Upload
a-sufit
View
216
Download
3
Embed Size (px)
Citation preview
Critical Care II 113
Methods: Twenty-four Swiss male mice were randomlydivided into 3 groups: Sham, IO (intestinal obstruction)and CIT. The CIT group received 30 mg/day of citrullineadded to the chow and the other groups ate conventionalchow. Both diets were isocaloric and isoproteic. After7 days, the groups were gavaged with 108 CFU/mL ofE. coli labeled with technetium 99m (99mTc-E. coli).Ninety minutes later, the animals were anesthetizedand underwent terminal ileum ligation. The Sham groupunderwent only laparotomy. After 18 hours, blood andorgans (mesenteric lymph nodes, liver, spleen andlungs) were removed for radioactivity determination. Theintestinal fluid and serum were also collected to assesssecretory IgA and cytokines by ELISA. We used Kruskal-Wallis ANOVA for bacterial translocation data analysis andone-way ANOVA for cytokines and sIgA data. Statisticalsignificance was set at p� 0.05.Results: Bacterial translocation was significantly higherin IO group than control and treated groups (p < 0.05).CIT and Sham animals demonstrated the same levelsof bacterial translocation to mesenteric lymph nodes,spleen and lungs (p > 0.05). SIgA levels were raised inCIT group (2414.78±828.24 mg/mL), when compared withSham (921.50±182.06) and IO groups (876.62±136.49)(p < 0.05). IO group presented the highest serum lev-els of IFN-g (56.86±13.03 pg/mL), considering Sham(17.08±1.92) and CIT groups (21.36±8.03)(p < 0.05). Thelevels of IL-10 did not differ between IO, CIT andSham groups (69.44±11.17; 87.30±13.42 and 71.93±2.28pg/mL) (p > 0.05).Conclusion: Citrulline might protect against bacterialtranslocation by increasing intestinal sIgA and decreasingthe levels of pro-inflammatory cytokine (IFN-g).
Disclosure of Interest: None declared
PP231ORAL GLUTAMINE REDUCES MYOCARDIAL INJURY INPATIENTS UNDERGOING CARDIAC SURGERYA. Sufit1, K. Queensland2, C. Hamiel2, A. Baer2,P. Wischmeyer1. 1Anesthesiology, 2University ofColorado, Aurora, CO, United States
Rationale: Glutamine (GLN) can protect against in vitroand in vivo myocardial cell injury following ischemiaand reperfusion injury. This effect may be mediated byincreased heat shock protein (HSP) expression. However,the potential for GLN to protect the myocardium inpatients undergoing cardiac surgery is unknown. Thus, ourobjective was to perform a proof-of-concept pilot trial todetermine if pre-operative GLN therapy could attenuatemyocardial injury as measured by serum injury markersin patients undergoing cardiac surgery.Methods: Subjects undergoing elective cardiac surgery(CABG or heart valve replacement/repair), in whichcardiopulmonary bypass was required were enrolled ina randomized, double-blinded trial to receive oral GLN(25 mg BID) (n = 7) or maltodextran control (C) (n = 7) dailyfor 3 days prior to surgery. Serum troponin (TROP I),creatine kinase (CK-MB), myoglobin, and white cell HSP70level was obtained at: baseline, pre-anesthesia, and at 6,24, 48, and 72 h post-surgery.
Results: Of enrolled patients, 2 withdrew (1 GLN, 1 C),1 expired in OR (C pt), and 1 underwent non-qualifyingsurgery (GLN pt). No adverse effects were noted ineither group. Thus, 10 patients (4 GLN and 6 C) hadsamples available for analysis. Our data reveals patientsreceiving GLN had significantly decreased TROP I, at 24,48, and 72 h post-surgery (all p < 0.05) versus C. GLNtherapy also reduced CK-MB at 24 and 48 h (p < 0.05 andp < 0.001 respectively) and myoglobin 24 h post-surgery(p < 0.05) versus C. GLN treated patients showed a non-statistically significant trend towards increased cellularHSP70 content.Conclusion: In this pilot study, GLN therapy prior tocardiac surgery reduces myocardial injury as measuredby serum injury markers. This may be due to increasedcellular HSP70 expression. This data indicates a largertrial of GLN therapy in cardiac surgery powered on clinicaloutcomes is warranted.
Disclosure of Interest: A. Sufit: None declared, K. Queensland:None declared, C. Hamiel: None declared, A. Baer: None de-clared, P. Wischmeyer Grant/Research Support from: FreseniusInc
PP232CELLULAR MECHANISMS UNDERLYING THE PROTECTIVEEFFECTS OF PREOPERATIVE CARBOHYDRATE LOADING:A RANDOMISED STUDY INVESTIGATING MITOCHONDRIALFUNCTION, GENE AND PROTEIN EXPRESSION(NCT00662376)
S. Awad1, D. Constantin-Teodosiu2, D. Constantin2,B.J. Rowlands1, K.C. Fearon3, I.A. Macdonald2,D.N. Lobo1. 1Division of Gastrointestinal Surgery,Nottingham Digestive Diseases Centre NIHR BiomedicalResearch Unit, Queen’s Medical Centre, NottinghamUniversity Hospitals, 2Metabolic Physiology Group,School of Biomedical Sciences, University of Nottingham,Nottingham, 3Clinical and Surgical Sciences, Universityof Edinburgh, Edinburgh, United Kingdom
Rationale: Preoperative carbohydrate loading attenuatespostoperative insulin resistance but the mechanismsunderlying this are unclear. The effects of preopera-tive ingestion of a carbohydrate-based drink that alsocontained glutamine and antioxidants [Oral NutritionalSupplement (ONS), Fresenius Kabi] on mitochondrialfunction and the expression of key metabolic genes andproteins were studied.Methods: Two groups of 20 patients undergoing laparo-scopic cholecystectomy participated in this randomisedplacebo-controlled double-blind study. Patients ingestedeither 600 ml of ONS or placebo the evening beforesurgery and 300 ml 3 4 h before anaesthesia. 300 ml ofONS contained 50 g carbohydrate, 15 g glutamine andantioxidants. Rectus abdominis muscle and liver biopsieswere performed intraoperatively to study mitochondrialfunction (complex II, II+III, IV and citrate synthaseactivities and ATP content), pyruvate dehydrogenasekinase-4 (PDK4), FOXO1 and Metallothionein 1A (Mt1A)gene and protein expression.Results: The mean (SE) age and BMI of the 40 patients(31 female) were 50.3 (2.1) years and 29.0 (0.9) kg/m2
respectively. There were no differences in mitochondrial