同步放化疗患者的临床资料,根据CTCAE 5.0将ARE≥2级的患者归为ARE≥2级组,否则归为ARE <2级组。从剂量体积直方图中提取患者肠道剂量参数,采用单因素及多因素logistic回归分析ARE≥2级与肠道剂量学参数的相关性。结果 26例(16.46%)患者发生≥2级ARE。营养不良、三维适形放疗的患者ARE≥2级的发生率高于营养良好、调强放疗的患者(P <0.05);发生ARE≥2级的患者肠袋V5、V40和直肠V50高于ARE <2级的患者(P <0.05);ROC曲线显示肠袋V5和V40是ARE≥2级的显著预测因子(AUC> 0.7,P <0.05)。结论 宫颈癌同步放化疗的患者应考虑肠袋V5和V40剂量,合理优化放疗计划,以期降低ARE≥2级的发生率。

葛根芩连汤加味治疗急性肠炎的临床观察

目的探究葛根芩连汤加味治疗急性肠炎的效果。方法纳入急性肠炎患者共80例,按照随机数字表法分为对照组与观察组各40例。对照组接受奥美拉唑等常规西医治疗,观察组在此基础上加用葛根芩连汤治疗。观察两组疗效,并比较治疗前后中医证候积分、炎症指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL6)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)]、白蛋白、前白蛋白及免疫指标[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)]。结果观察组临床总有效率为95.00%,比对照组的80.00%高(P<0.05)。两组治疗后胃脘疼痛、身热不扬、大便稀溏、恶心呕吐评分比治疗前低,且观察组比对照组低(P<0.05);TNF-α、IL-6、hs-CRP及PCT比治疗前低,且观察组比对照组低(P<0.05);白蛋白、前白蛋白、IgG、IgA及IgM比治疗前高,且观察组比对照组高(P<0.05)。结论中西医结合治疗急性肠炎疗效确切,可明显抑制患者炎症反应,改善其血清白蛋白、前白蛋白水平。

胸腹腔镜食管癌根治术联合早期肠内营养支持治疗老年食管癌的临床观察

目的:研究胸腹腔镜根治术联合早期肠内营养支持治疗老年食管癌的效果。方法:研究对象选取2018年01月至2021年12月我院收治的96例老年食管癌患者,按照随机数字法分为观察组和对照组,每组各48例。对照组术后采取肠外营养支持治疗,观察组术后采取肠内营养支持治疗,比较两组患者术后住院时间、肛门排气时间、首次排便时间、下床活动时间、恢复饮食时,以及术前及术后7 d的营养相关状况指标白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)和体质量指数(BMI),免疫功能相关指标CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+),观察两组主要并发症的发生情况。结果:观察组住院时间、肛门排气时间、首次排便时间、恢复饮食时间均少于对照组(P<0.05);观察组术后7 d的ALB、TP、PA、BMI均高于对照组(P<0.05);观察组术后7 d的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05);观察组吻合口瘘、肺部并发症及总并发症的发生率(P<0.05),均低于对照组。结论:早期肠内营养支持可以有效改善老年患者在胸腹腔镜联合食管癌根治术后营养状态,增强免疫功能,减少并发症,促进术后恢复,具有较大临床价值。

某三甲医院药字号肠内营养制剂的使用分析

目的分析西安市某三甲医院药字号肠内营养制剂的使用情况,为临床合理使用药字号肠内营养制剂提供参考。方法从该院信息管理系统(hospital information system,HIS)中提取2019年至2021年药字号肠内营养制剂的用药数据,对全院药字号营养制剂的销售情况及构成比、用药频度(defined daily doses,DDDs)、限定日费用(defined daily cost,DDC)等药物经济学指标以及各科室使用量进行回顾性统计分析。结果该院肠内营养制剂使用量2019年至2020年呈增长趋势,但2021年度有所下降。DDDs排名前3的制剂分别是百普力、能全素和瑞素。DDC排序前3的制剂是瑞先、百普素和百普力。肝胆外科3年间短肽类制剂使用量位居第1,整蛋白制剂使用量前3的科室分别是神经内科、重症医学科和康复科。结论该院肠内营养制剂平均年使用量偏低,肠内营养与肠外营养治疗比例不均衡。整蛋白制剂瑞先价格较高,患者经济负担重,肠内营养制剂应保质保效,同时应降低价格。临床肠内营养治疗率远低于实际营养不良反应发生率,营养科需进一步加强与临床科室的沟通协作,提高住院患者肠内营养治疗比例。

“临床营养”团体标准在提高神经重症患者肠内营养治疗全流程管理达标率中的应用

目的提高神经重症患者肠内营养治疗全流程管理达标率。方法对照中国医院协会中国《医院质量安全管理》“第2-29部分患者服务临床营养”团体标准中肠内营养标准条款,对神经创伤重症科住院患者肠内营养治疗全流程管理达标情况进行调查,通过现状调查、原因解析,制订针对性方策,从组建肠内营养治疗全流程管理“医-护-营-康”多学科团队、构建基于“知-信-行”理论的肠内营养治疗培训闭环管理模式、建立以肠内营养治疗数据精准分析为基础的质量改进体系3方面予以改进。结果科室肠内营养治疗全流程管理达标率由改善前33.9%上升至改善后62.5%。结论开展“临床营养”团体标准实践可有效提高神经重症患者肠内营养治疗全流程管理达标率,规范肠内营养治疗操作流程,减少并发症,保障患者安全。

高压氧联合肠内营养对重症颅脑损伤患者术后炎性因子、肠道菌群及神经功能的影响

目的探讨高压氧联合肠内营养对重症颅脑损伤患者术后炎性因子、肠道菌群及神经功能的影响。方法选取2021年9月至2022年8月收治的重症颅脑损伤患者98例,根据治疗方式不同分为对照组和观察组,每组49例。对照组给予高压氧联合肠外营养治疗,观察组给予高压氧联合肠内营养治疗。比较2组治疗前后血清炎性因子水平、免疫功能、肠胃黏膜功能、肠道菌群及神经功能变化情况。结果2组血清TNF-α、IL-6、IL-8水平下降,且观察组较对照组明显(P<0.05)。2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)升高,CD8^(+)降低,且观察组更明显(P<0.05)。与治疗前相比,2组血清D-乳酸、二胺氧化酶、内毒素水平下降,且观察组更明显(P<0.05)。观察组肠道内的乳酸杆菌、双歧杆菌含量高于对照组,大肠杆菌、肠球菌含量低于对照组(P<0.05)。2组FMA、GCS评分升高、NIHSS评分下降,且观察组更明显(P<0.05)。结论重症颅脑损伤患者术后给予高压氧联合肠内营养治疗,可减轻炎性反应,改善肠胃黏膜屏障功能,调节肠道菌群失调,增强免疫功能,促进神经功能恢复,具有重要的临床应用价值。

重症颅脑损伤患者术后早期营养策略探讨

目的探讨不同营养支持方式对重症颅脑损伤患者术后营养状况、并发症及预后的影响。方法72例入院当日完成手术治疗的重症颅脑损伤患者,根据院区的不同分为试验组(东湖院区)与对照组(象湖院区),每组36例。试验组实施肠内序贯喂养+肠外营养方案,对照组实施全肠内营养方案。比较两组患者的营养指标[血清总蛋白(TP)、血清白蛋白(ALB)和血红蛋白(Hb)]、三头肌皮褶厚度(TSF)、并发症(腹泻、呕吐)发生情况及预后指标[简化急性生理学评分系统Ⅱ(SAPSⅡ)评分]。结果试验组Hb水平为(97.33±7.91)g/L,高于对照组的(89.94±6.17)g/L,差异具有统计学意义(P<0.05)。两组ALB、TP、TSF水平比较,差异无统计学意义(P>0.05)。试验组腹泻发生率80.56%高于对照组的38.89%,腹内压(26.13±4.38)cm H2O(1 cm H2O=0.098 kPa)、SAPSⅡ评分(45.28±3.54)分低于对照组的(30.13±3.91)cm H2O、(55.78±10.16)分,差异有统计学意义(P<0.05);两组呕吐发生率比较,差异无统计学意义(P>0.05)。结论虽然两种营养方案在营养指标上无明显差别,但是肠内序贯喂养结合肠外营养可以改善患者预后。因此,在重症颅脑损伤患者术后管理上,肠内序贯喂养结合肠外营养治疗优于单一的全肠内营养治疗。

儿童轮状病毒性肠炎季节性分布特征及预防策略探讨

目的 探究儿童轮状病毒性肠炎(RVE)季节性分布特征及预防策略。方法 选择2020年1月至2022年12月本院收治的腹泻患儿(246例)为研究对象,纳入训练集;根据RV抗原检测结果,分为RVE组(132例)和非RVE组(114例)。按照相同标准,另选腹泻患儿(82例)纳入验证集。收集患儿的临床资料,分析RVE发病季节及月份分布情况,以及两组患儿的临床资料和生化指标。采用多因素Logistic回归分析危险因素,构建列线图预测模型并评价。结果 本地区RVE多见于冬春季,其中12月至次年3月为RVE高发期,其发病情况占全年的59.09%。有吮指习惯、无餐前洗手习惯、非母乳喂养、有RVE患儿接触史、平均每天户外活动时间≤1h、无RV疫苗接种史、处于冬春季以及25(OH)D<35.5μg/L,均是RVE发生的独立危险因素(χ^(2)/t值分别为5.922、24.583、5.125、11.750、4.322、12.670、11.705、14.374,均P<0.05)。受试者工作特征(ROC)曲线评估列线图预测儿童RVE发病情况的曲线下面积(AUC)显示,训练集为0.924(95%CI:0.890~0.951)、验证集为0.912(95%CI:0.865~0.998);决策曲线分析法(DCA)曲线显示阈值概率在1%~91%时,净获益率>0。结论 本地区儿童RVE全年均可发病,多见于冬春季。有吮指习惯、无餐前洗手习惯、非母乳喂养、有RVE患儿接触史、平均每天户外活动时间≤1h、无RV疫苗接种史、处于冬春季以及25(OH)D<35.5μg/L均是RVE发生的独立危险因素。基于上述危险因素构建的列线图模型对儿童RVE发病情况具有较高的预测价值。临床应继续加强防控工作,重点保护易感者。

犬细小病毒感染生物标志物及其检测方法研究进展

犬细小病毒感染是诱发幼犬肠炎和死亡的重要病因之一,其对各类及各年龄段犬均有较大危害,通过特定生物标志物及配套检测方法对犬的感染状况进行评估,以及对于感染犬的快速诊断及其治疗方案的确定实施有重要意义。文章通过对国内外犬细小病毒感染相关生物标志物及其检测方法方面的研究进展进行总结归纳,以期为犬细小病毒病的检测和诊疗提供参考。

急性胃肠功能损伤分级指导下脓毒症患者早期肠内营养的效果及对近期预后的影响

目的探讨急性胃肠功能损伤(AGI)分级指导下脓毒症患者早期肠内营养(EN)的效果及对近期预后的影响。方法回顾性选择2014年3至8月浙江省14个成人综合ICU收治的脓毒症患者102例,按照入院后1周内最差的AGI分级分为4组:无AGI组、AGIⅠ级组、AGIⅡ级组、AGIⅢ+Ⅳ级组。比较各组入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、平均动脉压(MAP)等基本资料及住院28 d生存率、无机械通气时间、抗生素使用时间、入院7 d内EN达标比例等指标。采用Kaplan-Meier生存曲线和log-rank检验评估不同AGI分级脓毒症患者生存率的差异,采用Cox回归分析脓毒症患者生存预后的独立影响因素。结果4组患者APACHEⅡ评分、SOFA评分、MAP、乳酸、无机械通气时间及抗生素使用时间比较,差异均有统计学意义(均P<0.05)。存在AGI的患者住院28 d生存率低于无AGI患者,且AGI分级越高,生存率呈下降趋势,差异均有统计学意义(均P<0.05)。入院第3天EN 80%达标、第7天EN达标的患者住院28 d生存率高于未达标组,差异均有统计学意义(均P<0.05)。Cox回归分析发现乳酸(HR=1.180,95%CI:1.045~1.340,P=0.008)、AGI分级(HR=1.304,95%CI:1.041~1.567,P=0.012)、APACHEⅡ评分(HR=1.069,95%CI:1.013~1.129,P=0.015)和SOFA评分(HR=1.183,95%CI:1.040~1.330,P=0.005)是导致脓毒症患者死亡的独立危险因素,而MAP(HR=0.969,95%CI:0.949~0.989,P=0.003)和入院第7天EN达标(HR=0.458,95%CI:0.225~0.930,P=0.031)则是保护性因素。结论基于AGI分级标准来指导脓毒症患者的早期EN具有一定的临床适用性。同时,AGI分级越高预示死亡率越高,而EN早期达标则可降低脓毒症患者的死亡率。

重力引导螺旋型鼻肠管空肠置管操作流程及教学歌诀

为了提高鼻肠管床旁定位的有效性和空肠置管的成功率,根据经典文献,结合自己的操作实践,编写了一个重力引导螺旋型鼻肠管空肠置管的操作流程及教学歌决。歌决内容:肠内营养寓胜算,空肠置管莫等闲。方法多样各神通,大力推广路漫长。半坐吞咽进食管,回抽自如识胃腔。右卧轻张过幽门,左卧低阻到空肠。胃内折返何征象?导管反弹最先见,充气受阻“折返征”,染色定位胜影像。真空试验最敏感,酸碱序变特异强,美蓝试验神答问,三法联用共导航。腹部平片金标准,超声时代仍可参。立体影像整体观,更有断层解疑难。此教学歌决以简明扼要、易于记忆的形式,成为临床手把手鼻肠管置管教学的有力工具。