Plasma D-lactic Acid Research Articles

Dietary resveratrol supplementation on growth performance, immune function and intestinal barrier function in broilers challenged with lipopolysaccharide

This study discusses the effects of resveratrol (RES) on the productive performance, immune function and intestinal barrier function of broiler chickens challenged with lipopolysaccharide (LPS). Two hundred and forty 1-day-old male Arbor Acres broilers were randomly divided into 4 groups of 6 replicates each, with 10 broilers per replicate. This experiment used a 2×2 factorial design with dietary factors (basal diets or basal diets supplemented with 400 mg/kg RES were administered from d 1 to 21) and stress factors (intraperitoneal injection of 0.5 mg/kg BW of saline or LPS at 16, 18 and 20 d of age). The results showed that LPS challenge had a significant adverse effect on average daily gain (ADG) in broilers at 16 to 21 d of age (P < 0.05), whereas the addition of RES to the diet inhibited the LPS-induced decrease in ADG (P < 0.05). RES also alleviated LPS-induced immune function damage in broilers, which was manifested by the decrease of spleen index (P < 0.05) and the recovery of serum immunoglobulin M and ileal secretory immunoglobulin A content (P < 0.05). The LPS challenge also disrupts intestinal barrier function and inflammation, and RES mitigates these adverse effects in different ways. RES attenuated LPS-induced reduction of villus height in the jejunum and ileum of broilers (P < 0.05). LPS also caused an abnormal increase in plasma D-lactic acid levels in broilers (P < 0.05), which was effectively mitigated by RES (P < 0.05). LPS challenge resulted in a significant decrease in mRNA expression of occludin in the intestinal mucosa (P < 0.05), which was mitigated by the addition of RES (P < 0.05). RES significantly decreased the mRNA expression of toll-like receptor 4, nuclear factor kappa-B and tumor necrosis factor alpha in the ileum tissue stimulated by LPS (P < 0.05). Taken together, this study shows that RES exerts its beneficial effect on broilers challenged with LPS by alleviating immune function damage, relieving intestinal inflammation and barrier damage, and thus improving growth performance.

Supplemental bifid triple viable capsule treatment improves inflammatory response and T cell frequency in ulcerative colitis patients

BackgroundUlcerative colitis is a common non-specific chronic disease. Supplementing probiotics has become an important method for the treatment of ulcerative colitis. This study aimed to explore the effect of supplementing bifid triple viable capsules on background mesalazine plus somatostatin on plasma inflammatory factors and T cell frequency in ulcerative colitis patients.MethodsA total of 130 ulcerative colitis patients admitted to our hospital from August 2018 to March 2020 were included and divided into the experimental group (65 patients with mesalazine plus somatostatin and bifid triple viable capsules for treatment) and the control group (65 patients treated with mesalazine plus somatostatin) using the random number table method. Bifid triple viable bacteria capsules were given orally, 420 mg each time, with 3 times a day for 2 months.ResultsBefore treatment, the plasma levels of IL-6, IL-8, hs-CRP, TNF-α, D-lactic acid, and endotoxin (ET), CD4+, CD8+, CD4/CD8 ratio, diamine oxidase (DA0), emotional ability, social ability, intestinal and systemic symptoms were not significantly different between the two groups (all P > 0.05). After treatment, the plasma levels of IL-6, IL-8, hs-CRP, and TNF-α decreased in both groups, and were lower in the experimental group than those in the control group (all P < 0.05). The levels of CD4+ and CD4/CD8 ratio increased, and were higher in the experimental group than those in the control group (P < 0.05); the CD8+ levels were reduced, and were lower in the experimental group than those in the control group (P < 0.05). The plasma D-lactic acid, ET, and DA0 levels were decreased, and were lower in the experimental group than those in the control group; emotional ability, social ability, intestinal and systemic symptoms were improved, and were higher in the experimental group than those in the control group (all P < 0.05). During the course of treatment, 2 cases of abdominal discomfort and 1 case of rash occurred in the experimental group, with an adverse event rate of 4.62% (3/65); 3 cases of abdominal discomfort and 2 cases of rash occurred in the control group, with an adverse event rate of 7.69% (5/65).ConclusionThe supplementary treatment of bifid triple viable capsules can effectively enhance the curative effect in ulcerative colitis patients, reduce plasma inflammatory factors, and regulate T cell frequency, which is worthy of clinical application.

The combined impact of xylo-oligosaccharides and gamma-irradiated Astragalus polysaccharides on growth performance and intestinal mucosal barrier function of broilers

This study was conducted to investigate the individual and combined effects of xylo-oligosaccharides (XOS) and gamma-irradiated Astragalus polysaccharides (IAPS) on the growth performance and intestinal mucosal barrier function of broiler chickens. A total of 240 1-day-old Ross-308 chicks were allocated into 5 groups for 21 d: control group (basal diet), antibiotic growth promoter (AGP) group (basal diet supplemented with 50 mg/kg chlortetracycline), XOS group (basal diet supplemented with 100 mg/kg XOS), IAPS group (basal diet supplemented with 600 mg/kg IAPS), and XOS + IAPS group (basal diet supplemented with 100 mg/kg XOS and 600 mg/kg IAPS). The results showed that birds in the XOS + IAPS group showed higher ADG and lower feed-to-gain ratio than those in the control group (P < 0.05). The XOS, IAPS, and XOS + IASP treatments significantly increased villus height (VH) of all intestine segments, jejunal goblet cell numbers, and VH–to–crypt depth ratio (VH/CD) of broilers than those of the control group (P < 0.05). Birds in the XOS + IAPS group had higher jejunal VH/CD ratio and goblet cell numbers than those from the XOS or IAPS groups (P < 0.05). In addition, there was a synergy effect between XOS and IAPS on increasing duodenal goblet cell numbers and improving ileal morphology (higher VH and VH/CD ratio) (P < 0.05). The XOS, IAPS and XOS + IAPS treatments increased the mRNA expression of zonula occludens-1 and occludin of the jejunum as compared with the control group (P < 0.05). Simultaneously, birds in the XOS + IAPS group showed lower plasma D-lactic acid concentration and higher mRNA expression of claudin-1, claudin-3, and occludin in the jejunum than those in the control or IAPS groups (P < 0.05). Moreover, there was no significant difference in growth performance, intestinal morphology, and intestinal barrier function of broilers between the AGP and XOS + IAPS groups. In conclusion, the combination of XOS and IAPS had a better potential as chlortetracycline substitute for improving the growth performance, intestinal morphology, and intestinal barrier function of broilers.

Role of high mobility group box 1 in intestinal mucosal barrier injury in rat with sepsis induced by endotoxin

To investigate the role and mechanism of the high mobility group box 1 (HMGB1) in intestinal mucosal barrier injury in rat with sepsis induced by endotoxin lipopolysaccharide (LPS). The rats were given intraperitoneal injection of LPS to reproduce a model of sepsis. The effect of HMGB1 inhibitor EP solution (40 mg/kg) on sepsis was observed, and phosphate buffer (PBS) control group was set up. Seventy-two hours after modeling, abdominal aortic blood was obtained, and enzyme-linked immunosorbent assay (ELISA) was used to measure the plasma levels of D-lactic acid and diamine oxidase (DAO) of mucosal barrier permeability. The pathological changes of the intestinal mucosal were observed with light microscope and the Chiu score was recorded. The intestinal mucosal ultrastructural changes were observed with electron microscopy. Real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and Western Blot were used to measure the mRNA and protein expressions of Occludin, inflammatory factor HMGB1 and its downstream signal molecule nuclear transcription factor-κB p65 (NF-κB p65) in the rat small intestine. The results of histopathology and ultrastructure of the small intestine showed that in the LPS group, the intestinal mucosa tissue swelled obviously, part of the glands were incomplete, the infiltration of neutrophils increased, themicrovillus cells were absent, arranged indisorder, and the number of tight connections significantly reduced compared with the PBS control group. The levels of D-lactic acid and DAO indicating mucosal barrier permeability, the levels of inflammatory factor HMGB1 and its downstream signaling molecule NF-κB p65 mRNA and protein expressions in the LPS group were significantly higher than those in the PBS control group, and the mRNA and protein expression of Occludin in the small intestine was significantly lower than that in the PBS control group, suggesting that the intestinal mucosal barrier function in septic rats was damaged, permeability increased, and the structure was damaged. After the administration of the HMGB1 inhibitor EP, the intestinal mucosal barrier damage was significantly improved. The performance was as follows: the Chiu score of the small intestine tissue and the plasma D-lactic acid and DAO levels in the EP intervene group were significantly lower than those in the LPS group [Chiu score: 1.60±0.48 vs. 3.40±0.48, D-lactic acid (mmol/L): 3.30±0.22 vs. 5.30±0.16, DAO (U/L): 23.66±0.97 vs. 30.47±1.11, all P < 0.05]. Occludin mRNA and protein expression levels were significantly higher than those in the LPS group [Occludin mRNA (2-ΔΔCt): 0.82±0.05 vs. 0.37±0.08, Occludin protein (Occludin/β-actin): 1.04±0.09 vs. 0.75±0.11, both P < 0.05], while the mRNA and protein expression levels of HMGB1 and NF-κB p65 were significantly lower than those in the LPS group [HMGB1 mRNA (2-ΔΔCt): 1.63±0.10 vs. 3.57±0.10, HMGB1 protein (HMGB1/β-actin): 1.40±0.07 vs. 1.87±0.07; NF-κB p65 mRNA (2-ΔΔCt): 1.47±0.09 vs. 2.62±0.13, NF-ΚB p65 protein (NF-κB p65/β-actin): 1.24±0.14 vs. 1.60±0.13, all P < 0.05]. Intestinal mucosal barrier function of septic rats was damaged, permeability increased, and structure was damaged. The mechanism may be that the expression of inflammatory factor HMGB1 was up-regulated and promoted the activation of its downstream signaling molecule NF-κB, thereby mediated the inflammatory cascade reaction and caused damage to the intestinal mucosa.

Clinical roles of plasma D-lactate, endotoxin and diamineoxidase in assessment of intestinal mucosal barrier function post traumatic brain injury

Objective To investigate the roles of plasma D-lactate, endotoxin and diamineoxidase (DAO) in assessment of intestinal mucosal barrier function post traumatic brain injury (TBI). Methods We retrospectively studied 70 patients with TBI (TBI group) admitted to Department of Neurosurgery, the 904th Hospital of the Joint Service of Chinese People′s Liberation Army from January 2017 to August 2018, and 45 healthy subjects were enrolled as well (healthy control group) at the physical examination center during the same period. All TBI patients were treated conservatively or surgically. Peripheral blood of patients and healthy subjects were collected to detect levels of plasma D-lactic acid, endotoxin, and DAO. Further use of Spearman correlation analysis was conducted to determine the correlation between preoperative serum D-lactic acid, endotoxin and DAO and Glasgow Coma Scale (GCS) in patients with TBI. Results Compared with the healthy control group, the levels of D-lactic acid (24.7±9.4 mg/L vs. 9.8±4.0 mg/L), endotoxin (9.1±5.8 U/L vs. 4.0±2.2 U/L) and DAO (36.3±22.6 U/L vs. 15.2±3.6 U/L) were significantly increased (t=9.82, 2.84 and 3.49, respectively, all P<0.05). Further correlation analysis showed that serum D-lactic acid, endotoxin and DAO levels were negatively correlated with preoperative GCS scores (r=-0.543, -0.617 and -0.672, respectively, all P<0.01). Conclusion The preliminary results have suggested that the levels of D-lactic acid, bacterial endotoxin and DAO in the serum could be used as important indexes in evaluation of the intestinal mucosal barrier function in patients post TBI. Key words: Traumatic brain injury; Diamineoxidase; D-lactate; Endotoxin; Intestinal mucosa barrier

Relationship between anesthetic factor and intestinal injury in patients undergoing cardiac surgery with cardiopulmonary bypass: a comparison of propofol- versus sevoflurane-based anesthesia

Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 18-64 yr, with New York Heart Association grade Ⅱ or Ⅲ, undergoing elective cardiac surgery with CPB, were divided into 2 groups(n=45 each) using a random number table: propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S). CPB was established routinely after anesthesia induction.Before induction (T0), immediately after aortic unclamping (T1), at 30 min after aortic unclamping (T2) and at 2 h after discontinuation of CPB (T3), blood samples were collected from the radial artery for determination of the plasma endotoxin, D-lactic acid, diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP) concentrations (by enzyme-linked immunosorbent assay) and plasma interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) concentrations (using radio-immunity method). Results Compared with the baseline at T0, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly increased at T1-T3 in both groups (P<0.05). Compared with group P, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly decreased at T1-T3 in group S(P<0.05). Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia, sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB. Key words: Anesthesia, general; Propofol; Cardiopulmonary bypass; Intestinal mucosa; Wounds and injuries; Sevoflurane

Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non-Heart-Beating Animal Model.

The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d-lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO2 were maintained over 60 and 267 mmHg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups (P > 0.05), the levels of intestinal mucosa TJ protein decreased (P < 0.05), and plasma d-lactic acid increased progressively (P < 0.05). With the extension of extracorporeal support, the degree of intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury.

Effects of lactadherin on plasma D-lactic acid and small intestinal MUC2 and claudin-1 expression levels in rats with rotavirus-induced diarrhea.

The aim of the present study was to investigate the effects of lactadherin on plasma D-lactic acid and small intestinal mucin (MUC) 2 and claudin-1 expression levels in rats with diarrhea induced by rotavirus (RV) infection. A total of 75 seven-day-old healthy Sprague-Dawley rats were randomly divided into the following five groups: Control (C), RV infection (RVI), lactadherin before rotavirus infection (LBRI), lactadherin after rotavirus infection (LARI), and blank (B). On day 4 of artificial feeding, the rats in groups RVI, LBRI and LARI were intragastric administered 1×106 PFU RV; whereas the rats in groups C and B were intragastrically administered an equal volume of maintenance solution from the RV supernatant and normal saline, respectively. In the LBRI and LARI groups, rats received daily intragastric administration of 0.25 mg lactadherin for three days prior to and following infection with RV, respectively. The course of diarrheal symptoms was observed in each group and samples were collected on days 1, 4, and 7 post-infection in order to determine the mucosal morphology, plasma D-lactic acid levels and the expression levels of MUC2 and the intracellular junction protein, claudin-1, in the small intestine. On day 4 post-infection, the rats in group RVI demonstrated severely damaged small intestines and typical diarrheal characteristics, as detected by light microscopy; whereas rats in groups LBRI and LARI demonstrated intact small intestinal villi with partial vacuolation of epithelial cells and changes in the position of their nuclei. Electron microscopy demonstrated that the rats in the RVI group had sparse, shortened, disordered intestinal microvilli and widened intercellular junctions; whereas those in groups LBRI and LARI had long intestinal microvilli sparser compared with groups B and C and slightly widened intercellular junctions. Plasma D-lactic acid levels were increased in groups RVI, LBRI and LARI, as compared with groups B and C, and the greatest levels were detected in the RVI group on days 1, 4 and 7 post-infection. In addition to maintaining intestinal permeability, lactadherin enhanced the expression levels of MUC2 and reduced the expression of claudin-1; therefore, further protecting the intestinal epithelial barrier, which may contribute to the prevention and treatment of diarrhea induced by infection with RV.

Impact of different pneumoperitioneal pressure on pathomorphism and function of intestines following laparoscopic radical gastrectomy

To investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy (LG). Forty-eight gastric cancer patients were prospectively enrolled in the study. Among them, 36 patients scheduled for elective LG were randomly assigned to low pressure group (LP), middle pressure (MP), and high pressure group (HP) with 12 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP, 11-13 mmhg in MP, and 14-16 mmhg in HP. The control group was open gastrectomy group (OG) in 12 cases. The intestinal pathomorphism and level of plasma D-lactic acid before, during and after operation, and postoperative intestinal function of four groups were examined and compared. There were no statistical differences in preoperative data among the four groups(all P>0.05). LG group was associated with a lower rate of surgical complications than OG (8.3% vs. 41.7%, P<0.05). No obvious damage of intestinal mucosa was found in OG group. Damage degree of intestinal mucosa after operation in LP, MP and HP groups was 0-1, 1-2, and 2-3 respectively. There was significant change in intestinal pathomorphism after operation in both HP and MP groups. The levels of D-lactic acid before operation were not significantly different among all the four groups, but increased significantly in each group after operation (all P<0.05). HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return (4.5 d), time to first flatus (5.4 d), and intake (6.0 d) as compared to the other 3 groups (all P<0.05). Laparoscopic radical gastrectomy is safe and minimally invasive. Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function. Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation.

Clinical research on intestinal bacteria shift and intestinal barrier of pediatric intestinal surgery

Objective To investigate the clinical correlation of intestinal bacterial translocation(BT) and in-testinal barrier of pediatric intestinal surgery,and to observe the relationship between BT and postoperative infection.Methods The plasma D-lactic acid,LPS level of 61 children with intestinal surgery in our hospital were detected before and after surgery.Polymerase chain reaction (PCR) was used to test blood bacterial DNA,in order to judge whether there is BT.Results The PCR results of preoperative children were negative,the PCR positive for 3 cases.According to the PCR results,postoperative systemic inflammatory response syndrome(SIRS) and complications of infection of PCR positive group were obviously higher than those of PCR negative group(P ＜ 0.01).And plasma D-lactic acid,LPS inspection of PCR positive group were obviously higher than PCR negative group(P ＜ 0.01).Conclusion Intestinal barrier damage has close relationship with BT in children after intestinal surgery,SIRS and infection complications also has a direct relationship with BT. Key words: Digestive system surgical procedures; Bacterial translocation; Gastrointestinal tract

The effects of natural and modified clinoptilolite on intestinal barrier function and immune response to LPS in broiler chickens

The protection of intestinal barrier function and the anti-inflammatory effects of natural clinoptilolite (NCLI) and modified clinoptilolite (MCLI) were investigated in broilers that were repeatedly challenged with lipopolysaccharide (LPS). A total of 288 1-d-old broiler chicks were divided equally into three treatment groups: control, NCLI-treated (2%) and MCLI-treated (2%). Half of the birds from each treatment group were challenged with 0.9% NaCl solution or LPS (250μg/kg body weight, administered orally) at 16, 18 and 21d of age. The results indicated that, prior to LPS challenge, the diet had no effect on bird growth performance (P>0.05). The oral administration of LPS was also not associated with any significant changes in poultry performance (P>0.05). In LPS-challenged birds that were pretreated with NCLI (2%) or MCLI (2%), the LPS-induced increases in the plasma and intestinal mucosa concentrations of TNF-α, IL-1β, IL-2, IL-6, IL-4 and IL-10 were dramatically attenuated. Additionally, significant decreases in the plasma d-lactic acid and diamine oxidase (DAO) levels were found in birds that were pretreated with NCLI or MCLI. Furthermore, both NCLI and MCLI reduced the sICAM-1 concentration in the intestinal mucosa. In conclusion, NCLI and MCLI are able to prevent the LPS-induced intestinal mucosa damage and inflammatory response in vivo. These beneficial effects suggest that NCLI and MCLI act as anti-inflammatory agents in part by inhibiting neutrophil infiltration and hyperactivation and by suppressing the secretion of various plasma and intestinal mucosa inflammatory mediators.

Effects of the Chinese medicine matrine on experimental C. parvum infection in BALB/c mice and MDBK cells

To date, there are no effective methods of treating Cryptosporidium infection in animals or humans. Matrine, a main active alkaloid extract from Sophora flavescens, has potential antineoplastic, antifibrotic, anti-inflammatory, and antitumor activities. However, the treating effects of matrine on Cryptosporidium infection as well as its mechanisms of action are largely unknown. The present study investigated the effects of matrine on Cryptosporidium parvum infection in both in vitro and in vivo models. Oocyst excretion, plasma D-lactic acid concentrations, and bacterial translocation rates were assayed to evaluate the efficacy of treatment in experimentally infected BALB/c mice. Matrine effects on parasite replication and lactate dehydrogenase (LDH) activity were assessed in cell cultures. The results showed that matrine could significantly reduce the number of C. parvum oocysts by 54-63%, and the number of C. parvum-infected cells by 28-58%. Plasma D-lactic acid concentrations and LDH activity in the matrine-treated groups were lower than the infected group (P < 0.05) and higher than the control (P < 0.05). The bacterial translocation rates in groups treated with matrine at high doses were lower than the infected group (P < 0.05) and not higher than the control (P > 0.05). These results clearly demonstrate that matrine can inhibit C. parvum infection. Integrity of cell membranes and of the mucosal barrier is improved in treated animals as compared to untreated infected controls. Thus, it is concluded that matrine has a potential in therapeutic applications against C. parvum infection.

Increased plasma d-lactic acid associated with impaired memory in rats

d-Lactic acidosis is associated with memory impairment in humans. Recent research indicates that d-lactic acid may inhibit the supply of energy from astrocytes to neurons involved with memory formation. However, little is known about the effects of increased hind-gut fermentation due to changes in diet on circulating lactic acid concentrations and memory. Thirty-six male Wistar rats were fed three dietary treatments: a commercial rat and mouse chow, a soluble carbohydrate based diet or a fermentable carbohydrate based diet. The parameters estimating memory were examined by employing the object recognition test. Physical parameters of fermentation including hind-gut and plasma lactic acid concentrations were examined after sacrifice, either 3 or 21h after feeding. Increased fermentation in the hind-gut of rats, indicated by lower caecum pH, was associated with increased plasma l-lactic acid (r=-0.41, p=0.020) and d-lactic acid (r=-0.33, p=0.087). Memory, being able to discriminate between a familiar and a novel object during the object recognition test, was reduced with increasing plasma d-lactic acid (r=-0.51, p=0.021). Memory impairment was associated with alterations in plasma d-lactic acid following the fermentation of carbohydrate in the hind-gut. Further work is still required to determine whether these effects are mediated centrally or via direct connections through the enteric nervous system.

The protective effects of intra-peritoneal fluid resuscitation on small intestinal mucosa in rats with hemorrhagic shock

Objective To investigate the protective effects of intra-peritoneal fluid resuscitation on small intestinal mucosa in rats with hemorrhagic shock. Method Fifty Sprague-Dawley (SD) rats were randomly (random number) divided into five groups, namely sham operation group (group I ), hemorrhagic shock group (group Ⅱ ), intra-venous fluid resuscitation group (group Ⅲ ) . intravenous fluid resuscitation plus intra-peritoneal saline resuscitation (group Ⅳ ) and intravenous fluid resuscitation plus intra-peritoneal PD-2 solution resuscitation group (group Ⅴ ). The rats of 5 groups were processed with cannulations of right common carotid artery, right femoral vein and left femoral artery with systemic heparinization. The rat models of hemorrhagic shock were established with modified Wigger' s method by which the blood exsanguinated from left femoral artery. The rats of group Ⅲ were resuscitated with shed blood plus twice equal volume of Ringer's solution after modeling of hemorrhagic shock.The rats of group Ⅳ and group Ⅴ were administered intra-peritoneally with 30 mL saline and 30 mL of 2.5% PD-2 solution, respectively as adjuncts to those used in the group Ⅲ . The specimens of blood and small intestine of rats of all groups were collected 60-120 minutes after modeling and resuscitation. The activity of plasma diamine oxidase (DAO) was determined with chromatometry, the level of plasma D-lactic acid (D-LA) with spectorophotometry and the level of plasma lipopolysaccharide (LPS) with nephelometry. The histopathological and ultrastructure changes of small intestine tissue of rats were observed under light microscope and electronic microscope. Results There were remarkable differences in activity of DAO, and the levels of D-LA and IPS in rats between those ingroup Ⅱ and group I (P <0.01), and between those in group V and groups Ⅱ , Ⅲ or Ⅳ (P <0.05 or P < 0.01) The pathomorphology and ultra-structure of small intestine tissues were severely damaged in group Ⅱ compared with those in group Ⅰ , and those markedly lessened in group V compared with groups Ⅱ , Ⅲ and Ⅳ . Conclusions Intraperitoneal fluid resuscitation with PD-2 solution can significantly protect the integrity of intestinal mucosa and the normal permeability of intestinal wall, and blunts the histopathological changes, and restrains bacterial translocation from gut and reduces the level of plasma endotoxin. Key words: Hemorrhagic shock; intestinal mucosa intraperitoneal resuscitation; bacterial translocation; multiple organ dysfunction syndrome; diamine oxidase; D-lactic acid; Lipopolysaccharide

Acidose d-lactique chez un enfant présentant un syndrome de grêle court

d-lactic acidosis is a rare and severe complication of short bowel syndrome in children that may result from important ileal bacterial overgrowth by lactobacilli. Intestinal flora (Lactobacilli) is responsible for the production of d-lactic acid after fermentation of food carbohydrates. We report on the case of a 6-year-old child with a short bowel syndrome treated with both home enteral and parenteral nutrition. The patient suddenly presented with acute neurological symptoms including dysarthria and disorientation. Biological analysis revealed metabolic acidosis, increased plasma d-lactic acid assessed by organic acid chromatography analysis and a very important increase in expired hydrogen during glucose breath test. Lactobacillus fermentum (known to produce d and L isomers of lactic acid) was isolated in the gastric liquid and rectal swabs. Clinical and biological evolution was rapidly favourable after treatment with intravenous sodium bicarbonate, antibiotic therapy and interruption of enteral nutrition. d-lactic acidosis should be suspected when neurological symptoms occur in a child with short bowel syndrome. They can be prevented by treating intestinal bacterial overgrowth.

Serial Transverse Enteroplasty for Management of Refractory d‐Lactic Acidosis in Short‐bowel Syndrome

Short-bowel syndrome (SBS) is a relatively common disease of insufficient small-bowel absorptive capacity with an estimated 5-year mortality rate of 37.5%, mostly because of sepsis and liver failure associated with central venous access and parenteral nutrition (1,2). Manifestations of SBS include growth retardation, malnutrition, diarrhea and frequent infection. Sources of infection include central venous access and bacterial overgrowth within chronically dilated bowel. One complication of bacterial overgrowth is d-lactic acidosis, a syndrome of neurological disturbances and acidemia first described in 1979 (3). Patients present with recurrent, often escalating episodes of neurological derangement associated with acidosis, widened anion gap and elevated levels of plasma d-lactic acid. d-Lactic acid, the product of anaerobic carbohydrate metabolism by resident intestinal bacteria, is believed to cause acidosis because it is metabolized much more slowly than l-lactic acid and therefore accumulates if produced in abundance. In the case of SBS, decreased absorption of enteral carbohydrates and bacterial overgrowth are thought to lead to increased bacterial production of lactic acid. The responsible bacteria may colonize the remnant small or large intestine as a result of stasis and dysmotility within chronically dilated bowel or administration of probiotic medications such as the gram-positive anaerobic rod Lactobacillus acidophilus (4,5). Traditional treatment of this disease consists of altering the intestinal flora with antibiotics and minimizing the metabolic substrate by using a low-carbohydrate diet (6). Unfortunately, these therapies are not always successful, and refractory cases are a difficult management problem in this chronically ill patient population. Serial transverse enteroplasty (STEP), which involves sequential linear stapling of the dilated bowel from opposite directions to create a new “zig-zag” lengthened and tapered intestinal channel, has gained acceptance in the treatment of patients with SBS since its introduction in 2003 (7–12). In addition, a recent animal study has shown that the STEP procedure reduces bacterial overgrowth in SBS (13). A potential advantage of the STEP operation compared with conventional tapering is its ability to narrow dilated bowel while preserving small-bowel mucosal mass. Thus, the STEP procedure could be a useful therapy for treatment of SBS patients with refractory d-lactic acidosis. We describe here the case of a patient with SBS who had been relatively well until she developed recurrent episodes of d-lactic acidosis. After failure of medical management, she was successfully treated with the STEP procedure to provide tapering of a massively dilated segment of duodenum that was felt to be a reservoir for d-lactic acid producing bacterial flora.

Plasma D-Lactic Acid Level: A Useful Marker to Distinguish Perforated From Acute Simple Appendicitis

Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis) before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 +/- 0.687 mg/dL) than patients in the control group (0.478 +/- 0.149 mg/dL) and patients with acute appendicitis (1.409 +/- 0.324 mg/dL; p < 0.05). For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.

Carrier-mediated blood-brain barrier transport of short-chain monocarboxylic organic acids

Carrier-mediated blood-brain barrier transport of short-chain monocarboxylic organic acids