Heat preconditioning prevents enterocyte mitochondrial damage induced by surgical manipulation

Thermal preconditioning can reduce the incidence of intraoperatively acquired pressure injuries

Intraoperatively acquired pressure injuries (IAPIs) occur frequently among patients who undergo surgical procedures that last longer than 3 h. Several studies indicated that heat shock proteins (HSPs) play an important role in the protection of stress-induced damages in skin tissues. Hence, the aim of this study was to investigate the potential preventive effect of thermal preconditioning (TPC) on IAPIs in surgical patients and rats and to identify the differentially expressed HSP genes in response to the above treatment. TPC was performed on one group of hairless rats before the model of pressure injuries was established. Subsequently, the size of skin lesions was measured and the expression levels of mRNA and protein of HSPs of the pressured skin were detected by real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into the TPC group (n = 59) and the control group (n = 59), respectively. The temperature and pressure of sacral skin, as well as the incidence of pressure injury (PI) were detected and compared. In animal studies, TPC significantly reduced both the size and incidence of PI in rats on the second, third and fourth days post treatment. In addition, the expression levels of both mRNA and protein of HSP27 were increased in the TPC group, compared with the control group. Immunohistochemical staining showed that HSP27 was distributed in various types of dermal cells and increased in basal cells. In human studies, a significant reduction (75%) of IAPIs was observed among the patients in the TPC group. TPC can reduce the incidence of PI in rats and humans, and the upregulation of HSP27 may play an important role in this biological progress. Further studies are warranted to explore the molecular mechanism of the preventive effect in PI mediated by HSP27.

Thermal Preconditioning for Surgery: A Systematic Review

BACKGROUND

Optimising patients pre-operatively reduces the chance of complications. This may be achieved by preconditioning. Thermal preconditioning refers to the supraphysiological heating of organisms or specific organs prior to an environmental insult. This review explores the current application and efficacy of thermal preconditioning for surgery.

METHODS

A comprehensive search of Medline (via PubMed), Embase and the Cochrane library was performed. Only articles evaluating the use of supraphysiological heating prior to a surgical intervention were included. Qualitative syntheses of data were undertaken due to the heterogeneity of the studies. The quality of each article was appraised using risk of bias tools (Cochrane and SYRCLE).

RESULTS

The primary literature search returned 3175 articles. After screening and reviewing reference lists, 28 papers met the inclusion criteria. The majority of studies were performed in animals, with only three clinical trials. Although there was broad coverage of different surgical techniques, flap transfer was the most commonly performed procedure. Most studies demonstrated a beneficial effect of thermal preconditioning, ranging from increased joint mobility to improved flap or organ transplant survival rates. The quality of evidence was variable, with experimental animal studies limited by a lack of methodological detail.

CONCLUSIONS

Thermal preconditioning for surgery has been primarily investigated using animal models. A beneficial effect has been demonstrated in most cases, across specialties ranging from plastic to general surgery. Future studies should aim to assess the clinical significance through large multicentre randomised controlled trials.

Mild whole-body heat stress alters retinoid metabolism in the rat small intestine

Mild heat treatment can modulate metabolism and prevent stress-induced alterations in cells and tissues. Retinoids are known to influence cellular metabolism and are essential for growth and differentiation, particularly of epithelial tissue. This study examines the effect of mild heat treatment on retinoid alterations in enterocytes in the rat small intestine. Heat treatment changed the differentiation pattern of enterocytes along the villus-crypt axis, accompanied by increases in retinol, retinaldehyde, and retinoic acid in proliferating crypt cells. Activities of retinoid metabolizing enzymes such as retinaldehyde oxidase and retinaldehyde reductase were also increased. These results suggest that mild heat treatment can alter retinoid metabolism in the small intestine, which might influence epithelial cell proliferation and differentiation.

Amelioration of intestinal ischemia-reperfusion injury with intraluminal hyperoxygenated solution: studies on structural and functional changes of enterocyte mitochondria

BACKGROUND

The aim of this study was to investigate the effects of intraluminal hyperoxygenated solution (HOS) on enterocyte mitochondrial structure and respiratory function after intestinal ischemia-reperfusion (IR) in rabbits.

MATERIALS AND METHODS

Thirty-two rabbits were divided randomly into four groups: control group in which sham operation was performed (Sham group), ischemia-reperfusion group (IR group), and two HOS treatment groups (H1 group and H2 group). Intestinal IR model was produced by clamping superior mesenteric artery (SMA) with an atraumatic vascular clamp for 1 h, followed by reperfusion for 2 h. Animals in the H1 group and H2 group received intraluminal HOS infusion for 1 h immediately after occlusion of SMA, and the rates of infusion were 10 and 20 mL/kg.h, respectively. After 2 h of reperfusion, enterocyte mitochondria morphological quantitative analysis was made with electron microscopy and biogenetics stereology, and the following parameters, including mitochondrial respiratory control ratio (RCR), intestinal O(2) extraction ratio (ER), and mucosal ATP contents, were measured, respectively.

RESULTS

After IR, the mitochondria was severely swollen with broken cristae, and mean transaction area, diameter, surface density, and volume density of the mitochondria increased significantly. Meanwhile, specific surface and numeral density of the mitochondria decreased significantly. The mitochondrial RCR, intestinal O(2) ER, and mucosal ATP contents were all decreased significantly. There were no differences in all parameters between the IR group and H1 group. In the H2 group, the mitochondria were slightly swollen, and mean transaction area, diameter, surface density, and volume density of the mitochondria were all significantly lower, with the specific surface and numeral density of the mitochondria significantly higher compared with the IR group. The mitochondrial RCR, intestinal O(2) ER and mucosal ATP contents in H2 group were all significantly higher than those in IR group.

CONCLUSIONS

Intraluminal HOS infusion at 20 mL/kg.h during ischemia ameliorates structural and functional changes of enterocyte mitochondria associated with intestinal IR injury, which is a safe, simple, and effective measure to protect the intestine from IR injury.

Surgical manipulation of the intestine and distant organ damage—protection by oral glutamine supplementation

BACKGROUND

The intestine is increasingly recognized as a primary effector of distant organ damage, such as the lung, after any abdominal surgery. Earlier studies have shown that surgical manipulation of the intestine induces generation of reactive oxygen species in the intestine, resulting in mucosal and lung damage. Because glutamine is preferentially used by the small intestine as an energy source, this study examined the effect of glutamine and glutamic acid on intestinal and lung damage after surgical manipulation.

METHODS

Controls and rats were pretreated for 7 days with 2% glutamine or glutamic acid, or the isonitrogenous amino acids glycine or alanine in the diet and subjected to surgical manipulation of the intestine. The intestine and lung were assessed for damage, and protection offered by various amino acids was studied.

RESULTS

Surgical manipulation resulted in oxidative stress in the intestine as evidenced by increased xanthine oxidase activity and decreased antioxidant status. Enterocyte mitochondria were also functionally impaired with altered calcium flux, decreased respiratory control ratio, and increased swelling. Gut manipulation also resulted in neutrophil infiltration and oxidative stress in the lung as assessed by an increase in myeloperoxidase activity, lipid peroxidation, and antioxidant status. Glutamine or glutamic acid supplementation for 7 days before surgical manipulation showed a protective effect against the intestinal and lung damage.

CONCLUSIONS

This study suggests that preoperative enteral glutamine or glutamic acid supplementation attenuates intestinal and lung damage in rats during surgical manipulation and that this effect might offer protection from postsurgical complications.

Role of intestine in postsurgical complications: involvement of free radicals

Surgery at any location in the body leads to surgical stress response and alterations in normal body homeostasis. The intestine is extremely sensitive to surgical stress even at remote locations and the gastrointestinal tract plays an important role in the development of postsurgical complications such as sepsis, the systemic immune response syndrome (SIRS), and multiple organ failure syndrome (MOFS). The generation of free radicals and subsequent biochemical alterations at the cellular and subcellular level in the intestine has been suggested to play an important role in this process. These oxidative stress-induced events in the mucosa might act as an initiator of distant organ damage and also facilitate bacterial adherence onto the epithelium and translocation into the systemic circulation. This review attempts to highlight the important role of intestine and oxygen free radicals in initiating post-surgical complications.

Variations of mitochondrial D-loop region plus downstream gene 12S rRNA-tRNAphe and gastric carcinomas

AIM: To explore the instabilities, polymorphisms and other variations of mitochondrial D-loop region and downstream gene 12S rRNA-tRNA^phe in gastric cancers, and to study their relationship with gastric cancer.

METHODS: Three adjacent regions (D-loop, tRNA^phe and 12S rRNA) were detected for instabilities, polymorphisms and other variations via PCR amplification followed by direct DNA sequencing in 22 matched gastric cancerous tissues and para-cancerous normal tissues.

RESULTS: PolyC or (CA)_n instabilities were detected in 13/22(59.1%) gastric cancers and 9/22(40.9%) in the control (P > 0.05). There existed 2/12(16.7%) and 6/10(60%) alterations of 12S rRNA-tRNA^phe in well differentiated gastric cancers and poorly differentiated ones, respectively (P < 0.05). Some new variations were found, among which np 318 and np 321 C-T transitions in D-loop region were two of the five bases for H-strand replication primer. np 523 AC-deletion and np 527 C-T transition occurred at mtTF1 binding site (mtTFBS), which were associated with the transcription of downstream mitochondrial genome. Seven samples showed the np 16182 polyC instabilities, five of which simultaneously showed np 16189 T-C transitions.

CONCLUSION: There is no statistic significance of instabilities and polymorphisms in mitochondrial D-loop region between gastric cancerous and para-cancerous normal tissues, which suggests that the instability might relate to heredity or be dependent on aging. There is a significant correlation between differentiation degree of gastric cancer and variant frequencies of 12S rRNA-tRNA^phe. The poorly differentiated gastric cancers are more prone to 12S rRNA-tRNA^phe variations, or gastric cancers with 12S rRNA-tRNA^phe variations are more likely to be poorly differentiated. np 16189 T-C transition may be one of the important reasons for polyC instability in gastric cancer.