Entire Intestine Research Articles

Quality indicators for colonoscopy.

Colonoscopy is widely used for the diagnosis and treatment of colonic disorders. Properly performed, colonoscopy is generally safe, accurate, and well tolerated by most patients. Visualization of the mucosa of the entire large intestine and distal terminal ileum is usually possible at colonoscopy. In patients with chronic diarrhea, biopsy specimens can help diagnose the underlying condition. Polyps can be identified and removed during colonoscopy, thereby reducing the risk of colon cancer. Colonoscopy is the preferred method to evaluate the colon in most adult patients with bowel symptoms, iron deficiency anemia, abnormal radiographic studies of the colon, positive colorectal cancer screening tests, postpolypectomy and postcancer resection surveillance, surveillance in inflammatory bowel disease, and in those with suspected masses. The use of colonoscopy has become accepted as the most effective method of screening the colon for neoplasia in patients over the age of 50 years and in younger patients at increased risk (1). The effectiveness of colonoscopy in reducing colon cancer incidence depends on adequate visualization of the entire colon, diligence in examining the mucosa, and patient acceptance of the procedure. Preparation quality affects the ability to perform a complete examination, the duration the procedure, and the need to cancel or reschedule procedures (2, 3). Ineffective preparation is a major contributor to costs (4). Longer withdrawal times have been demonstrated to improve polyp detection rates, (5‐7) and conversely, rapid withdrawal may miss lesions and reduce the effectiveness of colon cancer prevention by colonoscopy. The miss rates of colonoscopy for large (≥1 cm) adenomas may be higher than previously thought (8, 9) Thus, careful examinations are necessary to optimize the effectiveness of recommended intervals between screening and surveillance examinations. Finally, technical expertise will help prevent complications that can offset any cost benefit ratio gained by removing neoplastic lesions. The following quality indicators have been selected to establish competence in performing colonoscopy and help define areas for continuous quality improvement. The levels of evidence supporting these quality indicators were graded according to Table 1. PREPROCEDURE The preprocedure period encompasses the time from first contact by the patient until administration of sedation or instrument insertion. The aspects of patient care addressed in prior documents apply here as well, including timely scheduling, patient preparation, identification, history and physical examination, appropriate choice of sedation and analgesia, evaluation of bleeding risk, etc. Because many examinations are currently being performed for colon cancer screening and are elective, care must be taken to be certain that all potential risks have been reduced to as low as practically achievable. The American Society for Gastrointestinal Endoscopy (ASGE) (10) and the U.S. Multi-Society Task Force on Colon Cancer have published appropriate indications for colonoscopy (11) (Tables 2 and 3).

The mRNA expression of amino acid transporters, aminopeptidase N, and the di- and tri-peptide transporter PepT1 in the embryo of the domesticated chicken (Gallus gallus) shows developmental regulation

The mRNA expression profile for 10 amino acid transporters, the di-and tri- peptide transporter (PepT1), and aminopeptidase N (APN) during chick embryogenesis was determined. Fertilized eggs were sampled at d 9, 11, 15, 17, 19, and 20 of incubation. Three to 4 embryos were sampled at each time period. At d 9 and 11, the entire intestine was collected due to its undifferentiated appearance. The ceca, duodenum, midgut, and liver were sampled at d 15, 17, 19, and 20. Gene expression was measured using absolute quantitation quantitative reverse-transcription PCR. In the liver, all genes except for PepT1 were expressed at most time points. At d 9, only the expression of Na+-independent cationic amino acid transporter 1, Na+-independent cationic amino acid transporter 2, and excitatory amino acid transporter 3 was detectable in the intestine, but by d 11, all genes associated with transporters of the basolateral surface were expressed, and at higher levels than genes associated with brush border transporters. By d 15, all of the genes tested were expressed in the duodenum, midgut, and ceca at high levels that remained relatively constant until d 20. Statistical analysis shows that at d 15, 17, 19, and 20 there is a significant interaction between the 2 main effects (days of incubation and region of the gut); therefore, it is likely that gene expression in different regions of the gut is dependent on the age of the embryo. At d 9 and 11, the gut may not function in amino acid uptake from the lumen and possibly relies on other structures such as the yolk sac. As the gut matures and protein becomes available in the lumen, amino acid transporters become highly expressed in all parts of the intestine. The data suggest that by d 15 of embryo development the gut may be capable of amino acid absorption.

Goblet Cells and Mucus Types in the Digestive Intestine and Respiratory Intestine in Bronze Corydoras (Callichthyidae: Teleostei).

The structure and histochemical properties of the intestine in bronze corydoras (Corydoras aeneus), a stomach-containing teleost, are described, with emphasis on goblet cells and mucin types. The proximal intestine displayed a normal structure for teleosts, whereas the distal intestine was wide, translucent, thin-walled, richly vascularized and constantly filled with air, suggesting an important respiratory role. Goblet cells were common throughout the entire intestine and displayed a variable, but mainly faint metachromatic colour after toluidine blue. They were moderately coloured by alcian blue at both pH 2.5 and 0.2 and displayed no colour after periodic acid followed by Schiff's solution (PAS), but a distinct purple-brown colour after high iron diamine followed by alcian blue (pH 2.5). Together, these results suggest that the mucin in the intestine goblet cells consists mainly of sulphated proteoglycans. Further, the results from the present lectin and neuraminidase tests suggest that these mucins contain much N-acetylglucoseamines and some N-acetylgalactosamines and sialic acid, but seem to lack glucose and mannose. They also contain some galactose-N-acetylgalactosamines sequences, normally hidden by sialic acid. The distinct brush border and mucus layer on the epithelial cells in the respiratory intestine may indicate some digestive roles, such as absorption of water, ions and simple carbohydrates. As sulphated proteoglycans are tough and attract much water, this mucus may play important roles in the protection against mechanical and chemical damages and in the defence against micro-organisms throughout the entire intestine, but in the respiratory intestine it may impede significantly the oxygen uptake. However, as this part of the intestine usually contains no digesta, but is completely filled with air, frequently renewed by dry air from the atmosphere, and the main function of the mucus may be to protect the respiratory epithelium against a destroying and dangerous desiccation.

P259 Comparative retrospective assessment of prospectively recorded endoscopic and histological findings between CD and GI-TB; the first Eastern European registry data

is recommended as one of imaging techniques for detection of intestinal involvement of CD, but its findings in the deep small intestine have not been well compared to the endoscopic findings. We developed MR enterocolonography (MREC) to assess CD lesions in small intestine and colon simultaneously. On the other hand, device-assisted enteroscopy is able to assess the mucosa in detail, as well as to take histopathological specimen. Additionally, endoscopic therapeutic procedures such as balloon dilatation for stenoses are available. The aim of this study was to evaluate the efficacy of MREC by comparing its findings to those of enteroscopy. Methods: MREC and enteroscopy were performed in the same day in eighty patients. The segmentation and assessment of the endoscopic findings were defined based on modified SES-CD. The terminal ileum was defined up to 10 cm from the ileocecal valve; the proximal ileum was defined as part of bowel extending between the proximal end of the terminal ileum up to 300 cm from the valve; the jejunum was defined as proximal part of small bowel. We summed the three scores of ‘size of ulcers’, ‘ulcerated surface’ and ‘affected surface’, and the active lesions were defined in the following manner; major mucosal lesions (MML: sum 5), all mucosal lesions (AML: sum 1). Major stenoses were defined as the lesions that the scope could not pass through. MREC sensitivity and specificity were studied. Results: The scope was passed in retrograde fashion and reached the proximal ileum in 78 patients (97.1%), the jejunum in 34 patients (42.5%), and the entire intestine in 9 patients (11.3%). In the assessment of active lesions, MREC sensitivities in the colon for MML and AML were 75.0% and 51.0%, while specificities were 91.3% and 94.3%, respectively. MREC sensitivities in the small intestine for MML and AML were 79.2% and 66.0%, while specificities were 89.2% and 95.7%, respectively. As for intestinal damage in the small intestine, MREC sensitivity and specificity for major stenoses were 57.1% and 91.0%, while those for all stenoses were 37.8% and 93.5%, respectively. Conclusions: Our protocol of MREC technique is useful in detecting active lesions in both the small intestine and the colon. However, MR imaging is not sensitive enough in detecting stenosis. Evaluation of active lesions is important to determine medical treatment, while that of intestinal damage is important to determine the indication of surgical or endoscopic treatment. Adequate choice of modalities is required for assessing CD lesions.

Functional morphology of the gut of the tropical house gecko Hemidactylus mabouia (Squamata: Gekkonidae)

The purpose of this study was to characterize morphophysiological aspects of the gut of the gecko Hemidactylus mabouia, a predator species of tiny arthropods. Fourteen adult specimen of the gecko H. mabouia were euthanized and fragments of their small and large intestines were collected and processed according to routine methods for anatomical, topological, histological and histochemical analyses. Histological sections were stained with toluidine blue or submitted to techniques for identification of argyrophil and argentaffin endocrine cells, glycoconjugates and alkaline phosphatase activity. The small intestine of H. mabouia is much more extensive and convolute than the large intestine. There are subtle regional differences along the small intestine, as the tubule diameter and height of the inner folds noticeably decrease from the proximal toward the distal segment. There is no caecum between the small and large intestines and the abrupt change in the caliber marks the transition of the small intestine into the large intestine. The large intestine consists of a very dilated proximal segment followed by a short distal segment. The villi are absent, but the tall folds in the internal covering of the small intestine constitute important amplifier structures of the digestive and absorptive area. No mucosal or submucosal glands were observed along the intestine. The epithelial lining of the entire intestine is simple columnar with enterocytes, mucus-secreting cells and endocrine cells. The enterocytes are abundant in the small intestine and the mucus-secreting cells are abundant in the large intestine, which reflects the functional role of these organs. In sum, H. mabouia has small intestine that is longer than the large intestine, which is consistent with the species being a carnivorous reptile.

Reversible endotracheal tube obstruction caused by meconium acting as a check valve.

Endotracheal intubation is necessary in almost all cases of general anesthesia to maintain the airway. The endotracheal tube (ETT) sometimes causes airway obstruction secondary to secretions or other intraluminal materials, and it may cause hypoxemia and fatal outcomes [1,2]. We herein describe a case of a reversible ETT obstruction caused by meconium acting as a check valve, which was mistaken initially to be leakage from the anesthetic machine. The patient was a 1-day-old male infant (height, 43 cm; weight, 1.7 kg). He was born by cesarean delivery at gestational age 34 +3 weeks due to an omphalocele. The ruptured sac of the omphalocele (approximately 5 cm in diameter) was found at birth, and the emergency operation was planned. Before the surgery, he was already intubated because of meconium aspiration. In the operating room, initial blood pressure and heart rate were 52/32 mmHg and 160 /min, respectively, and SpO2 was 98%. A 3.0 mm uncuffed ETT had been placed at a depth of 8.5 cm, and a small amount of gas leakage was confirmed at the peak inflation pressure of 20 cmH 2O. Both lungs were clear by auscultation, and no secretions drained from the ETT upon suction. The patient underwent pressure-controlled ventilation using the following settings: inspiratory pressure, 15 cmH2O; respiratory rate, 30 /min; I : E ratio, 1 : 2. The tidal volume and end-tidal CO2 (ETCO2) were maintained at approximately 18–20 ml and 32–35 mmHg, respectively. SpO2 was maintained at > 95% during the operation. The surgeon repaired the entire intestine and began to close the abdominal cavity 3 hours after the surgical incision. Capnography showed an obstructive pattern, and ETCO2 increased slightly to 38–40 mmHg with no change in ventilator settings. We suctioned the ETT again using a 6-Fr suction tip, and there was no resistance or secretion. Upon completion of the abdominal closure, the surgeon decided to place an internal jugular venous catheter for postoperative care. The ventilator leakage alarm sounded during venous cut-down. The tidal volume decreased from 20 to 5–7 ml, and ETCO2 decreased to < 10 mmHg. The capnography curve exhibited a blunt concave slope during the expiratory phase. The ETT was confirmed to be positioned correctly, and there was little gas leakage around the ETT. A full examination of the anesthetic machine and breathing circuit, including capnography, revealed no abnormalities, but the SpO2 had decreased to 88%. Upon switching to manual ventilation during examination, we encountered resistance during the inspiratory phase. Chest auscultation revealed inspiratory rales and faint expiratory wheezing in both lung fields. The ETT suction was repeated, but no secretion was seen. The ETT was removed, and we reintubated with another 3.0 mm uncuffed ETT under direct laryngoscopy. The tidal volume was 20–25 ml at an inspiratory pressure of 15 cmH2O, and capnography showed a normal plot. The ETCO2 measured immediately after reintubation was 58 mmHg and decreased to 33–35 mmHg after hyperventilation for 3 minutes. Inspection of the removed ETT revealed thick meconium approximately 2 cm long plugging the distal lumen of the ETT. Additionally, an approximately 0.3 cm-long inspissated meconium was dangling from the superior portion of the inner wall

Wireless transmission method for VGA capsule endoscopy using Manchester encoding

Purpose Recently, technologies related to endoscopes have been rapidly developing with the improvements in electronics and MEMS technology. The human intestine is very long and twisted, and traditional wired endoscopes are able to monitor the entire intestine except for the small intestine. To overcome the limited view of wired endoscopes, the capsule endoscope has been developed. There are some commercial capsule endoscopes and others under development, but these capsule endoscopes have been limited to CIF images, and the image transmission rate is 2 frames per second. To obtain high-quality images, fast wireless communication technology is needed.

An in vitro analysis of intestinal ammonia handling in fasted and fed freshwater rainbow trout (Oncorhynchus mykiss)

Ammonia transport and metabolism were investigated in the intestinal tract of freshwater rainbow trout which had been either fasted for 7 days, or fasted then fed a satiating meal of commercial trout pellets. In vivo, total ammonia concentrations (T amm) in the chyme were approximately 1 mmol L(-1) across the entire intestine at 24 h after the meal. Highest chyme pH and P NH3 values occurred in the posterior intestine. In vitro gut sac experiments examined ammonia handling with mucosal (Jmamm) and serosal (Js amm) fluxes under conditions of fasting and feeding, with either background (control ≤ 0.013 mmol L(-1)) or high luminal ammonia concentrations (HLA = 1 mmol L(-1)), the latter mimicking those seen in chyme in vivo. Feeding status (fasted or fed) appeared to influence ammonia handling by each individual section. The anterior intestine exhibited the greatest Jm amm and Js amm values under fasted control conditions, but these differences tended to disappear under typical post-feeding conditions when total endogenous ammonia production (Jt amm = Js amm - Jm amm, signs considered) was greatly elevated in all intestinal sections. Under fasted conditions, glutamate dehydrogenase (GDH) and glutaminase (GLN) activities were equal across all sections, but the ammonia-trapping enzyme glutamine synthetase (GS) exhibited highest activity in the posterior intestine, in contradiction to previous literature. Feeding clearly stimulated the total rate of endogenous ammonia production (Jt amm), even in the absence of a high luminal ammonia load. This was accompanied by an increase in GDH activity of the anterior intestine, which was also the site of the largest Jt amm. In all sections, during HLA exposure, either alone or in combination with feeding, there were much larger increases in endogenous Jt amm, most of which was effluxed to the serosal solution. This is interpreted as a response to avoid potential cytotoxicity due to overburdened detoxification mechanisms in the face of elevated mucosal ammonia. Thus T amm of the intestinal tissue remained relatively constant regardless of feeding status and exposure to HLA. Ammonia production by the gut may explain up to 18 % of whole-body ammonia excretion in vivo under fasting conditions, and 47 % after feeding, of which more than half originates from endogenous production rather than from absorption from the lumen.

Absence of the superior mesenteric artery in an adult and a new classification method for superior–inferior mesenteric arterial variations

This paper aims to report the complete absence of the superior mesenteric artery (SMA) in an adult and to propose a new classification method for the superior-inferior mesenteric arterial variations (SIMAV). A 69-year-old female was referred for abdominal pain and change of stool habits and characteristics. Multi-detector computed tomography (MDCT) was performed. Based on the CT findings of the patient and previous reports on the abnormalities of the superior-inferior mesenteric arteries, attempt was made to propose a new classification method for SIMAV. MDCT with enhancement revealed complete absence of SMA and compensatory dilation of the inferior mesenteric artery (IMA). Aneurysm of the splenic artery and both inferior phrenic arteries aberrantly arising from the aorta at the same level of the celiac trunk were also noted. Based on our case and literature reports, we were able to propose a new classification method for SIMAV. Without considering the relationship with the celiac arteries, SIMAV can be divided into 4 types. Type I is the normal type or "textbook" type. In type II, SMA is defective and in type III, IMA is defective. In type IV, there is an aberrant middle mesenteric artery (MMA). Complete absence of SMA is extremely rare. However, awareness of such a variation is of great importance during operations for rectal and sigmoid cancer. In such patients, ligation of the trunk of IMA, which is the only artery for the entire intestine, will lead to disastrous consequence. The new classification method may be helpful in the scientific and systematic description of SIMAV.

Grape Exosome-like Nanoparticles Induce Intestinal Stem Cells and Protect Mice From DSS-Induced Colitis

Food-derived exosome-like nanoparticles pass through the intestinal tract throughout our lives, but little is known about their impact or function. Here, as a proof of concept, we show that the cells targeted by grape exosome-like nanoparticles (GELNs) are intestinal stem cells whose responses underlie the GELN-mediated intestinal tissue remodeling and protection against dextran sulfate sodium (DSS)-induced colitis. This finding is further supported by the fact that coculturing of crypt or sorted Lgr5⁺ stem cells with GELNs markedly improved organoid formation. GELN lipids play a role in induction of Lgr5⁺ stem cells, and the liposome-like nanoparticles (LLNs) assembled with lipids from GELNs are required for in vivo targeting of intestinal stem cells. Blocking β-catenin-mediated signaling pathways of GELN recipient cells attenuates the production of Lgr5⁺ stem cells. Thus, GELNs not only modulate intestinal tissue renewal processes, but can participate in the remodeling of it in response to pathological triggers.

Thickened colon wall in follicular lymphoma

A 57-year-old woman was admitted to our emergency room for severe pain in the lower abdomen and lower right thigh. Twenty days previously, she had visited another hospital, which performed fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/ CT) to test for systemic lymphadenopathy. The PET/CT scan revealed systemic lymph node swellings, subcutaneous tumor of the lower right thigh, and diffuse thickened colon wall with high uptake of FDG (Fig. 1). From a tumor specimen from her lower right thigh, she was pathologically diagnosed with follicular lymphoma (FL) grade 2 (Fig. 2a), as immunohistochemical staining was positive for CD10 (Fig. 2b), CD20, and bcl2; partially positive for Ki-67 (15–20 % of tumor cells); and negative for CD3 and CD5 (data not shown). Combination chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone was immediately initiated. After the first cycle of chemotherapy, she achieved partial remission with disappearance of abdominal pain (Fig. 3). As she had severe lower abdominal pain and a significant risk of colonic perforation was expected prior to the chemotherapy, we did not perform endoscopic examination. Although we did not obtain a pathological specimen from the colon lesion, chemotherapy was equally effective for the lymph nodes, the subcutaneous tumor of the thigh, and the colon lesion. Thus, we judged the colon lesion to be an involvement of lymphoma. FL typically involves the lymph nodes, spleen, and bone marrow, and its stage is frequently stage III or IV at diagnosis. Although the duodenum and terminal ileum are considered to be the most commonly affected sites in FL of gastrointestinal tract origin, approximately 70 % of patients have multiple lesions throughout the entire intestine. Patients present with vague symptoms, usually abdominal pain or nausea; however, the largest number of patients has no symptoms. Multiple polypoid lesions of various sizes have been reported, infrequently, in cases of colonic involvement (2 of 80 patients with FL). To our knowledge, there have been no reports describing thickened colon wall as observed in the present case. The course of FL is highly variable, with differences in clinical presentation, histological appearance, clinical course, and response to therapy. Clinically, cases of FL can be divided into those with a prolonged indolent course ‘‘low-grade’’ and those with a more aggressive course ‘‘high-grade’’, although there is no clear demarcation between the two. Our present case might be classified under ‘‘high-grade’’. Physicians should be encouraged to consider the possible involvement of FL when treating patients with diffuse colonic wall thickening and systemic lymphadenopathy.

Abstract 176: Thymoquinone attenuates tumor development in a mouse model of Lynch syndrome.

Abstract Background: Hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) is caused by germline mutations of DNA mismatch repair proteins leading to microsatellite instability (MSI). Nigella sativa oil has known antitumorigenic effects and was identified in an in vitro screen for compounds that reduce microsatellite instability (C. Campregher, unpublished data). Here we used a mouse model for HNPCC (Villin-Cre Msh2loxP/loxP) to test the effect of thymoquinone (TQ), the active ingredient of Nigella sativa oil, on intestinal tumor development. Methods: 60 mice (20 per group) were treated for 10 months with chow containing TQ-low (37.5 mg/kg diet), TQ-high (375 mg/kg diet) or regular mouse chow. Serial tissue sections of paraffin embedded Swiss rolls of the entire intestine were H&amp;E stained and analyzed for tumor multiplicity, incidence and size. As tumor multiplicity in these mice is generally low (1-2 tumors/mouse) serial sections were prepared from the upper-, middle- and lower part of the paraffin block. Tumor size was scored as small, medium or large according to its presence on 1, 2 or all 3 sections of the block. DNA was isolated from microdissected normal intestinal and tumor tissue and tested for MSI by fragment analysis using a panel of six markers (Kabbarah 2003). Data were quantitated as nucleotide shift per marker (NSPM) and compared to germline DNA from mouse tails. Results: Treatment with TQ-low and TQ-high resulted in a significant reduction of tumor incidence from 94.4% to 57.9% (p&amp;lt;0.01) and 55.0% (p&amp;lt;0.006), respectively. TQ-low and TQ-high also reduced tumor multiplicity from 3.1 to 1.4 (p=0.003) and to 0.9 (p&amp;lt;0.001), respectively. The number of small and medium sized tumors was reduced in both treatment groups. The number of large tumors was not affected. Fragment analysis demonstrated global MSI in normal intestinal epithelial cells (on average 1.8 NSPM). TQ-low and TQ-high reduced the global MSI in normal intestinal epithelial cells to 0.9 and 0.9 NSPM, respectively. Tumor DNA displayed generally higher MSI than normal intestinal epithelial cells (2.7, 2.5, and 1.5 NSPM for control mice, TQ-low, and TQ-high, respectively) and was only reduced by TQ-high. Conclusion: In this mouse model of HNPCC TQ reduces the tumor incidence and tumor multiplicity by increasing replication fidelity in the Msh2-deficient intestinal epithelial cells. We propose TQ as a candidate compound for prevention of colorectal cancer in carriers of HNPCC mutations. Citation Format: Benedikt Kortüm, Christoph Campregher, Matthias Pinter, Michaela Lang, Rayko Evstatiev, Vineeta Khare, Melanie H. Kucherlapati, Winfried Edelmann, Christoph Gasche. Thymoquinone attenuates tumor development in a mouse model of Lynch syndrome. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 176. doi:10.1158/1538-7445.AM2013-176

Transepithelial Transport of a Natural Cholinesterase Inhibitor, Huperzine A, along the Gastrointestinal Tract: the Role of Ionization on Absorption Mechanism

During recent years there has been increasing interest in the Lycopodium alkaloid huperzine A as a potential therapeutic agent for neurodegenerative diseases. This study aimed to characterize huperzine A's permeability across the enterocyte barrier along the gastrointestinal tract with an emphasis on the effect of ionization on the drug absorption. Intestinal permeability of huperzine A was evaluated by in vitro Caco-2 and parallel artificial membrane permeation assay models and by the ex vivo Ussing chamber model. The permeability rate was strongly dependent on the degree of ionization and increased with elevation of the donor medium pH in all studied models. The transport of the unionized fraction was similar to the permeability of the markers for passive transcellular diffusion. Addition of the paracellular permeability modulator palmitoylcarnitine in the Caco-2 model led to significant enhancement in the permeability of the ionized huperzine A fraction. No evidence of active transport of huperzine A was detected in this study. The Ussing chamber model experiments showed similar drug permeability along the entire rat intestine. In conclusion, huperzine A permeates the intestinal border mainly by passive transcellular diffusion whereas some fraction, dependent on the degree of huperzine A ionization, is absorbed by the paracellular route. Huperzine A's permeability characteristics pave the way to the development of its oral extended release dosage form. The specific population of the potential users of huperzine A and the high potency of this molecule support the rationale for such a delivery.

Full‐field optical coherence microscopy is a novel technique for imaging enteric ganglia in the gastrointestinal tract

Noninvasive methods are needed to improve the diagnosis of enteric neuropathies. Full-field optical coherence microscopy (FFOCM) is a novel optical microscopy modality that can acquire 1 μm resolution images of tissue. The objective of this research was to demonstrate FFOCM imaging for the characterization of the enteric nervous system (ENS). Normal mice and EdnrB(-/-) mice, a model of Hirschsprung's disease (HD), were imaged in three-dimensions ex vivo using FFOCM through the entire thickness and length of the gut. Quantitative analysis of myenteric ganglia was performed on FFOCM images obtained from whole-mount tissues and compared with immunohistochemistry imaged by confocal microscopy. Full-field optical coherence microscopy enabled visualization of the full thickness gut wall from serosa to mucosa. Images of the myenteric plexus were successfully acquired from the stomach, duodenum, colon, and rectum. Quantification of ganglionic neuronal counts on FFOCM images revealed strong interobserver agreement and identical values to those obtained by immunofluorescence microscopy. In EdnrB(-/-) mice, FFOCM analysis revealed a significant decrease in ganglia density along the colorectum and a significantly lower density of ganglia in all colorectal segments compared with normal mice. Full-field optical coherence microscopy enables optical microscopic imaging of the ENS within the bowel wall along the entire intestine. FFOCM is able to differentiate ganglionic from aganglionic colon in a mouse model of HD, and can provide quantitative assessment of ganglionic density. With further refinements that enable bowel wall imaging in vivo, this technology has the potential to revolutionize the characterization of the ENS and the diagnosis of enteric neuropathies.

705 Gastrointestinal Hemorrhage in a 21-Month-Old Girl in The Course of Lymphoodular Hyperplasia. Case Report

Gastrointestinal hemorrage is an emergency condition requiring immediate diagnostics. Lymphonodular hyperplasia, as a cause of bleeding from the gastrointestinal tract in children, is a rarely observed pathology of unknown etiology....

A case of the large retroperitoneal solitary fibrous tumor

A rare autopsy case of the extremely large retroperitoneal solitary fibrous tumor is reported. A 52-year-old female with a huge abdominal distention was found dead at home. She showed remarkable emaciation. The autopsy revealed a huge retroperitoneal tumor weighing 11.9kg (36×30×20cm in size), which occupied the entire intraperitoneal cavity. Histologically, the tumor consisted of spindle parenchymal cells with fibrous tissues. Immunohistochemically, CD34 was positively stained, whereas S-100, smooth muscle actin, and factor VIII were negative. Her cause of death was diagnosed as emaciation due to the compression of the entire intestine by the tumor. This is a rare case of the extremely large retroperitoneal solitary fibrous tumor, which caused the occasional intestinal obstruction. This disease should be considered in the differential diagnosis of retroperitoneal large tumors that cause accidental deaths in forensic autopsies.

Ghrelin does not affect gastrointestinal contractility in rainbow trout and goldfish in vitro

Ghrelin has been identified in rainbow trout and goldfish, and it has been shown to regulate growth hormone release and food intake in these species as seen in mammals. The aim of this study was to investigate the functional role of ghrelin in regulation of gastrointestinal contractility in both fishes. Neither rainbow trout ghrelin nor rat ghrelin affected the contractility of gastrointestinal strips of rainbow trout. Similarly, goldfish ghrelin-17 and rat ghrelin did not cause marked contraction in the goldfish intestinal bulb. Detail examinations using the goldfish intestine revealed that human neurotensin, substance-P, goldfish neuromedine-U and carbachol showed apparent contractile activities in the intestinal strips. Electrical field stimulation (EFS, 1–20Hz) caused a frequency-dependent contraction of the intestinal bulb. Atropine partially inhibited and tetrodotoxin abolished the EFS-induced contraction. Pretreatments with goldfish ghrelin-17 and rat ghrelin did not modify the EFS-induced contraction. The mRNAs of two types of growth hormone secretagogue receptor (GHS-R), GHS-R1a-1 and GHS-R1a-2, were detected in the goldfish intestine, and the expression level of GHS-R1a-2 was 4-times higher than that of GHS-R1a-1. The expression levels of GHS-R1a-1 and GHS-R1a-2 in four regions of the goldfish intestine (intestinal bulb, intestine-1, intestine-2 and intestine-3) were almost the same. In conclusion, ghrelin does not affect gastrointestinal contractility of the rainbow trout and goldfish, although GHSR-like receptor/GHS-R1a is expressed entire intestine. These results suggest diversity of ghrelin function in vertebrates.

Successful conservative treatment of pneumatosis intestinalis associated with intraperitoneal free air: report of a case

While pneumatosis intestinalis (PI) is a rare condition associated with a wide variety of underlying diseases, PI with intraperitoneal free air and ascites is extremely uncommon and is difficult to distinguish from diffuse peritonitis. We herein describe the case of an 87-year-old male who was admitted to our hospital with abdominal pain, distension and nausea. Abdominal plain radiography and computed tomography revealed intramural air collection in the entire intestine, intraperitoneal free air and ascites. Although we first suspected bowel necrosis and perforation, his physical findings and the properties of the diagnostic abdominal paracentesis did not support this diagnosis. Therefore, we selected conservative management, and the intramural air, intraperitoneal free air and ascites disappeared 1 week later. Recognition of the possible presence of non-surgical PI and intraperitoneal free air, although it is extremely rare, is important to avoid a misdiagnosis and the associated unnecessary surgical intervention.

Phenotype and Polyp Landscape in Serrated Polyposis Syndrome

Serrated polyposis syndrome (SPS), also known as hyperplastic polyposis, is a syndrome of unknown genetic basis defined by the occurrence of multiple serrated polyps in the large intestine and associated with an increased risk of colorectal cancer (CRC). There are a variety of SPS presentations, which may encompass a continuum of phenotypes modified by environmental and genetic factors. To explore the phenotype of SPS, we recorded the histologic and molecular characteristics of multiple colorectal polyps in patients with SPS recruited between 2000 and 2010 from genetics clinics in Australia, New Zealand, Canada, and the United States. Three specialist gastrointestinal pathologists reviewed the polyps, which they classified into conventional adenomas or serrated polyps, with various subtypes, according to the current World Health Organization criteria. Mutations in BRAF and KRAS and mismatch repair protein expression were determined in a subset of polyps. A total of 100 patients were selected for the study, of whom 58 were female and 42 were male. The total polyp count per patient ranged from 6 to 150 (median 30). The vast majority of patients (89%) had polyposis affecting the entire large intestine. From this cohort, 406 polyps were reviewed. Most of the polyps (83%) were serrated polyps: microvesicular hyperplastic polyps (HP) (n=156), goblet cell HP (n=25), sessile serrated adenoma/polyps (SSA/P) (n=110), SSA/P with cytologic dysplasia (n=28), and traditional serrated adenomas (n=18). A further 69 polyps were conventional adenomas. BRAF mutation was mainly detected in SSA/P with dysplasia (95%), SSA/P (85%), microvesicular HP (76%), and traditional serrated adenoma (54%), whereas KRAS mutation was present mainly in goblet cell HP (50%) and in tubulovillous adenoma (45%). Four of 6 SSA/Ps with high-grade dysplasia showed loss of MLH1/PMS2 expression. CRC was diagnosed in 39 patients who were more often found to have a conventional adenoma compared with patients without CRC (P=0.003). Patients with SPS referred to genetics clinics had a pancolonic disease with a high polyp burden and a high rate of BRAF mutation. The occurrence of CRC was associated with the presence of conventional adenoma.

The Effects of Glutamate and Citrate on Absorption and Distribution of Aluminum in Rats

The objective of this study was to evaluate the effect of glutamate (Glu) and citrate (Cit) on the absorption and distribution of aluminum in rats. In the in vitro experiment, 18 adult male Sprague-Dawley rats (average weight of 250 ± 15 g) were randomly divided into three groups. The entire intestine was rapidly removed and cultured in prediction samples of 20 mmol AlCl(3), 20 mmol AlCl(3)+20 mmol Cit, and 20 mmol AlCl(3)+20 mmol Glu, respectively. Liquid in different intestines and the intestines were obtained for Al determination. In the in vivo chronic study, 24 adult male Sprague-Dawley rats (average weight of 127 ± 10 g) were divided into four groups fed with the following diets: no Al and Glu added (control), AlCl(3) (1.2 mmol), AlCl(3) (1.2 mmol) + Cit (1.2 mmol), and AlCl(3) (1.2 mmol) + Glu (1.2 mmol) daily for 50 days, respectively. After rat sacrifice, blood samples were obtained for biochemical analyses, and organ samples like the brain, kidney, liver, and bone were rapidly taken for Al determination. The results showed that the absorption rate of Al with the following order: duodenum > jejunum > ileum in the in vitro study and the administration of AlCl(3)+Cit or AlCl(3)+Glu resulted in significant increases in Al absorption in the three parts of the gut (duodenum, jejunum, and ileum) compared to the AlCl(3) alone group based on wet weight (P < 0.05). There were no differences between the AlCl(3)+Cit and AlCl(3)+Glu groups. In the in vivo chronic study, supplementing either AlCl(3) alone or AlCl(3)+Glu decreased food consumption significantly (P < 0.05) compared with the control group. Compared with the control group, animals fed with the AlCl(3) diet monitored for red blood cell, kidney, and liver showed a higher level (P < 0.05), but did not significantly increase Al retention in the brain and bone (P > 0.05); animals fed with AlCl(3)+Cit diets were monitored for higher Al retention in the brain, kidney, bone, and liver (P < 0.05), while animals fed with AlCl(3)+Glu diets were monitored for red blood cell, brain, and kidney (P < 0.05). Compared with the AlCl(3) group, simultaneous administration of AlCl(3) and Glu led to a significant increase in Al retention in red blood cell, brain, and kidney (P < 0.01) while AlCl(3) and Cit in the kidney and bone (P < 0.01). Simultaneous administration of AlCl(3) and Cit significantly increases plasma malondialdehyde level (P < 0.05); both simultaneous administration of AlCl(3) and Glu or AlCl(3) and Cit led to significant decreases in superoxide dismutase level in the plasma (P < 0.05), while AlCl3 alone did not. The results indicated that both Cit and Glu enhanced Al absorption in the intestine in vitro, and Glu increased Al deposition in red blood cell, brain, and kidney in vivo.