Abdominal Blood Research Articles

Morphological changes in lung tissue in case of blunt abdominal trauma, massive blood loss, and ischemia-reperfusion of the limb

Introduction. Combined trauma remains an urgent problem in medicine because it is the leading cause of death in victims of working age. Among the main causes of death in the prehospital stage among the injured is massive blood loss and further development of organ dysfunction, including lung. In recent years, significant progress has been made in providing assistance to victims of massive blood loss, but the impact of ischemia-reperfusion of the extremities in the development of systemic changes remains unresolved.Objective of the research: to study morphological changes in lung tissue in the model of combined abdominal trauma, massive blood loss and ischemia - reperfusion of the lower extremities.Materials and methods. To conduct the experimental study used 80 adult white male rats of the Wistar line weighing 190-220 g. The experimental animals were in the standard diet of vivarium.The experimental animals were divided into the following groups: control and 3 experimental (8 animals in each group). In animals of the first experimental group under thiopental-sodium disorder (40 mg kg-1) proximal to the lower limbs was imposed hemostatic plait for a period of 120 min. In the second experimental group, a combined injury of the abdominal organs was simulated by applying two metered blows to the abdominal area; hypovolemic shock was modeled by blood flow from 20 to 22% of circulating blood volume from the femoral vessels. In the third experimental group, the combined injury of the abdominal organs, massive blood loss and reperfusion of the extremities was modeled. Animals in the control group were administered only in anesthesia.The animals of the experimental groups were removed from the experiment under conditions of thiopental sodium anesthesia by total blood flow from the heart after 1, 3 and 7 days after modeling trauma. Pulmonary tissue was collected for the study.For histological examination, the lower lobe of the right lung was removed, which was fixed in 10% formalin solution, after which the macrodrug was compacted in paraffin. Sections were obtained on a microtome followed by staining with hematoxylin eosin. After fixation of sections on individual slides studied the structure of the lungs in the study groups. Used equipment: LOMO Biolam I microscope; system of digital display of images of histological preparations. Particular attention in the study was paid to changes in the parenchyma and the main structural components of the lungs.Results and Discussion. In the simulation of ischemia-reperfusion in the early periods in animals, changes were visualized from the first day in the form of endothelial lesions, increased perivascular edema, and cellular infiltration with signs of acute inflammation up to 3 days of experiment and formation of dyslectases up to 7 days of the experiment. When modeling closed abdominal trauma and massive blood loss in the lungs, structural changes increase from the first day of the experiment in the form of a sharp decrease in blood supply, lymphoplasmic infiltration of the stroma of the interalveolar septa, and the appearance of segmental leukocytes from 1 day of the experiment. After 3 days in the lumen of the vessels appear manifestations of erythrocyte aggregation and the formation of small parietal thrombi and pronounced dystrophic-necrotic changes in pneumocytes. After 7 days of the experiment, the acute manifestations are somewhat reduced, but there are pronounced dystrophic changes of the epithelium and pronounced lympho-plasmacytic infiltration of the stroma of the interalveolar septa, dystelectasis.Closed abdominal trauma, massive blood loss, and ischemic-reperfusion syndrome in the early periods in the lungs were manifested by pronounced structural changes: thickening of the interalveolar septa due to intensive infiltration of lymphoplasmocytes, especially on day 3 of the experiment with a moderate inflammatory reaction. After 7 days of the experiment, the cellular and inflammatory infiltration of the stroma and dystrophic manifestations decreased slightly. The obtained data indicate the development of systemic changes in experimental animals and a significant increase in the possibility of developing multiple organ failure syndromes. This indicates the need for further study of the effects of reperfusion in the context of combined trauma and, accordingly, the development of effective means of correction.Conclusions. Ischemia-reperfusion of the extremities alone and in combination with other injuries causes changes in lung tissue from the first day, progression to the third day of observation and a slight decrease in manifestations up to 7 days of the experiment. The results of the study suggest that ischemia-reperfusion is an important traumatic component in combined trauma.

Green/Roasted Coffee May Reduce Cardiovascular Risk in Hypercholesterolemic Subjects by Decreasing Body Weight, Abdominal Adiposity and Blood Pressure.

In previous studies, after regularly consuming a green/roasted coffee blend, body weight, body fat%, glucose, plasminogen activator inhibitor-1 (PAI-1), resistin, leptin, ghrelin, diastolic (DBP) and systolic blood pressure (SBP) significantly changed in healthy and hypercholesterolemic subjects. However, glucagon, total-cholesterol (T-C), triglycerides (TG), LDL-cholesterol (LDL-C) and Homeostasis Model Assessment index to estimate insulin resistance (HOMA-IR) only changed in the hypercholesterolemics. This work looks into the antiobesity effects of coffee blend and into the relationship of antiobesity with the aforementioned cardiometabolic modifications in hypercholesterolemics. (1) Methods: Tricipital and subscapular skinfolds, hip, thigh, arm and waist circumference (WC) were measured in normocholesterolemic and hypercholesterolemics. To understand the relationship between cardiometabolic and antiobesity results in hypercholesterolemics, factor analysis was carried out using baseline values of the variables that changed. (2) Results: WC, WC/hip and WC/height showed significant coffee×group interaction, and in hypercholesterolemics tended to decrease. After factor analysis, three factors emerged, accounting for 29.46, 13.13 and 11.79% of variance. Only factor 1 (main loadings: WC, DBP and SBP, body weight, WC/hip and WC/height ratios, TG and ghrelin, inversely) decreased after coffee intake. (3) Conclusion: Regularly consuming green/roasted coffee may help to control body weight, and in hypercholesterolemics, may reduce cardiovascular risk by reducing abdominal adiposity and blood pressure.

Preliminary study on the application of abdominal aortic balloon occlusion in the treatment of cesarean scar pregnancy

Objective: To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). Methods: Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed. Results: All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml (P>0.05), the time of uterine curettage were (37±20), (42±19) minutes (P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days (P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion: Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.

An assessment of symptom burden in inflammatory bowel diseases to develop a patient preference-weighted symptom score

Inflammatory bowel disease (IBD) patients experience diverse symptoms and the impact of these different symptoms varies substantially. Current disease activity measures do not account for the relative importance of the different symptoms and severity levels. In this study, we aimed to quantify the relative importance of different symptoms for IBD patients and to develop a patient preference-weighted symptom (PWS) score to assess symptom burden in IBD. We performed a choice-based conjoint analysis (CBCA) survey with 129 IBD patients to estimate the relative importance of four common IBD symptoms: stool frequency, abdominal pain, blood in stools, and urgency. We then developed the PWS score using the preferences obtained from the CBCA, which we validated against existing measures. CBCA revealed that urgency was the most important symptom to patients, followed by abdominal pain and blood in stools. Urgency associated with incontinence received particularly high scores and was perceived to be more than 3 times as important as urgency without incontinence. Our results confirmed that different symptoms are not equally bothersome, and we showed that the relation between symptom-level and importance is not linear. The PWS score, which we developed using these estimates was highly correlated with existing disease activity measures. We quantified the relative importance of four common IBD symptoms and developed the PWS score for IBD, which takes the relative importance of different symptoms and symptom-levels into account. The PWS score can be used to obtain a patient-centered assessment of symptom burden.

Transcription of mtDNA and dyslipidemia are ameliorated by aerobic exercise in type 2 diabetes.

Physical inactivity and unhealthy food intake are strongly associated with the growing prevalence of type 2 diabetes (T2D). Dyslipidemia, a characteristic of T2D patient, contributes to an increase in intra-myocellular lipid accumulation and mitochondria dysfunction, in skeletal muscle cells and further to insulin resistance. The aim of this study was to evaluate the effect of aerobic exercise on dyslipidemia, mitochondrial homeostasis and mitochondrial DNA (mtDNA) transcription in T2D- induced animals. Wistar rats (8weeks old) were fed a diet containing 60% fat over 9weeks, at day 14 a single injection of STZ (25mg/kg) was administered (T2D-induced). At week 3 of the experiment half of the animals started on an aerobic exercise 5-days/week. Blood and soleus muscle were collected at 9th experimental week. Abdominal fat, blood glucose, triglyceride, low-density-lipoprotein and high-density lipoprotein (HDL), and cellular mtDNA copy number, cytochrome b (cytb) mRNA and 8-isoprostane were measured. T2D-induced animals exhibited changes in blood glucose, weight gain, abdominal fat, LDL and muscular 8-isoprostane, mtDNA copy number and cytb mRNA. Aerobic exercise attenuated the increase in weight gain and abdominal fat and the decreased cytb mRNA, and increased HDL. Our results suggest that aerobic exercise might not affect all characteristics related to the development of T2D in the same way. However, since T2D is a multifactorial disease, improvement in parameters such as HDL levels, abdominal fat and weight gain induced by aerobic exercise might delay or inhibit the onset of T2D.

Vitamin K Supplementation to Improve Vascular Stiffness in CKD: The K4Kidneys Randomized Controlled Trial.

Vascular calcification, a risk factor for cardiovascular disease, is common among patients with CKD and is an independent contributor to increased vascular stiffness and vascular risk in this patient group. Vitamin K is a cofactor for proteins involved in prevention of vascular calcification. Whether or not vitamin K supplementation could improve arterial stiffness in patients with CKD is unknown. To determine if vitamin K supplementation might improve arterial stiffness in patients in CKD, we conducted a parallel-group, double-blind, randomized trial in participants aged 18 or older with CKD stage 3b or 4 (eGFR 15-45 ml/min per 1.73 m2). We randomly assigned participants to receive 400 μg oral vitamin K2 or matching placebo once daily for a year. The primary outcome was the adjusted between-group difference in carotid-femoral pulse wave velocity at 12 months. Secondary outcomes included augmentation index, abdominal aortic calcification, BP, physical function, and blood markers of mineral metabolism and vascular health. We also updated a recently published meta-analysis of trials to include the findings of this study. We included 159 randomized participants in the modified intention-to-treat analysis, with 80 allocated to receive vitamin K and 79 to receive placebo. Mean age was 66 years, 62 (39%) were female, and 87 (55%) had CKD stage 4. We found no differences in pulse wave velocity at 12 months, augmentation index at 12 months, BP, B-type natriuretic peptide, or physical function. The updated meta-analysis showed no effect of vitamin K supplementation on vascular stiffness or vascular calcification measures. Vitamin K2 supplementation did not improve vascular stiffness or other measures of vascular health in this trial involving individuals with CKD. Vitamin K therapy to improve vascular health in patients with chronic kidney disease, ISRCTN21444964 (www.isrctn.com).

Diagnóstico y manejo de invaginación intestinal en población pediátrica

La invaginación intestinal es la causa más frecuente de obstrucción intestinal y la segunda de abdomen agudo en la población pediátrica. Un 90% de los casos es primario o idiopático. Suele tener una triada de síntomas que incluyen: dolor abdominal, vómitos y presencia de sangre en heces. Generalmente, involucra el íleon el cual se invagina dentro del ciego por medio de la válvula ileocecal. Puede conducir a isquemia y luego perforación si no es tratada de forma correcta en un tiempo adecuado. La reducción por enema es un procedimiento efectivo y seguro para el tratamiento de la invaginación intestinal. El manejo inicial siempre es con enemas, sin importar si es una invaginación inicial o si es una recurrencia, antes de considerar opciones quirúrgicas, y usualmente resuelve un 85-90% de los casos.

Role of transient receptor potential cation channel subfamily M member 2 in hepatic ischemia-reperfusion injury in the mouse and the underlying mechanisms.

To investigate the role of transient receptor potential cation channel subfamily M member 2 (TRPM2) in hepatic ischemia-reperfusion injury of mouse (HIRI) and the possible mechanisms. Sixty adult male C57BL/6 mice were randomly divided into 4 groups: a sham group (S group), a HIRI model group (M group), a TRPM2 adenovirus interference vector group (T group), and a TRPM2 adenovirus control vector group (C group) (n=15 in each group). The liver tissues of mice before perfusion were obtained. The efficiency of adenovirus infection was detected by fluorescence microscopy, and the silencing efficiency of adenovirus against TRPM2 was detected by real-time PCR.The abdominal aorta blood and liver tissues were collected from mice at 2, 4 and 8 h after reperfusion. The activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum of mice were detected. Hepatic pathological changes were examined by hematoxylin-eosin (HE) staining. The protein expression of TRPM2 and Rac family small GTPase 1 (RAC1) in liver tissues was detected by Western blotting. Changes of malondialdehyde (MDA), superoxide dismutase (SOD) and myeloperoxidase (MPO) activities in liver tissues were detected by enzyme-linked immunosorbent assay. A strong signal of green fluorescence was observed in the liver tissues of mice in the T and C groups compared to the S or M group. Compared with the S, M or C group, the expression of TRPM2 mRNA in liver tissue in the T group was significantly down-regulated (all P<0.05). The morphology of hepatocytes was normal in the S group under light microscope.Hepatic sinus dilatation, congestion, hepatocyte degeneration, central necrosis of lobule, and massive inflammatory granulocyte infiltration were observed in the M and C group, respectively. The degree of hepatocyte damage in the T group was significantly reduced compared with that in the M and C group, respectively. Compared with the S group, the serum ALT and AST activities in the M, T and C groups were significantly increased at 2, 4 and 8 h after reperfusion (all P<0.05). Compared with the M or C group, the serum ALT and AST activities in the T group were significantly lower in serum of mice at 2, 4, and 8 h after reperfusion (all P<0.05). Compared with the M or C group, the serum SOD activity in the T group was significantly increased at 2, 4, and 8 h after reperfusion (all P<0.05), while the serum MDA and MPO activities were significantly decreased (all P<0.05). The protein expression of TRPM2 and RAC1 in liver tissues in the T group were significantly lower than those in the M and C groups at 2, 4 and 8 h after reperfusion (all P<0.05). Pretreatment with TRPM2 adenovirus interference vector can effectively silence TRPM2 gene expression in liver tissues of mice and attenuate HIRI, which may be related to inhibiting oxidative stress and reducing the expression of RAC1 protein.

Catch-Up Growth in Children Born Small for Gestational Age Related to Body Composition and Metabolic Risk at Six Years of Age in the UK

Objectives: To determine differences in body composition and glucose metabolism according to childhood growth outcomes in a population-based sample of children born small for gestational age (SGA). Methods: A single-centre study of 259 children born SGA identified through hospital records and contacted when aged 4–7 years. Questionnaire data on pre/perinatal history and growth parameters during childhood was collected from the parents, and in a subgroup of 150 children face-to-face assessments were performed, including anthropometric parameters, lean and fat mass, blood pressure, fasting glucose, and C-peptide. Results: Based on the questionnaires, few children had formal clinic follow-up of growth, but 7% of the cohort showed a height and weight of <–2SDS during childhood, and only 2 children met the criteria for growth hormone therapy. Out of the 150 children assessed at a mean age of 6.1 ± 0.8 years, 122 (81%) showed a catch-up growth in weight. Compared to those without weight catch-up, these children had a higher fat mass index (3.13 ± 1.36 vs. 2.56 ± 0.91 kg/m², p = 0.04), trunk-to-limb fat mass ratio (0.63 ± 0.14 vs. 0.56 ± 0.08, p = 0.002), systolic blood pressure SDS (0.09 ± 0.71 vs. –0.32 ± 0.63, p = 0.008), fasting glucose (4.5 ± 0.5 vs. 4.3 ± 0.5 mmol/L, p = 0.03), and C-peptide (306 ± 116 vs. 256 ± 112 pmol/L, p = 0.08). Among children with weight catch-up growth, those with less height gain had a lower limb lean mass index (4.25 ± 0.48 vs. 4.48 ± 0.56 kg/m², p = 0.02) and fat mass index (1.57 ± 0.59 vs. 1.83 ± 0.77 kg/m², p = 0.04). Conclusions: Within this population-based sample of SGA children, catch-up growth in weight was associated with higher abdominal fat mass, blood pressure and glycemia; furthermore, in these children, less height gain was associated with reduced limb lean and fat mass.

Counterpoint: Investigators should not control for menstrual cycle phase when performing studies of vascular control that include women.

Observed sex differences in the epidemiology of cardiovascular disease incidence and the efficacy of clinical intervention strategies, coupled with recent mandates from the National Institutes of Health (NIH), and its international counterparts to consider sex as a biological variable in all preclinical and clinical work (15), have led to increased enrollment of women in human physiology studies of vascular function with the goal of improving external validity and clinical applicability of the findings. However, standard practice in these studies is to test women during the early follicular phase (~days 1-5) of the menstrual cycle, during which estrogen and progesterone concentrations are lowest, and either exclude or limit testing of women who use hormonal contraceptives to the placebo phase. This approach seeks to control for, or limit, differences in circulating hormone concentrations between men and women and is based on the dogmatic theory that cyclic changes in estrogen and progesterone concentrations lead to greater variability in study outcomes and uninterpretable datasets. Contrary to this common approach, we propose that limiting testing of women to this single phase 1) decreases external validity of the findings, 2) obfuscates potential physiological differences contributable to differences in sex hormone concentrations between men and women, and 3) is, in many instances, contradicted by literature that demonstrates limited or no variability in vascular measurements across the menstrual cycle.

Effects of early supplement of exogenous L-carnitine on renal function in severely scalded rats

Objective: To explore the effects of early exogenous L-carnitine supplementation on renal function in severely scalded rats. Methods: According to the random number table, sixty-six adult female Sprague-Dawly rats were divided into healthy control group (n=6), scald alone group (n=30), and scald+ carnitine group (n=30). In the latter two groups, the rats were inflicted with full-thickness scald of 30% total body surface area on the back, and the lactated Ringer's solution was injected through the tail vein for resuscitation immediately after scald. At post injury hour (PIH) 1, rats in scald+ carnitine group were intraperitoneally injected with 100 mg/mL L-carnitine solution 400 mg/kg, while rats in scald alone group were intraperitoneally injected with the same volume of normal saline. Rats in these two groups were injected once every 24 hours thereafter. Six rats were taken from each of scald alone group and scald+ carnitine group to collect the renal tissue and abdominal aorta blood at PIH 6, 12, 24, 48, and 72, respectively. The serum content of total protein, albumin, urea nitrogen, creatinine, and cystatin C were determined by the automatic biochemical analyzer. Renal tissue was stained with hematoxylin-eosin to observe histopathological changes. Rats in healthy control group did not undergo any treatment, and their renal tissue and blood sample were extracted and analyzed in the same way as those of severely scalded rats. Data were statistically analyzed with one-way analysis of variance and Bonferroni method. Results: (1) The serum content of total protein and albumin of rats in scald alone group at each time point after injury was significantly lower than that in healthy control group (P<0.05). The serum content of total protein of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 and 24 (P<0.05), and the serum content of albumin of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 (P<0.05). The serum content of total protein and albumin of rats in scald alone group and scald+ carnitine group showed a trend of decrease followed by an increase, with the lowest value at PIH 24. (2) The serum content of urea nitrogen and creatinine of rats in scald alone group at each time point after injury was significantly higher than that of healthy control group (P<0.05). The serum content of urea nitrogen of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 6, 48, and 72 (P<0.05). The serum content of creatinine of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 12, 24, 48, and 72 (P<0.05). The serum content of urea nitrogen and creatinine of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (3) The serum content of cystatin C of rats in scald alone group at PIH 6, 12, 24, 48, and 72 was (0.250±0.030), (0.330±0.070), (0.300±0.060), (0.240±0.060), and (0.190±0.030) mg/L, and the content at the first 4 time points were significantly higher than (0.170±0.020) mg/L of healthy control group (P<0.05). At PIH 24, the serum content of cystatin C of rats in scald+ carnitine group was (0.210±0.040) mg/L, which was significantly lower than that of scald alone group (P<0.05). The serum content of cystatin C of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (4) The renal tissue of rats in healthy control group was almost normal, and the degree of renal tissue injury of rats in scald+ carnitine group was lighter than that in scald alone group at each time point after injury. At PIH 24, the renal tissue of rats in scald alone group showed extensive swelling of the renal tubular epithelial cells, vacuolar degeneration and necrosis, loss of brush borders, and nuclear shrinkage; more than 2/3 of the renal tubular cell nuclei disappeared, the tubular lumen was narrowed, necrotic exfoliated cells could be seen in the lumen, and edema and inflammatory cell infiltration could be seen in the renal interstitial. Compared with those of scald alone group, significantly reduced severity of edema and necrosis of renal tubular epithelial cells, as well as less inflammatory cell infiltration were observed in the renal tissue of rats in scald+ carnitine group. Conclusions: Early supplement of L-carnitine in severely scalded rats can reduce the damage of renal cells, accelerate the restoration of the content of total protein, albumin, urea nitrogen, creatinine, and cystatin C, thereby maintaining the stability of renal function metabolism level.

Incorporating the American College of Cardiology/American Heart Association hypertension diagnostic criteria into metabolic syndrome criteria will significantly increase the prevalence of metabolic syndrome among college students

The purpose of this study was to examine the impact that the revised American College of Cardiology/American Heart Association (ACC/AHA) hypertension diagnostic criteria would have on the prevalence of metabolic syndrome (MBS) among college students. Students completed an objective health assessment between September 2015 and April 2018 that involved the assessment of abdominal girth, blood glucose, lipids, and blood pressure (BP). Data of 5681 students (60.1% Men; 21 ± 1 years) who had all MBS risk factors assessed were analyzed to compare differences between old and new diagnostic criteria and identify which component of BP best predicts metabolic risk factors. The prevalence of MBS increased by 40.6% and 104.5% with the change to ACC/AHA criteria from the AHA/National Heart Lung and Blood Institute and theSeventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP criteria, respectively. The greatest relative increase in the prevalence of MBS was observed among women. Systolic BP and diastolic BP were significant predictors of abdominal obesity, and diastolic BP was a significant predictor of elevated triglycerides. Changes in hypertension diagnostic criteria had a significant impact on MBS prevalence. This is positive as it will allow earlier identification of young adults at risk of developing various noncommunicable diseases, but the ability of colleges to identify and then intervene to improve the health of at-risk students remains unclear. Furthermore, findings indicate that BP may hold utility as a cost-effective predictor of certain metabolicrisk factors in the absence of efficient, accurate, and affordable alternatives.

Two-day enema antibiotic therapy for parasite eradication and resolution of symptoms.

BACKGROUNDBlastocystis hominis (B. hominis) and Dientamoeba fragilis (D. fragilis) are two protozoan parasites of human bowel that are found throughout the world. There is still debate about the pathogenicity of these protozoans, despite them being commonly associated with gastrointestinal symptoms and can cause health issue in both children and adults. These parasites are usually transmitted through faecal-oral contact particularly under poor hygiene conditions or food/water contamination. Once a person is infected, the parasites live in the large intestine and are passed in the faeces.AIMTo investigate the effect of triple antibiotic therapy using enema infusion in the treatment of B. hominis and D. fragilis infections.METHODSThis retrospective longitudinal study was conducted in a single medical centre, which included fifty-four patients (≥ 18 years) who were positive for D. fragilis, B. hominis or both between 2017 and 2018. The treatment consisted of triple antibiotics that were infused over two consecutive days through rectal enema. Faecal samples were collected from participants pre- and post-treatment and were tested for parasites using microscopy and polymerase chain reaction. Patients’ symptoms were recorded prior and after the treatment as well as patient demographic data.RESULTSPatients (n = 54), were either positive for B. hominis (37%), D. fragilis (35%) or both (28%). All patients completed the two-day treatment and no serious adverse effect was reported. The most common side effect experienced by the patients during the treatment was urine discolouration which was cleared by six weeks of follow-up. Common symptoms reported prior to treatment were diarrhoea, abdominal pain, constipation and fatigue. Other symptoms included abdominal discomfort, dizziness and blood in the stool. Eighty-nine percent of patients completed a final stool test post-treatment. At six weeks post-treatment, 79% of patients cleared the parasites from their faeces. Symptoms such as abdominal discomfort, dizziness and blood in the stool decreased significantly at both seven days and six weeks post-treatment (P < 0.040). The enema retention time, bowel preparation, previous antibiotic treatment or previous gastrointestinal problems had no significant effect on parasite eradication.CONCLUSIONOverall, eradication of parasites and improvement of clinical outcomes were observed in treated patients, showing the efficacy of this combination to eradicate the parasites and provide positive clinical outcome.

Role of high mobility group box 1 in intestinal mucosal barrier injury in rat with sepsis induced by endotoxin

To investigate the role and mechanism of the high mobility group box 1 (HMGB1) in intestinal mucosal barrier injury in rat with sepsis induced by endotoxin lipopolysaccharide (LPS). The rats were given intraperitoneal injection of LPS to reproduce a model of sepsis. The effect of HMGB1 inhibitor EP solution (40 mg/kg) on sepsis was observed, and phosphate buffer (PBS) control group was set up. Seventy-two hours after modeling, abdominal aortic blood was obtained, and enzyme-linked immunosorbent assay (ELISA) was used to measure the plasma levels of D-lactic acid and diamine oxidase (DAO) of mucosal barrier permeability. The pathological changes of the intestinal mucosal were observed with light microscope and the Chiu score was recorded. The intestinal mucosal ultrastructural changes were observed with electron microscopy. Real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and Western Blot were used to measure the mRNA and protein expressions of Occludin, inflammatory factor HMGB1 and its downstream signal molecule nuclear transcription factor-κB p65 (NF-κB p65) in the rat small intestine. The results of histopathology and ultrastructure of the small intestine showed that in the LPS group, the intestinal mucosa tissue swelled obviously, part of the glands were incomplete, the infiltration of neutrophils increased, themicrovillus cells were absent, arranged indisorder, and the number of tight connections significantly reduced compared with the PBS control group. The levels of D-lactic acid and DAO indicating mucosal barrier permeability, the levels of inflammatory factor HMGB1 and its downstream signaling molecule NF-κB p65 mRNA and protein expressions in the LPS group were significantly higher than those in the PBS control group, and the mRNA and protein expression of Occludin in the small intestine was significantly lower than that in the PBS control group, suggesting that the intestinal mucosal barrier function in septic rats was damaged, permeability increased, and the structure was damaged. After the administration of the HMGB1 inhibitor EP, the intestinal mucosal barrier damage was significantly improved. The performance was as follows: the Chiu score of the small intestine tissue and the plasma D-lactic acid and DAO levels in the EP intervene group were significantly lower than those in the LPS group [Chiu score: 1.60±0.48 vs. 3.40±0.48, D-lactic acid (mmol/L): 3.30±0.22 vs. 5.30±0.16, DAO (U/L): 23.66±0.97 vs. 30.47±1.11, all P < 0.05]. Occludin mRNA and protein expression levels were significantly higher than those in the LPS group [Occludin mRNA (2-ΔΔCt): 0.82±0.05 vs. 0.37±0.08, Occludin protein (Occludin/β-actin): 1.04±0.09 vs. 0.75±0.11, both P < 0.05], while the mRNA and protein expression levels of HMGB1 and NF-κB p65 were significantly lower than those in the LPS group [HMGB1 mRNA (2-ΔΔCt): 1.63±0.10 vs. 3.57±0.10, HMGB1 protein (HMGB1/β-actin): 1.40±0.07 vs. 1.87±0.07; NF-κB p65 mRNA (2-ΔΔCt): 1.47±0.09 vs. 2.62±0.13, NF-ΚB p65 protein (NF-κB p65/β-actin): 1.24±0.14 vs. 1.60±0.13, all P < 0.05]. Intestinal mucosal barrier function of septic rats was damaged, permeability increased, and structure was damaged. The mechanism may be that the expression of inflammatory factor HMGB1 was up-regulated and promoted the activation of its downstream signaling molecule NF-κB, thereby mediated the inflammatory cascade reaction and caused damage to the intestinal mucosa.

Stressful Exercise Reveals Hidden Correlations Between Anthropometric Measurements And Cardiovascular Parameters

Camera-based girth measures paired with multi-spectrum bioelectrical impedance spectroscopy can aid in bodily measurements helpful for assessing composition. Fit3D is a relatively new technology for the determination of anthropometric circumferences. There are known relationships between abdominal obesity and blood pressure, but there are fewer investigations exploring the relationship between peripheral circumferences and cardiovascular parameters. PURPOSE: To evaluate relationships between anthropometric measurements calculated by the Fit3D to pre- and post-exercise blood pressure values. METHODS: 17 subjects (7 female, 10 male) underwent laboratory testing beginning with a body composition assessment by the Fit3D (Fit3D, Inc., USA). Subjects then had resting heart rate and blood pressure recorded, followed by a treadmill VO2 max assessment during which ventilatory threshold was identified using the V-slope method. This value was used to determine work rate in a subsequent 60-minute exercise session. Immediately after exercise, subjects were retested on the Fit3D and had post-exercise values of heart rate and blood pressure collected. Descriptive statistics characterized the study sample; simple linear regressions tested the relationships between anthropometric assessments and cardiovascular parameters. RESULTS: Subjects were 20.5 ± 1.7 years old, weighed 73.8 ± 15.4 kg, had a body fat of 24.2 ± 6.6%, resting heart rate (HR) of 78.1 ± 14.9 bpm, systolic blood pressure (SBP) of 122.8 ± 4.6 mmHg, and diastolic pressure of 74.6 ± 4.9 mmHg. Fit3D-calculated "Body Shape Rating" was unrelated to HR at baseline (p=0.297) but a higher value predicted a lower post-exercise HR (β=-0.691, p=0.033). Resting forearm circumference was unrelated to SBP (p=0.978) and DBP (p=0.539), but post-exercise forearm circumference predicted both SBP (β=1.336, p=0.031) and DBP (β=1.823, p=0.038). Calf circumference was unrelated to SBP, but demonstrated trends with DBP at rest (β=0.942, p=0.033) and post-exercise (β=1.403, p=0.080). Upper arm and upper leg circumferences were unrelated. CONCLUSION: In a condensed age group, stressful exercise seemed to reveal otherwise-hidden correlations between peripheral anthropometric measurements and cardiovascular assessments.

Longitudinal relationships between changes in body composition and changes in selected metabolic risk factors (abdominal obesity and blood pressure) among South African adolescents.

BackgroundIncidence of childhood high blood pressure (BP) is increasing worldwide. This study examined the longitudinal relationship between changes in body composition (i.e. body mass index (BMI), waist circumference (WC) and percentage body fat) and selected metabolic risk factors (abdominal obesity and BP) among adolescents from the Tlokwe municipality in the North West Province of South Africa.MethodOne hundred and eight-six adolescents (81 boys and 105 girls) aged 14 to 16 years participated in the study. Body composition was measured following the International Society of the Advancement of Kinanthropometry standard procedures. BMI, abdominal obesity using WC measurement, and resting BP were determined. Analysis of variance (ANOVA) for repeated measures was calculated to determine changes in anthropometric measures and body composition as well as changes in BP. Additionally, Univariate analysis of variance with repeated measures and participants as a random sample was applied. Diastolic BP (DBP) and systolic BP (SBP) were used as dependent variables and sex, age, BMI, WC, and waist-to-height ratio as independent variables.ResultsSignificant changes were found for stature, BMI, body mass, WC, SBP, and DBP. BMI for the total group was significant and positively related to abdominal obesity in 2012 (r = 0.55; p < 0.01) and in 2013 (r = 0.77; p < 0.01) and to SBP (r = 0.26; p < 0.05) in 2012 and (r = 0.17; p = 0.43) in 2013. BMI among the boys was significantly and positively related to abdominal obesity in 2012 (r = 0.83; p < 0.01) and 2013 (r = 0.91; p < 0.01). For the girls, BMI was significantly and positively related to abdominal obesity (r = 0.49; p < 0.01) and to SBP (r = 0.32; p = 0.05) in 2012. Boys with a higher WC in 2012 had significantly increased DBP (p < 0.05). Boys measured in 2012 with greater WC and BMI show a significant increase in SBP.ConclusionsBMI was positively related to BP and abdominal obesity over time. Relatively high BMI and abdominal obesity significantly increased the likelihood of elevated BP over time, especially in boys. BMI was a predictor of abdominal obesity in boys, while in girls, BMI was a predictor of both abdominal obesity and SBP. In view of the future health implications of both abdominal obesity and elevated BP, urgent strategic interventions programs aimed at increasing physical activity and advocating for well-balanced dietary practices as well as importance of keeping normal blood pressure among South African adolescents are needed.

Three-dimensional printing - Assisted planning for complete and safe resection of retroperitoneal tumor.

Surgery is usually recommended to treat retroperitoneal tumors. However, complete surgical resections often remain challenging. To assess the assistant role of three-dimensional (3D) imaging and printing model in retroperitoneal tumor resection, as well as compare the difference between 3D printing and computed tomography (CT) in preoperative planning and confidence building. We admitted a patient with retroperitoneal mass (13.0×6.4×14.8 cm) adjacent to important abdominal blood vessels whose surgery was thought to be difficult. 3D printing and CT was arranged. A novel questionnaire and scoring system consisting of surgery difficulty and safety were designed to compare doctors understanding and confidence for surgery based on 3D printing and CT. Twenty-four doctors completed the scoring table based on CT and then 3D imaging, respectively. Paired t-test was applied for statistics analysis. Preoperative evaluation based on 3D printing indicated that the tumor could be removed completely. The operation lasted 120 minutes to successfully remove the tumor and the estimated blood loss was less than 100 ml. Scores based on 3D printing is significantly higher than CT in difficulty and safety of surgery (p < 0.001). Interestingly, the junior doctors seem to benefit more from 3D printing than the senior doctors. 3D imaging and printing model provides greater help for preoperative planning and confidence building than using CT in resection of retroperitoneal tumor, especially for the junior doctors.

Reductions of cardiovascular and metabolic risk factors after a 14-week periodized training model in patients with knee osteoarthritis: a randomized controlled trial.

To evaluate the effects of a periodized circuit training (CT) compared with a conventional strength training (ST) and an educational protocol (EP) on body composition, metabolic parameters, muscle strength, pain, and physical performance in patients with knee osteoarthritis (KOA). This study followed a randomized controlled trial design. A sample of sixty-one patients with KOA, 40-65years old and BMI < 30kg/m2, were randomly divided into three 14-week protocols: CT, ST, or EP. The CT performed whole body exercises organized in circuit, 3 times a week. The ST performed conventional resistance exercises also 3 times a week, and the EP joined in educational meetings twice a month. Body composition (dual-energy X-ray absorptiometry (DXA)); metabolic parameters (abdominal obesity, triglyceride, HDL, blood pressure and fasting glucose), knee maximal isometric voluntary contraction (MIVC) extension and flexion, performance-based tests (40-m walk test, 30-s chair test, and stair climb test), self-reported pain, stiffness, and physical function (WOMAC) and pain catastrophism were evaluated at baseline and follow-up. Repeated measures ANOVA were used to compare differences between groups (CTxSTxEP) at the different times of assessment (baseline × follow-up). When group-time interaction was found, a one-way ANOVA, followed by a Bonferroni post hoc test, was used to compare groups in each time point; while a paired t test was used to verify the time effect in each group. Additionally, the training effect was analyzed in terms of the percent change (Δ%). Effect size was calculated for post intervention (week 14) between groups. For all analyses a significance level of 5% was adopted (p < 0.05). The CT was the only protocol that presented significant lower body mass (p = 0.018; Δ% = - 1.4), fat mass (p = 0.017; Δ% = - 10.3), %fat mass (p < 0.001; Δ% = - 13.9), adipose indices (%fat trunk/%fat legs p = 0.031; Δ% = 7.8; fat mass/height2 p = 0.011; Δ% = - 15.1; trunk/limb fat mass p = 0.012; Δ% = - 8.2; visceral adipose tissue (VAT) volume (cm3) p = 0.039; Δ% = - 11.6; VAT area (cm2) p = 0.044; Δ% = - 12.2), blood pressure levels (SBP p = 0.042; Δ% = - 3.4 and DBP p = 0.001; Δ% = - 4.9), higher lean mass and HDL (p < 0.001; Δ% = 5.9) compared to baseline. CT and ST presented lower WOMAC pain, stiffness and physical function (p < 0.001; Δ% = - 64.0 for CT and p < 0.001; Δ% = 0.001; Δ% = - 46.4 for ST in WOMAC total score, pain catastrophizing (p < 0.001; Δ% = - 66.7 for CT and p < 0.001; Δ% = - 61.5 for ST) a higher functional performance (30s chair test: p < 0.001; Δ% = 45.7 for CT and p < 0.001; Δ% = 26.9 for ST; 40m walk test: p < 0.001; Δ% = 26.7 for CT and p < 0.001; Δ% = 12.5 for ST; stair climb test: p = 0.002; Δ% = - 33.9 for CT and p < 0.001; Δ% = - 18.8 for ST) and knee extension MIVC (p < 0.001; Δ% = 21.92 for CT and p < 0.001; Δ% = 30.25 for ST). A periodized CT model reduces visceral adipose tissue, SBP and DBP, and improves HDL, important cardiovascular and metabolic risk factors, in patients with KOA. Both trained groups (CT and ST) improve self-reported clinical symptoms, muscle strength, and physical performance in this sample. ClinicalTrials.gov , NCT02761590 (registered on May 4, 2016). • A 14-week periodized circuit training reduces visceral adipose tissue, systolic and diastolic blood pressure, and improves HDL blood levels in patients with knee osteoarthritis. • Both periodized circuit training and conventional strength training improve clinical symptoms, functional performance and muscle strength in this sample.

Reconstruction of Complex Abdominal Wall Defect With Autogenous Pedicled Demucosalized Seromuscular Flap

Abdominal wall reconstruction is indicated when 1 or more of the abdominal wall components (skin, fascia, or muscle) are either injured or absent. When faced with defects requiring flap reconstruction, the decision regarding flap choice should take into consideration the volume of soft tissue required, the extent of the defect, donor site morbidity, and prior surgical scars that affect flap vascularity. We present a case of an abdominal wall defect with limited reconstructive options in which a spare ileal bowel segment was filleted to create a seromuscular flap for improving the abdominal wall blood supply. The postoperative course was complicated by abdominal fluid collection, which resolved following an ultrasound-guided drain. The patient had normal wound healing and recovery without further postoperative complications at the 7-month follow-up. Seromuscular flaps are a practical option in the armamentarium of plastic surgeons performing abdominal wall reconstruction, especially when other alternatives are limited.

Giant multiple vesical calculi: A case report

Giant multiple vesical calculi are rare entities in modern urological practice. Very few cases of vesical calculi of more than 100 g has been reported in English literature. Largest vesical calculus was of weight 6294 g by Arthur et al. Bladder stones may be asymptomatic and discovered as incidental finding. However, when symptoms occur, these include lower abdominal pain, difficult urination, frequent urination, painful urination and blood in urine. Our CASE report demonstrated two vesical calculi weighing 194 g and 292 g which is a rare finding in today's urological practice.