| The First Section: Establishment of a better swine model of acute necrotizing pancreatitisObjective To establish a new acute necrotizing pancreatitis(ANP) swine model for evaluating enteral adminstration therapy.Methods Tai-lake plum-mountain swines were randomized into acute necrotizing pancreatitis group (ANP)(n=4) and control group(C)(n=4). In anaesthetised eight swines were orthophoric inserted a nasojejunal catheter; In acute necrotizing pancreatitis group the pancreatic duct was cannulated and taurocholic acid was infused to induce acute necrotizing pancreatitis. Control group swines were cannulated alone and serviced as controls. Comparing two groups'general state of health; Computed tomography(CT) plain scanning and enhancement scanning were undergone 6 hour after operation; Observing serum amylase activity respectively at 30 minute before operation, 0, 6, 24, 48 and 72 hours after operation. Swines were sacrificed to observe pancreatic and lung pathological finding 72 hours later, Apoptosis cells were observed by the terminal deoxynucleotidyl transferase (TdT)-mediated d-UDP -biotin nick end labeling(TUNEL) method.Result Compared with control group, acute necrotizing pancreatitis group serum amylases were obviously increased (P<0.05). Pancreas volume was tumefacient, parenchyma density was unequal, peripancreatic fluid shadow was seen, and kidney anterior fascia thickened in CT plain scanning. Pancreas was unequally enhanced in dynamic enhanced scanning and many focal low density areas were found. Conclusions It is a simple, noninvasive, repeatability model of enteral nutrition and administration through intestinum in pancreatitis treatment.The Second Section: Experimental studies on the effect of 7.5% sodium chloride on intestinal barrier function and bacterial translocation in a swine model of acute necrotizing pancreatitisObjectives Acute necrotizing pancreatitis(ANP) is associated with gut barrier dysfunction. Hypertonic saline(HS) has attracted attention as a possible therapeutic approach to counteract deleterious immune responses. We hypothesized that HS would reduce severity of pancreatitis-associated intestinal dysfuction and bacterial and endotoxin translocation in ANP swines. Methods Severe acute pancreatitis was induced in swines by the intraductal infusion of 5% sodium taurocholate, and nasojejunal catheter was inserted into the jejunum. Swines were randomly divided into sham-operated group,acute necrotizing pancreatitis group, normal saline treatment group, 7.5% hypertonic saline treatment group; The 0.9% sodium chloride and 7.5% sodium chloride were given through nasojejunal catheter, total volume was 200ml, the speed was 1.5ml per minute. The swines were sacrificed after 72 h, specimens were harvested for bacterial culture with standare techniques. Endotoxin concentration was determined by limulus endotoxin analysis kit. Serum TNF-αand IL-6 concentrations were estimated by ELISA. Blood levels of DAO were measured at various time points. Tumor necrosis factor alpha(TNF-α),interleukin(IL)6 and toll-like receptor (TLR)4 messenger RNA expression level in the tissues of small intestine was assayed by reverse transcription polymerase chain reaction.Results Bowel sounds(BS) were decreased in group ANP, NS, and HS; Rectal temperature in group ANP, NS, and HS were higher than group C, but recovered more quickly in group HS compared with group ANP, NS(P<0.05). Compared with group C, serum amylase activity, serum TNF-α, IL-6 concentration, plasma endotoxin concentration and serum DAO levels were higher in group ANP, NS and HS(P<0.05). Endotoxin levels in group HS were significantly lower than group ANP and NS(P<0.05); Serum TNF-α, IL-6 concentration in group HS were lower than group ANP and NS, but the difference was not statistically significant(P>0.05). The levels of DAO in the ileal tissue homogenate in Group ANP, NS and HS were lower than group C, and the levels in group HS were higher than group ANP and NS(P<0.05); There was no significant BT to blood, peritoneal fluid, MLN, liver, spleen, pancreas and lung in group C, the incidence of translocation in group ANP and NS were respectively 64.3% and 53.6%, the incidence in group HS(35.7%) was lower than group ANP and NS. The samples of ileum taken from group ANP and NS showed that the mucosa demostrated severe atrophy with edema and slough of the villus tips,mucosa thickness and crypt depth were decrease compared with group C. An slight mucosal alteration was observed in group HS. Apoptitic index in group HS was lower than in group ANP and NS(P<0.05). NO relevant TNF-α, IL-6 and TLR4 mRNA were found in the ileum of group C, the expression in group ANP and NS were highly up-regulated, the expression in group HS was lower.Conclusions (1) ANP is associated with intestinal barrier dysfunction and bacterial translocation; (2)The use of 7.5% sodium chloride therapy through jejunum could improve the intestinal barrier function,further to reduce bacterial translocation and endotoxemia; The potential mechanisms of this phenomenon may be related to promote gut motivation, degrade intestinal permeability, down-regulation TLR4 expression and inhibit the excessive inflammatory reaction. |
