Digestive Tract Wall Research Articles

Biochemical and ecological components of Holothuria (Halodeima) grisea, Selenka 1867 (Echinodermata:Holothuroidea)

Sea cucumber is a marine invertebrate that is of great interest in Asian cuisine because of its nutritional characteristics and in scientific research due to its medicinal properties, including antioxidant, anti-inflammatory, antiviral and other actions. Knowledge of biochemical composition is an essential pillar to explain, confirm and/or instigate ecological and reproductive studies. This work aimed to determine the biochemical composition in relation to lipids, proteins and total carbohydrates and fatty acids of the gonad, digestive tract and/or body wall of Holothuria (Halodeima) grisea and relate the biochemical information with environmental conditions (temperature, pH, salinity, food sources) in the winter and summer. Biometric measurements were obtained by weighing of the entire body and the tissues. Quantifications and characterizations of biomolecules were obtained by combining gravimetric and analytical techniques. Sexes were identified using classical histology techniques. Atherogenic (AI), thrombogenic (TI) indices and the hypocholesterolemic/hypercholesterolemic ratio were used to assess the quality of fatty acids. The organisms showed significant differences between seasons and/or between sexes among biometric and biochemical parameters. In general, females have greater amounts of biomolecules than males and these fluctuations are related to water temperature and reproductive stage. The fatty acids coincided with the literature for sea cucumbers and the nutritional quality indices were better than other species, in addition to indicating summer as the ideal season for consumption. Therefore, Holothuria (Halodeima) grisea presented a variable biochemical composition between seasons and sexes, being influenced by water temperature and diet, and has the potential to be used in an aquaculture system and in the management of natural stocks.

A study of traction endoscopic submucosal dissection using a unique traction device with a ring and a clip with an obtuse tip.

Appropriate use of traction devices is important in Endoscopic Submucosal Dissection (ESD). The Sure-Clip Traction Band (Microtec: "traction band") is a disposable clip with a series of three small silicone rings, which can be used as a traction device by inserting the clip through two holes. The SB clip long with a 125-degree tip claw angle (SB Kawasumi: hereafter referred to as SB clip) has an obtuse angle tip, can be re-gripped and is considered to cause less damage to the digestive tract wall when withdrawn after clipping. We performed traction ESD using a traction band and SB clip. These were used for gastric ESD in 4 cases and colorectal ESD in 3 cases.

Multi-task Learning with Hierarchical Guidance for Locating and Stratifying Submucosal Tumors.

Locating and stratifying the submucosal tumor of the digestive tract from endoscopy ultrasound (EUS) images are of vital significance to the preliminary diagnosis of tumors. However, the above problems are challenging, due to the poor appearance contrast between different layers of the digestive tract wall (DTW) and the narrowness of each layer. Few of existing deep-learning based diagnosis algorithms are devised to tackle this issue. In this article, we build a multi-task framework for simultaneously locating and stratifying the submucosal tumor. And considering the awareness of the DTW is critical to the localization and stratification of the tumor, we integrate the DTW segmentation task into the proposed multi-task framework. Except for sharing a common backbone model, the three tasks are explicitly directed with a hierarchical guidance module, in which the probability map of DTW itself is used to locally enhance the feature representation for tumor localization, and the probability maps of DTW and tumor are jointly employed to locally enhance the feature representation for tumor stratification. Moreover, by means of the dynamic class activation map, probability maps of DTW and tumor are reused to enforce the stratification inference process to pay more attention to DTW and tumor regions, contributing to a reliable and interpretable submucosal tumor stratification model. Additionally, considering the relation with respect to other structures is beneficial for stratifying tumors, we devise a graph reasoning module to replenish non-local relation knowledge for the stratification branch. Experiments on a Stomach-Esophagus and an Intestinal EUS dataset prove that our method achieves very appealing performance on both tumor localization and stratification, significantly outperforming state-of-the-art object detection approaches.

Intraluminal Digestive Textiloma: Two Case Reports

Intraluminal textiloma is caused by the retention of surgical textile material in the digestive tract (compress, drape). Textiloma is found intraluminally due to an inflammatory process that causes necrosis and progressive passage of the material through the digestive tract wall. It can be found anywhere along the digestive tract, from the stomach to the colon. The symptoms are not very specific and vary from transit disorders to intestinal obstruction. Morphological examination is frequently used to make a diagnosis. The treatment depends on the locasation and consists of textiloma extraction. We present two (2) clinical aspects of postoperative digestive intraluminal migration of an abdominal field following digestive surgery in this study. The extremely rare nature of these two cases, as well as the diagnostic errors and management methods of this postoperative complication, prompt us to discuss them.

Single and combined effects of microplastics and cadmium on the sea cucumber Apostichopus japonicus

Microplastic pollution of the ocean has received extensive attention as plastic pollution increases globally, but the potential ecological risks caused by microplastic interactions with trace metals still require further research. In this study, Apostichopus japonicus was used to explore the individual and combined toxicities of cadmium (Cd) and microplastics and their effects on growth, Cd tissue accumulation, digestive enzymes, and gut microbes. The body weight gain and specific growth rate of animals exposed to a combination of high concentrations of Cd and microplastics decreased. The addition of high concentrations of cadmium to the diet led to an increase in cadmium content in the respiratory tree, digestive tract and body wall. Amylase, lipase and trypsin decreased to different degrees in the group treated with high concentrations of Cd/microplastics. Firmicutes were significantly reduced across multiple treatment groups, with the order Lactobacillales being the most significantly affected. Cd is the pollutant causing the greatest negative impact, but the presence of microplastics undoubtedly increases its toxicity.

Usefulness of endoscopic ultrasound for acquiring the pathological diagnosis of gastrointestinal lymphoma

Background and study aimsThis study aims to assess the value of endoscopic ultrasound (EUS) for acquiring a pathological diagnosis of gastrointestinal lymphoma (GIL). Patients and methodsWe retrospectively reviewed all GIL patients who underwent EUS from November 2011 to July 2020 at Fudan University Shanghai Cancer Center. All patients with pathologically confirmed GIL were included. The characteristics of the lesions were recorded, and the efficacy for acquiring pathologic diagnosis between white light endoscopy (WLE) and EUS was analyzed. ResultsIn total, 404 patients with GIL who underwent EUS examination were included in this study. GIL was confirmed in 143 cases by after EUS judgment biopsy (AEJ biopsy), 11 cases by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), 293 cases by WLE biopsy, and 10 cases by surgical pathology for repeated negative pathologic results from EUS and WLE. Among all cases, 78.71% (318/404) were T1-T2, whereas 32.18% (130/404) were determined to have multiple lesions in the digestive tract wall. The positive rates of the WLE biopsy and AEJ biopsy of the involved gastric wall were 77.93% (293/376) and 89.38% (143/160), respectively. Twelve cases showed diffuse thickening of the gastric wall, and the total positive rate of EUS was 91.67% but 0% for WLE with this type of GIL. The total positive rate and positive rate during the first examination of EUS were all significantly higher than those of WLE. Moreover, 19.68% of the patients showed negative results during their WLE examination and then received a positive pathologic diagnosis upon EUS examination, but none had the opposite process. ConclusionsEUS was found to be a better tool for acquiring a pathological diagnosis of GIL than conventional WLE, especially for GIL similar to linitis plastica.

Functional Histology and Ultrastructure of the Digestive Tract in Two Species of Chitons (Mollusca, Polyplacophora)

To continue the investigation on the digestive system of polyplacophoran molluscs, a histological and ultrastructural study of the oesophagus, stomach and intestine of Chaetopleura angulata and Acanthochitona fascicularis was carried out. Stomach content examination revealed an omnivorous diet. In both species the epithelium of the whole digestive tract consisted mostly of elongated absorptive cells with an apical border of microvilli. Cilia were also frequently present. Mitochondria and electron-dense lysosomes were the prominent organelles in the region above the nucleus. The basal region was characterised by an association of mitochondria, peroxisomes and lipid droplets. In general, glycogen deposits were also abundant in absorptive cells. The ultrastructural features indicate that the absorptive cells of the digestive tract epithelium are involved in endocytosis, intracellular digestion and storage of reserves. Histochemical techniques showed that the secretory cells of the digestive tract contained proteins and polysaccharides in their secretory vesicles. The secretory cells with vesicles of low electron density were classified as mucous cells, and the ones with electron-dense vesicles were designated basophilic cells due to their staining by basic dyes in light microscopy. Additionally, basal cells that seem to correspond to enteroendocrine cells containing oval electron-dense vesicles were found along the digestive tract epithelium of both species. The thin outer layer of the digestive tract wall consisted of muscle cells and nerves embedded in connective tissue.

Application of Endoscopic Ultrasound Image Analysis in the Treatment of Digestive Tract Diseases and Nursing

Objective: To study the diagnostic accuracy of microprobe endoscopic ultrasonography (mEUS) in the diagnosis of bulge of digestive tract, and to summarize and explore the characteristics of ultrasound images of gastrointestinal bulge in mEUS diagnosis, to comprehensively evaluate microprobe ultrasound. The ability of endoscope to diagnose gastrointestinal bulging lesions provides a certain clinical basis for later nursing. Methods: A retrospective analysis of 302 cases of gastrointestinal bulging cases underwent microprobe ultrasound endoscopy from November 2011 to December 2015. The diagnosis of all cases was confirmed by endoscopic pathology, surgical pathology or follow-up. Microprobes were compared. The diagnostic accuracy of the results of ultrasound endoscopy and traditional endoscopy. Results: A total of 302 patients underwent microprobe ultrasound endoscopy, including 274 upper gastrointestinal tract, 28 colorectal, 97 esophagi in upper gastrointestinal tract, 152 in stomach and 25 in duodenum. The coincidence rate of mEUS diagnosis of esophageal bulge lesions was 97.93% (95/97), and the coincidence rate of gastroscopy diagnosis was 68.04 (66/97). The coincidence rate of mEUS diagnosis in gastric elevated lesions was 94.07% (143/152), and the coincidence rate of gastroscopy diagnosis was 50.65% (77/152). Conclusion: Microprobe endoscopic ultrasound can clearly show the structure of each layer of the digestive tract wall, reflecting the origin of the lesion and the depth of infiltration. Therefore, it can make accurate diagnosis of most gastrointestinal bulging lesions.

Digestive Tract Injuries Caused by Ingested Foreign Bodies Containing Magnets

We report on 16 children with ingestion of magnetic foreign bodies, who were identified by a medical record review of our hospital data for the time period between January, 2017 and May, 2018. Digestive tract wall was sandwiched in 13 (75%) children and 11 (74%) had gaptic intestinal perforation.

Thermal stability and oral absorbability of astaxanthin esters from Haematococcus pluvialis in Balb/c mice.

Astaxanthin is used as a functional nutraceutical and pigment in many food products. It is mostly exists in the form of a fatty acid ester in nature. However, no detailed descriptions are available concerning the stability and oral absorbability of astaxanthin esters. In the present study, the thermal stability and absorbability of astaxanthin esters from Haematococcus pluvialis were evaluated in comparison with free-form astaxanthin. The thermal stability of astaxanthin esters was found to be higher than that of free-form astaxantin. After gavage with astaxanthin esters, only free-form astaxanthin was detected in the digestive tract wall, blood plasma and liver, indicating that astaxanthin esters must be hydrolyzed to free-form astaxanthin in the gut before absorption. Furthermore, there was a considerable selective accumulation of different astaxanthin isomers in Balb/c mice, which selectivity decreased in the order: 13-cis> all-trans>9-cis. Accumulated astaxanthin was mainly distributed in the heart, liver, spleen, muscle and adipose tissue, although significant differences between tissues were observed. From the present study, it can be concluded that astaxanthin esters had a higher thermal stability and higher bioavailability than free-form astaxanthin. These results provide important evidence with respect to using astaxanthin esters as bioactive components to replace free-form astaxanthin in functional food products. © 2019 Society of Chemical Industry.

A 30-Minute Supraceliac Aortic Clamping in the Rat Causes Death Due to an Inflammatory Response and Pulmonary Lesions

The treatment of thoracoabdominal aortic aneurysms through an open approach has general and pulmonary consequences of multiple etiologies. Our assumption was that the supraceliac aortic clamping needed for this operation causes a systemic inflammatory response associated with a pulmonary attack. We developed a model of 30-min supraceliac aortic clamping in Wistar rats weighing 300g. After 90min of reperfusion, the rats were sacrificed. The effects on the digestive tract wall were analyzed by measurement of the mucosal thickness/total thickness ratio. The effects on the mesenteric endothelial function were determined byan ex situ measurement of the arterial pressure/volume curves (third branch). Thesystemic consequences of the procedure were analyzed by dosing tumor necrosis factor alpha (TNFα), interleukin (IL)1β, and IL10 in the blood. The pulmonary consequences were analyzed by the measurement of macrophages, polymorphonuclear neutrophils (PNs), T lymphocyte infiltration, pulmonary apoptosis (TUNEL) and active caspase 3. The experimental scheme included 20 rats with ischemia-reperfusion (IR) and 20 control rats. An analysis of survival was carried out on 20 other rats (10 IR and 10 controls). The results were expressed as average±standard error of the mean. The statisticaltests were Student's t-test and Mann-Whitney test. This visceral IR model decreased the ratio of the thickness of the intestinal mucosa compared with that of the control rats (0.77±0.008 vs. 0.82±0.009 [P<0.001]). This local effect was not accompanied by any mesenteric endothelial dysfunction (P=0.91). On a systemic level, IR increased TNFα (37.9±1.5 vs. 28.2±0.6 pg/mL; P<0.0001), IL1β (67.1±9.8 vs. 22.5±5.6 pg/mL; P<0.001), and IL10 (753.3±96 vs. 3.7±1.7 pg/mL; P<0.0001). As regards the lungs, IR increased the parenchymal cellular infiltration by macrophages (6.8±0.8 vs. 4.5±0.4cells per field; P<0.05) and PNs (7.4±0.5 vs. 6.2±03cells per field; P<0.05). There was no increase in the pulmonary cellular apoptosis measured by TUNEL (P=0.77) or in the caspase 3 activity (P=0.59). The mortality of the visceral IR rats was 100% at 36hr vs. 0% in the animals without IR. This work showed that the inflammatory response to visceral IR had systemic and pulmonary effects which always results in the death in the rat.

Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication.

Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion.

The reality of the surgical fasting time in the era of the ERAS protocol.

Multimodal protocols to optimize perioperative care and to accelerate postoperative recovery include abbreviated pre-and postoperative fasting. The aim of this study was to investigate the pre and postoperative fasting period and the factors that influence it in patients who underwent elective operations. We included patients who underwent surgery of the digestive tract and abdominal wall. Data were collected from the patients and from their personal health records. We included 135 patients between 19 and 89 years old. Most were adults (75.55%), female (60.74%) and the most common procedures were hernioplasty (42.96%) and cholecystectomy (34.81%). The preoperative fasting periods for solids and liquids were similar, median 16.50 (5.50-56.92) and 15.75 (2.50- 56.92) hours, respectively. The preoperative fasting period was influenced by the instruction received and surgery time. Postoperative fasting period was 15.67 (1.67-90.42) hours and was influenced by type of surgery and lack of synchrony between the clinical meeting and the nutrition and dietetics service schedules.

AChE and EROD activities in two echinoderms, Holothuria leucospilota and Holoturia atra (Holothuroidea), in a coral reef (Reunion Island, South-western Indian Ocean)

AChE and EROD activities were investigated in two holothurian species, Holothuria leucospilota and Holoturia atra, from a tropical coral reef. These organisms were collected from 3 back-reef stations, where temperature and salinity were homogeneous. The activity levels of both AChE and EROD varied significantly between the two species, but were in the range of values determined in other echinoderm species. AChE activity levels were higher in the longitudinal muscle than in the tentacle tegument. Among the several tissues tested, the digestive tract wall exhibited higher EROD activity levels. Sex did not influence AChE and EROD activity levels in both species. Animal biomass and EROD activity levels were only correlated in the tegument tissue of H. atra, and we hypothesize a possible influence of age. EROD activity did not show intraspecific variability. A significant relationship was found between AChE activity and Cuvierian tubules time of expulsion in Holothuria leucospilota. Individuals collected at the southern site presented both lower AChE activity levels and Cuvierian tubules time of expulsion, indicating possible neural disturbance. More information on holothurians biology and physiology is needed to further assess biomarkers in these key species. This study is the first of its kind performed in the coastal waters of Reunion Island and data obtained represent reference values.

Does Abbreviation of Preoperative Fasting to Two Hours with Carbohydrates Increase the Anesthetic Risk?

The objective of the present study was to evaluate the incidence of possible anesthetic complications related with the abbreviation of preoperative fasting to two hours with a solution of 12.5% dextrinomaltose within the ACERTO (from the Portuguese for Acceleration of Total Postoperative Recovery) project. All patients undergoing different types of digestive tract and abdominal wall surgeries within a new protocol of perioperative conducts, established by the ACERTO project, between August 2005 and December 2007 were evaluated. All patients received oral nutritional supplementation (12.5% dextrinomaltose) six and two hours before the procedure. Data were collected prospectively without the knowledge of the professionals in the department. The length of preoperative fasting and anesthetic complications related with the short fasting time (pulmonary aspiration) were recorded. Three hundred and seventy five patients, 174 male (46.4%) and 201 female (53.6%), ages 18 to 90 years, were evaluated. The mean preoperative fasting time was four hours, ranging from two to 20 hours. Pulmonary aspiration was not observed during the procedures. The length of fasting was longer (p < 0.01) when combined anesthesia (blockade + general) was used. Adopting the multidisciplinary preoperative measures of the ACERTO project was not associated with any preoperative fasting-associated complications. Dextrinomaltose is a useful and safe nutritional supplement for the patient.

Current topics in pancreato-biliary endotherapy: what can we do?

Endotherapy is progressing steadily, especially for various pancreato-biliary diseases. This article introduced new procedures and devices, and revealed improvement of treatment outcomes. Biliary covered metallic stent (CMS) has developed, and the indication of CMS placement is changing because of its removability. CMS is effective not only for unresectable biliary malignancies but also for resectable tumors, benign biliary strictures, and benign pancreatic strictures. Drug-eluting CMS can be used as anti-tumor agents. Interventional endoscopic ultrasonography (EUS) has shifted the treatment paradigm because it is possible to approach lesions through the digestive tract wall. The diagnosis and treatment of pancreatic cancer using interventional EUS technique are effective, feasible, and promising. Recently, trans-gastric necrosectomy for an infected pseudocyst was reported as an alternative treatment to surgery. Double- and single-balloon enteroscopy will be performed more frequently to treat the pancreato-biliary disorders in the patients with altered anatomy. Endoscopic papillary large balloon dilation (EPLBD), new procedure to the papilla, can treat large bile duct stones effectively without lithotripsy. This paper introduces current developments in endotherapy to surgeons. These procedures are of very great interest because they alter the treatment algorithms for many pancreato-biliary diseases.

NADPH-diaphorase activity in the digestive system of gastropod molluscs Achatina fulica and Littorina littorea

Localization and peculiarities of NO-ergic elements were studied for he first time throughout the entire length of digestive tract of the marine gastropod mollusc Achatina fulica (Prosobranchia) and the terrestrial molusc Littorina littorea (Pulmonata) by using histochemical method of detection of NADPH-diaphorase (NADPHd). NO-ergic cells and fibers were revealed in all parts of the mollusc digestive tract beginning from pharynx. An intensive NADPHd activity was found in many intraepithelial cells of the open type and in their processes in intra- and subepithelial nerve plexuses, single subepithelial neurons, granular connective tissue cells, and numerous nerve fibers among muscle elements of he digestive tract wall as well as in nerves innervating the tract. NADPHd was also present in receptor cells of he oral area and in the central A. fulica ganglia participating in innervation of the digestive tract. The digestive tract NO-ergic system ofA. fulica has a more complex organization that that of L. littorea. In the A. fulica pharynx, stomach, and midgut, directly beneath epithelium, there is revealed a complex system of glomerular structures formed by thin NADPHd-positive nerve fibers coming from the side of epithelium. More superficially under the main groups of muscle elements, small agglomerations of NADPHd-positive neurons are seen, which could be considered as primitive, non-formed microganglia. Peculiarities of distribution and a possible functional role of NO-ergic elements in the digestive tract of molluscs are discussed as compared with other invertebrate and vertebrate animals.

Gastric femoral hernia in a male cadaver with gastroptosis: case report and review of the literature

The shape and the position of the stomach and its anatomic relations to the round viscera vary from individual to individual, but they also vary in the same subject depending on many factors. The downward displacement of the stomach is called gastroptosis. In the literature, there are only five case reports where the stomach constituted the content of a femoral hernia. The current study presents a case of a gastric femoral hernia in a cadaver along with a review of the relevant literature. During routine dissection of a 67-year-old male cadaver with a very large stomach and gastroptosis, a femoral hernia containing a part of the great curvature of the stomach was found. The length of the hernia sac was 5 cm, and its width was 3.5 cm. There was a disposition of the intestinal coils to the posterior wall and the lesser pelvis. The cadaver's former medical history and skin observation before dissection excluded any previous abdominal surgery. This is the second case of stomach herniation through the femoral ring in a male subject ever reported. The symptoms in this pathology vary from complete absence to symptoms due to high stenosis of the digestive tract, stomach strangulation and stomach wall necrosis.

Submucosal lesions / extrinsic compression of the upper digestive tract: Is it worthwhile to do endoscopic ultrasonography? Is it so in all cases?

Introduction: finding of localised protrusions in digestive tract wall, submucosal lesions (SL) or extrinsic compression (EC), during ultrasound is not unusual and is one indications for carrying out endoscopic ultrasonography (EUS). However, as this exam is not available in the majority of centres and is not without additional costs and risks, the ration of costs to benefits must be examined.

2216 Endoscopic gastric perforation repair with omental patch, using endoscopic clips.

INTRODUCTION - Perforation of the digestive tract wall is a complication of some therapeutic procedures. In such an event, the endoscopic repair is less invasive and its performance has been reported in several cases. On the other hand, the idea of using an omental patch for such repairs has been applied for a long time to the surgical treatment of gastroduodenal ulcer perforation. This study shows the results of combining both techniques and allows to establish a guideline for this kind of repair. METHOD -Ten threecross Large White, Landrace and Pietan pigs were submitted to a standardized gastric perforation procedure by aspiration and cutting, for which a polypectomy snare and an end adapter for endoscopic esophageal varices ligation were used. The omentum (OM) was pulled to the gastric cavity in most cases by aspiration with the endoscope) and then caught with the metallic snare and fixed to the muscular layer of the stomach by endoscopic metallic clips. By changing the position of the snare it was possible to place the clips in any convenient position. This procedure was carried out under general anesthesia. The animals received food on the first day after the operation. They were sacrificed on the 15th postoperative day. RESULTS - Nine animals had a normal postoperative course. In all of them, an ulcer could be seen at the repaired site. On the external side of the wall, the OM was adherent. No other alterations were observed in the peritoneal cavity. The gastric wall histology showed a moderate inflammatory process in these pigs. In one animal whose muscular layer could not be seen during the procedure, the clips attached the OM to the mucosa. This animal died on the 11th postoperative day. Examination of the peritoneal cavity at sacrifice revealed intense peritonitis. The perforation was not repaired in this animal. CONCLUSION - This seems to be a simple and easy technique for EGPR, as safe as the conventional surgery.With the use of antibiotics, the risk of infection could be considered acceptable, especially in view of the advantages offered by a less invasive procedure. It seems to be important to attach the omentum to the muscular layer. The EGPR with a patch of OM seems to be an interesting option to be confirmed by further studies.