Effect of transjugular intrahepatic portosystemic shunt on pulmonary gas exchange in patients with portal hypertension and hepatopulmonary syndrome

AIM: To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on pulmonary gas exchange and to evaluate the use of TIPS for the treatment of hepatopulmonary syndrome (HPS).METHODS: Seven patients, three of them with advanced HPS, in whom detailed pulmonary function tests were performed before and after TIPS placementat the University of Alabama Hospital and at the Hospital Clinic, Barcelona, were considered.RESULTS: TIPS patency was confirmed by hemodynamic evaluation. No changes in arterial blood gases were observed in the overall subset of patients. Transient arterial oxygenation improvement was observed in only one HPS patient, early after TIPS, but this was not sustained 4 mo later.CONCLUSION: TIPS neither improved nor worsened pulmonary gas exchange in patients with portal hypertension. This data does not support the use of TIPS as a specific treatment for HPS. However, it does reinforce the view that TIPS can be safely performed for the treatment of other complications of portal hypertension in patients with HPS.

Gas chromatography/mass spectrometry based metabolomic study in a murine model of irritable bowel syndrome

AIM To study the role of microbial metabolites in the modulation of biochemical and physiological processes in irritable bowel syndrome(IBS).METHODS In the current study, using a metabolomic approach, we analyzed the key metabolites differentially excreted in the feces of control mice and mice with IBS, with or without Clostridium butyricum(C. butyricum) treatment. C57 BL/6 mice were divided into control, IBS, and IBS + C. butyricum groups. In the IBS and IBS + C. butyricum groups, the mice were subjected to water avoidance stress(WAS) for 1 h/d for ten days. Gas chromatography/mass spectrometry(GC-MS) together with multivariate analysis was employed to compare the fecal samples between groups. RESULTS WAS exposure established an appropriate model of IBS in mice, with symptoms of visceral hyperalgesia and diarrhea. The differences in the metabolite profiles between the control group and IBS group significantly changed with the progression of IBS(days 0, 5, 10, and 17). A total of 14 differentially excreted metabolites were identified between the control and IBS groups, and phenylethylamine was a major metabolite induced by stress. In addition, phenylalanine metabolism was found to be the most relevant metabolic pathway. Between the IBS group and IBS + C. butyricum group, 10 differentially excreted metabolites were identified. Among these, pantothenate and coenzyme A(Co A) biosynthesis metabolites, as well as steroid hormone biosynthesis metabolites were identified as significantly relevant metabolic pathways.CONCLUSION The metabolic profile of IBS mice is significantly altered compared to control mice. Supplementation with C. butyricum to IBS mice may provide a considerable benefit by modulating host metabolism.

Hepatic portal venous gas due to cryptosporidiosis in a patient with acquired immunodefi ciency syndrome

Although the presence of hepatic portal venous gas (HPVG) on computed tomography (CT) is typically an ominous finding, HPVG may sometimes be less catastrophic. The clinical significance of HPVG is variable, and it depends primarily on the underlying pathol ogy. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who was found to have HPVG on CT as a presumed result of gastrointestinal cryp tosporidiosis, an association that, to our knowledge, has not been reported. This case illustrates another cause of HPVG that should be considered in patients with AIDS.

Protective effect of Renqing Changjue on acute respiratory distress syndrome in rabbits

OBJECTIVE To investigate whether Renqing Changjue has a protective effect on acute respiratory distress syndrome(ARDS)induced by endotoxin lipopolysaccharide(LPS)in rabbits.METHODS Thirty-six healthy male New Zealand white rabbits were randomly divided into six groups:normal control group,model group,dexamethasone group,Renqing Changjue high,middle and low dose group,with six rabbits in each group.LPS was used to replicate the ARDS model after five consecutive days of gavage.Arterial pressure,respiratory rate and anal temperature blood were recorded for arterial blood gas analysis at 0,0.5,1,2 and 4 h,respectively.At the end of the four-hour experiment,rabbits were killed by bloodletting,and the lung tissue was quickly removed to determine the cytokines,SOD,MDA and pathological examination of rabbit lung.RESULTS Renqing Changjue can significantly reduce the pathological changes of lung in ARDS model group.The expression of AQP1 and MPO in rabbit lung was significantly decreased by immunohistochemistry(P<0.05),reduce the lung wet/dry weight ratio,increase the ratio of PaO_(2)/FiO_(2),inhibit the release of inflammatory factors and scavenge free radicals and antioxidant effects.CONCLUSION Renqing Changjue can effectively protect rabbits with acute respiratory distress syndrome induced by LPS,and may protect the lung by inhibiting the release of cytokines and anti-oxidation.

An Unusual Cause of Hepatic Portal Venous Gas

A 27-years-old female with history of venous thromboembolism secondary to Lupus anticoagulant presented with sudden onset of chest pain and dyspnea. A CT angiogram of the chest showed superior vena caval (SVC) obstruction with anterior chest wall venous collaterals and hepatic portal vein gas (HPVG), which resolved without intervention on a repeated CT-scan of the abdomen. Previously, HPVG was considered to be a dangerous radiologic sign, however with the advancement in imaging technology more benign causes are being identified. This case highlights that this finding alone, if found, does not indicate aggressive management and that clinical correlation should be considered if found.

Identification of Potential Biomarkers for Urine Metabolomics of Polycystic Ovary Syndrome Based on Gas Chromatography-Mass Spectrometry

Background：Polycystic ovary syndrome （PCOS） is a complex endocrine and metabolic disorder, and it＇s diagnosis is difficult. The aim of this study was to investigate the metabolic profiles of PCOS patients by analyzing urine samples and identify useful biomarkers for diagnosis of PCOS.Methods：This study was carried out in the Department of Obstetrics and Gynecology of the Maternal and Child Health Hospital of Hunan Province from December 2014 to July 2016. In this study, the urine samples of 21 women with PCOS and 16 healthy controls were assessed through gas chromatography-mass spectrometry to investigate the urine metabolite characteristics of PCOS and identify useful biomarkers for the diagnosis of this disorder. The Student’s t-test and rank sum test were applied to validate the statistical significance of the between the two groups.Results：In total, 35 urine metabolites were found to be significantly different between the PCOS patients and the controls. In particular, a significant increase in the levels of lactose （10.01 [0,13.99] mmol/mol creatinine vs. 2.35 [0.16, 3.26] mmol/mol creatinine, P = 0.042）, stearic acid （2.35 [1.47, 3.14] mmol/mol creatinine vs. 0.05 [0, 0.14] mmol/mol creatinine, P 〈 0.001）, and palmitic acid （2.13 [1.07, 2.79] mmol/mol creatinine vs. 0 [0, 0] mmol/mol creatinine, P 〈 0.001） and a decrease in the levels of succinic acid （0 [0, 0] mmol/mol creatinine vs. 38.94 [4.16, 51.30] mmol/mol creatinine, P 〈 0.001） were found in the PCOS patients compared with the controls. It was possible to cluster the PCOS patients and the healthy controls into two distinct regions based on a principal component analysis model. Of the differentially expressed metabolites, four compounds, including stearic acid, palmitic acid, benzoylglycine, and threonine, were selected as potential biomarkers.Conclusions：This study offers new insight into the pathogenesis of PCOS, and the discriminating urine metabolites may provide a prospect for the diagnosis of PCOS.

Effect of Enteral Nutrition Formula on Fat Absorption and Serum Free Fatty Acid Profiles in Rat with Short-Bowel Syndrome

The effects of enteral nutrition containing long chain triglycerides （LCT） and medium chain triglycerides （MCT） or L-arginine （Arg） on fat absorbability, serum free fatty acid profiles and intestinal morphology in rats with short-bowel syndrome （SBS） were studied using gas chromatography. Twenty-eight Sprague-Dawley rats were randomly assigned to 4 groups： sham operation fed with LCT as control; 85% small bowel resection fed with LCT, MCT/LCT, and Arg/LCT, respectively. SBS rats showed a decrease of fat absorptivity. Enteral nutrition supplemented with MCT could increase fat absorptivity. L-Arginine enhanced enteral nutrition was associated with the elevation of fat absorptivity, possibly due to its enterotrophic effect on remnant small bowel mucosa. LCT group showed a significant deficiency of total free fatty acid and the decreased essential fatty acid content, which was improved in other two SBS groups.

Early stage nonclinical pulmonary disorder in COVID-19 may present asymptomatic and fuel the contagion

Evidence shows that pulmonary problems in coronavirus disease 2019(COVID-19)may set off from vascular injury that progresses to physiological disturbances through a compromised gas exchange,following an infection with the severe acute respiratory syndrome coronavirus 2.In this process,inefficient gas exchange in the alveolar could precipitate silent nonclinical hypoxemia.Unfortunately,patients with“silent hypoxemia”do not necessarily experience any breathing difficulty(dyspnea)at the early stage of COVID-19 while the disease progresses.As a result,several asymptomatic,presymptomatic and patients with mild symptoms may escape quarantine measure and thus continue to spread the virus through contacts.Therefore,early diagnosis of“silent hypoxemia“,which attracts no clinical warnings,could be an important diagnostic measure to prevent acute respiratory distress syndrome from the risk of pulmonary failure among the presymptomatic and as a screening tool in the asymptomatic who are hitherto potential spreaders of the virus.

Case Series of 10 Drug-Refractory IBS Patients Who Respond to Oral Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI)

Aim: The responses of 10 patients with long-standing, symptomatic, intractable drug-refractory histories of irritable bowel syndrome with diarrhea (IBS-D) and with abdominal pain, gas/bloating and distention, termed IBS undefined (IBS-U), were evaluated when administering a medical food product containing serum-derived bovine immunoglobulin/protein isolate (SBI). Methods: Patients in this case series were chosen based on their lack of satisfactory response to a variety of drugs, including antidiarrheal and antispasmodic medications, serotonin 5-HT3 receptor antagonists, selective serotonin re-uptake inhibitors (SSRIs), proton pump inhibitors (PPIs), antibiotics, and antidepressive drugs. Patients met Rome III criteria and were administered 5 g/day of SBI as standard-of-care nutritional support. A scale of 0% - 25%, 25% - 50%, 50% - 75%, 75% - 100% response to SBI was used for patient-reported improvement in overall IBS symptoms following administration for one month. Exact methods for calculating confidence intervals and p-values were used to assess complete management of symptoms and response to therapy. Adverse events were also monitored for this nutritional product. Results: The onset of gastrointestinal (GI) symptom reduction utilizing nutritional management with SBI occurred within an average time of 2-4 weeks with improved or near complete management in all 10 patients who were refractory to previous drug therapies by 4 weeks. When prompted, patients reported significant IBS symptom improvement which averaged between 50% - 100% (p = 0.002) with an average for complete management in all patients of 69%. No side effects were reported after SBI administration even when taken for up to 28 weeks. Conclusion: Based on the safety profile and reported outcomes in this case report, SBI should be considered as a nutritional option for management in IBS-D and IBS-U.

肠易激综合征患者肠道气体与肠道运动关系的研究

目的 通过X线腹部平片对肠道气体进行定量分析,吞服不透X线标志物法观察肠道运动,探讨肠道动力在肠易激综合征(IBS)患者肠道气体产生中的作用.方法 根据罗马川诊断标准选取IBS患者45例(便秘型24例和腹泻型21例),正常对照组22例,在空腹状态下吞服不透X线的标志物,48 h后摄立位X线腹部平片,扫描进入计算机,用图像处理软件选取腹部平片上肠道气体范围,并计算出肠道气体在规定范围内所占的百分比(GVS,Gas Volume Score),同时观察肠道内标志物残留个数.结果 便秘型IBS患者的GVS(0.078±0.040)明显大于腹泻型IBS患者(0.052±0.027,P<0.01)及正常对照组(0.051±0.045,P<0.05),而腹泻型IBS患者的GVS与正常对照组相比无差异.便秘型IBS患者GVS与肠道内标志物残留数呈正相关(r=0 706,P<0.05).结论 便秘型IBS患者肠道气体增多,且GVS与肠道内标志物残留数呈正相关,提示肠道动力障碍可能在便秘型IBS肠道气体的产生中起一定作用.

Promising gas therapies for severe COVID-19

The novel coronavirus disease 2019(COVID-19)pandemic is a worldwide catastrophe,thoroughly challenging the healthcare systems.A growing number of victims suffer from a remarkable acute respiratory distress syndrome(ARDS)that necessitates admission to the intensive care unit(ICU),but there are no satisfactory treatments.Various gas therapies including nitric oxide,ozone,hyperbaric oxygen,hydrogen,and heliox have been employed in the fight against the pandemic and have improved clinical outcomes.However,the potential roles of these gases in COVID-19 treatment need to be verified in well-designed randomized controlled trials.This paper reviews advances in gaseous therapy of COVID-19.