Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats

The Use of Newly Synthesized Composite Scaffolds for Bone Regeneration - A Review of Literature

At present, clamping of the portal triad is a widespread surgical procedure in hospitals. Such an operation can prevent pathological changes in the organs. However, the optimal time for clamping remains unclear. To determine the starting time of irreversible morphological changes in the small intestine due to the clamping of the portal triad. The study was carried out on rats (n=94). Animals were randomly subdivided into 4 groups based on the duration of clamping of the portal triad (PT): I control group (CG; without clamping the PT; n=10); II intervention group (6-IG; clamping PT for 6 min; n=28); III intervention group (12-IG; clamping time of the PT for 12 min; n=28); IV intervention group (24-IG; clamping time of the PT for 24 min; n=28). In groups 6- IG, 12-IG, 24-IG, after clamping the portal triad, animals were withdrawn from the experiment after 3 hours, 6 hours, 12 hours, 1 day, 3 days and 7 days. Morphological changes in the small intestine were assessed by measuring the diameter of the lumen of micro-vessels. In addition, the mortality in the groups was analysed as well. In the CG group, the diameter of the arterioles of the small intestine was 34±4 μm, the diameters of pre-capillaries were 15±2μm, the capillaries were 5.4±1 μm, the post-capillaries were 18±2 μm, and the diameter of the lumen of the venues was 40±3 μm. In the 6-IG group (on the 3rd day), the structure of the small intestine showed the recovery signs. By the 7th day, the indicators returned to their original values. In the 12-IG group, the parameters of the small intestine were restored on the seventh day that corresponds to the usual course of the disease. However, in the 24-IG group, changes in these organs persisted until the end of the study. No deaths were reported in the CG and 6-IG animal groups. Mortality among rats of the 12-IG group was 14.3%, while in the 24-IG group with PT clamping for 24 minutes it was 42.8%, respectively. The morphological changes in the microvasculature of the small intestine after 6-minute PT clamping showed a tendency to recover (back to the control parameters). Nevertheless, after 24 minutes of clamping, the changes in the intestinal tissue were irreversible.

The effect of immunonutrition on bacterial translocation after Pringle maneuverer in rats

Introduction

Temporary clamping of the hepatoduodenal ligament (the Pringle manoeuvre) is the most commonly used method to prevent intraoperative blood loss in liver surgery. Some side effects of the Pringle manoeuvre (PM) can occur.

Aim

To investigate the effectiveness of preoperative immunonutritional support to prevent bacterial translocation (BT) in rats due to PM.

Material and methods

Forty Wistar albino rats were randomly divided into four groups. Groups 1 and 2 were fed with normal rat diet and water, and groups 3 and 4 were fed with enteral immunonutrition (Impact Glutamine) containing 1 g/kg/day amino acid in the preoperative period. Group 1 (n = 10) and 4 (n = 10) rats were treated only with laparotomy; group 2 (n = 10) and 3 (n = 10) rats were treated with PM for 30 min with laparotomy. After 30 min, relaparotomy was applied to all groups and portal blood, mesentery, spleen samples were taken for culture purposes.

Results

Proliferation in portal blood cultures was significantly higher in the samples from the normally fed group (group 2) in whom PM was applied, compared to the other groups (p < 0.001). No proliferation was observed in the PM-treated group (group 3), who also received preoperative immunonutritional support.

Conclusions

Preoperative immunonutritional support is effective in the prevention of BT due to PM in rats.

Impact of Functional Hepatic Venous Outflow Obstruction on Perioperative Outcome After Living-Donor Liver Transplant

OBJECTIVES

An optimal initial graft function after living-donor liver transplant depends on optimal graft hemodynamics. Nonmechanical impediments to free hepatic venous outflow, due to elevated central venous pressure, may obstruct the "functional" hepatic venous outflow. Here, we evaluated whether central venous pressure affected early graft function and outcomes in adult living-donor liver transplant recipients.

MATERIALS AND METHODS

This prospective observational study included 61 living-donor liver transplant recipients without technical complications who received transplants from August 2013 to November 2014. Hemodynamic variables were measured preoperatively, at anhepatic phase, 30 minutes postreperfusion, at end of surgery, and during postoperative days 1-5.

RESULTS

Patients with high central venous pressure showed functional hepatic venous outflow obstruction, which caused delayed recovery of graft function. Although postoperative central venous pressure was the only identified independent risk factor for mortality, all 5 deaths in our study group occurred in those who had high central venous pressure at the anhepatic, postreperfusion, end of surgery, and postoperative phases. A postoperative central venous pressure value of ~11 mm Hg was determined to be the cutoff for high-risk mortality, with area under the curve of 0.859 (sensitivity of 80%, specificity of 68%). Increased central venous pressure was associated with increased portal venous pressure (increase of 45%, range, 28%-89%; P = .001). Central venous pressure at end of surgery (r = 0.45, P ≤ .001) and at posttransplant time points (r = 0.29, P = .02) correlated well with portal venous pressure at end of surgery. Other risk factors for early allograft dysfunction were Model for End-Stage Liver Disease and cardiac output posttransplant.

CONCLUSIONS

High central venous pressure, modulating portal venous pressure, can result in functional hepatic venous outflow obstruction, causing delayed graft function recovery and increased risk of mortality. Maintaining a central venous pressure below 11 mm Hg is beneficial.

Mosapride Stabilizes Intestinal Microbiota to Reduce Bacterial Translocation and Endotoxemia in CCl4-Induced Cirrhotic Rats

BACKGROUND

Impaired intestinal motility may lead to the disruption of gut microbiota equilibrium, which in turn facilitates bacterial translocation (BT) and endotoxemia in cirrhosis. We evaluated the influence of mosapride, a prokinetic agent, on BT and DNA fingerprints of gut microbiota in cirrhotic rats.

METHODS

A rat model of cirrhosis was set up via subcutaneous injection of carbon tetrachloride (CCl₄). The portal pressure, liver and intestinal damage, plasma endotoxin, BT, and intestinal transit rate (ITR) of cirrhotic rats were determined. Fecal DNA fingerprints were obtained by ERIC-PCR. The expressions of tight junction proteins were evaluated by western blotting.

RESULTS

Mosapride treatment to cirrhotic rats significantly reduced the plasma endotoxin level and incidence of BT, accompanied by increased ITR. Cirrhotic rats (including those treated with mosapride) suffered from BT exhibited significantly lower ITR than those who are free of BT. Pearson coefficient indicated a significant and negative correlation between the plasma endotoxin level and ITR. The genomic fingerprints of intestinal microbiota from the three groups fell into three distinctive clusters. In the mosapride-treated group, Shannon's index was remarkably increased compared to the model group. Significantly positive correlation was detected between Shannon's index and ITR. Mosapride did not improve hepatic and intestinal damages and ileal expressions of occludin and ZO-1.

CONCLUSIONS

Mosapride significantly increases intestinal motility in cirrhotic rats, thus to recover the disordered intestinal microbiota, finally resulting in decreased plasma endotoxin and BT.

Comparative study of bacterial translocation control with nitric oxide donors and COX2 inhibitor

OBJECTIVE AND DESIGN

To evaluate the beneficial effects of exogenous NO and an inhibitor of the COX2, and their action levels in a model of SIRS/bacterial translocation (BT) induced by Zymosan A(®).

MATERIAL AND METHODS

Ninety Wistar rats were submitted to different treatments, and after 12h and 24h they were anaesthetized in order to collect blood, mesenteric lymph nodes, and kidney for subsequent biochemical analyses and microbiological examinations.

TREATMENTS

A nitric oxide donor, Molsidomine(®), was compared with a COX2 inhibitor, Celecoxib(®).

METHODS

Zymosan A(®) was administered to Wistar rats. The animals were divided into 6 groups: one group for survival study, Group (1) No manipulation (BASAL); Group (2) vehicle of Zymosan A(®) given intraperitoneally (SHAM); Group I (control), with Zymosan A(®) (0.6g/kg) intraperitoneally; Group II (Molsidomine), with Molsidomine(®) (4mg/kg) through the penis dorsal vein, 30min prior to administration of the Zy(®) (0.6g/kg); Group III (Celecoxib), with Celecoxib(®) (400mg/kg) orally through a stomach tube, 6h prior to administration of the Zy (0.6g/kg).

DETERMINATIONS

The parameters survival, bacterial translocation, renal function, neutrophil accumulation, oxygen free radicals (OFR), detoxifying enzymes, and cytokines were measured at different times after Zymosan administration.

RESULTS

The model established induced a mortality rate of 100% and generated BT and systemic inflammatory response syndrome (SIRS) in all samples. It also significantly increased all variables, with p<.001 for MPO and all pro-inflammatory cytokines, and p<.01 for all OFR. Treatment with Molsidomine reduced mortality to 0%, decreased BT, MPO, pro-inflammatory cytokines and OFR (p<.001) significantly and increased IL-10 and IL-6 production. Moreover, the Celecoxib(®) showed a lower capacity for SIRS regulation.

CONCLUSIONS

The exogenous administration of NO prevented BT and controlled SIRS. Therefore these results suggest that Molsidomine could be used as a therapeutic strategy to protect against BT.