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OBJECTIVE: To assess the effect of Clinoleic 20% (olive oil-based, n-9) and Lipoven 20% (soy bean-based, n-6) lipid emulsions on inflammatory parameters in a murine acute lung injury (ALI) model induced by lipopolysaccharide (LPS) of E. coli O111:B4. METHODS: Male Balb/C mice were infused for three days with 0.9% NaCl, Clinoleic 20%, or Lipoven 20% respectively, and sacrificed either at 8 hours or 24 hours after intra-tracheal introduction of LPS. Survival rate, lung wet/dry weight ratio (W/D), lung tissue myeloperoxidase (MPO) activity were determined, and tumor necrosis factor-alpha (TNF-alpha) and macrophage inflammatory protein-2 (MIP-2) in bronchoalveolar lavage fluid (BALF) were determined with enzyme linked immunosorbent assay (ELISA). Serum free fatty acids [arachidonic acid (AA), oleic acid, linoleic acid] were determined by gas chromatography. Leukocytes in BALF were counted under light microscope. RESULTS: Lipoven significantly decreased survival rate at 24 hours after intra-tracheal LPS challenge compared to corresponding controls (both P<0.01). No significant difference was observed between Clinoleic and NaCl groups. MPO activity was obviously increased in lipids groups than that in NaCl group at 24 hours (both P<0.01), and no difference was found between two lipids groups. LPS markedly induced an increase in leukocyte infiltration, W/D ratio, lung MPO activity, release of TNF-alpha as well as MIP-2 into alveolar space in both lipids and NaCl groups. Pre-infusion with Lipoven gave rise to heavier leukocyte infiltration at 24 hours, which was blunted in Clinoleic group and NaCl group (both P<0.01). In contrast to Clinoleic and NaCl groups, Lipoven increased production of TNF-alpha at 24 hours and MIP-2 at 8 hours in LPS-treated mice (all P<0.01). Notably, lipid emulsions increased LPS-induced MPO activity, but no difference in effects was found in both Lipoven and Clinoleic groups. Clinoleic significantly reduced free AA at 8 and 24 hours compared with Lipoven (both P<0.01). There were no differences in lung tissues edema, serum oleic acid and linoleic acid among three groups. CONCLUSION: In murine model of ALI, although LPS caused an increase in alveolar leucocytic infiltration, MPO activity, cytokine generation in both lipids and NaCl groups, Lipoven 20%, n-6 lipid emulsion induces a severer inflammatory reaction. It is speculated that by increasing AA, Lipoven 20% may aggravate ALI, whereas Clinoleic 20%, n-9 lipid emulsion possibly offers an alternative choice in producing less impact on inflammatory lung injury.

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OBJECTIVE: Patients with liver cirrhosis have varying degrees of imbalance of the intestinal flora and probiotics can improve some of the symptoms of gastrointestinal dysfunction in these patients. In the present study, blood ammonia, fecal pH, fecal ammonia, and plasma endotoxin were measured after administration of two kinds of probiotics in order to detect the changes in intestinal flora. METHODS: Six bacteria and yeast were cultured and the colony forming units were counted. Fifty cirrhotic patients were randomized to receive probiotic capsules containing Bifidobacterium, Lactobacillus acidophilus and Enterococcus, or probiotic capsules containing Bacillus subtilis and Enterococcus faecium for 14 days. Fecal flora, pH and ammonia, blood ammonia (detected by test paper) and plasma endotoxin (detected by LAL test kits) were measured before and after the treatment. RESULTS: Patients with liver cirrhosis had varying degrees of imbalance of the intestinal flora as shown by a decrease in the Bifidobacterium count (10.04 +/- 0.78 vs 9.48 +/- 1.13, P < 0.05). The severity of the imbalance was matched by that of liver dysfunction, with the most serious imbalance observed in Child-Pugh C patients. Both types of probiotic increased the Bifidobacterium count (9.46 +/- 1.09 vs 10.30 +/- 1.11, 9.81 +/- 0.62 vs 10.44 +/- 1.08, respectively, P < 0.05) and reduced the levels of fecal pH and fecal and blood ammonia (P < 0.05). Probiotics containing B. subtilis and E. faecium reduced the level of endotoxin in cirrhotic patients with endotoxemia (0.0876 +/- 0.0117 Eu/mL vs 0.0685 +/- 0.0246 Eu/mL, P < 0.05). CONCLUSIONS: Patients with liver cirrhosis have an imbalance of intestinal bacteria flora. Probiotics effectively increased the Bifidobacterium count and reduced the level of fecal pH and fecal and blood ammonia.

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OBJECTIVE: To compare the efficacy and safety of polyethylene glycol (PEG) 3350 plus electrolytes (PEG+E; Movicol((R))) with that of ispaghula husk (psyllium; Konsyl((R))) in the treatment of constipation. PATIENTS: Male or female adults with chronic functional constipation. METHODS: This was a randomised, controlled, open-label, parallel-group trial. Study treatment was either PEG+E 13.8g/sachet dissolved in water twice daily or ispaghula husk 3.5g/sachet dissolved in water twice daily for a period of 2 weeks. Assessments were at baseline and after 1 and 2 weeks' therapy and by patient daily diary card. The primary outcome measures were weekly defaecation rate, stool consistency according to the Bristol Stool Form scale, time to first defaecation, and overall efficacy, which combined defaecation rate, stool consistency and difficulty on defaecation. Adverse effects were recorded and laboratory assessments were performed before and at the end of the treatment period. RESULTS: Sixty-three patients were randomised to each treatment group. Treatment was highly effective in 50/63 patients in the PEG+E group compared with 26/63 in the ispaghula husk group, and the overall efficacy rates were 92% and 73%, respectively (p = 0.005). PEG+E increased the mean weekly defaecation rate from 1.18 (SD 0.77) at baseline to 7.95 (SD 3.49) after 1 week and 8.48 (SD 3.55) after 2 weeks. In the ispaghula husk group the mean weekly defaecation rate increased from 1.33 (SD 0.68) at baseline to 5.33 (SD 2.81) after 1 week and to 5.71 (SD 2.49) after 2 weeks. The treatment differences for defaecation rates were all statistically significant (p < 0.001). Two weeks of treatment with PEG+E or ispaghula husk normalised stools in 55/63 (87.3%) and 42/63 (66.7%) of patients (p < 0.001). The incidence of adverse effects did not differ between groups and none were serious or required any treatment. Laboratory evaluations found no adverse effect from either treatment. CONCLUSION: The present study demonstrated that low-dose PEG 3350 plus electrolytes is more effective and more rapid in its onset of action than ispaghula husk, and is equally well tolerated.