Gastrointestinal Complications Research Articles

Gastrointestinal Complications and Visceral Circulation Changes After Intentional Celiac Artery Embolization During Complex Endovascular Aortic Aneurysm Repair

Gastrointestinal Complications and Visceral Circulation Changes After Intentional Celiac Artery Embolization During Complex Endovascular Aortic Aneurysm Repair

Phentolamine and B vitamins for feeding intolerance in late preterm infants: a randomised trial.

Feeding intolerance (FI) is a common problem in late preterm infants (34 weeks ≤ gestational age < 37 weeks). This study aimed to evaluate the efficacy and safety of phentolamine combined with B vitamins in treating FI in late preterm infants and to explore its effects on gastrointestinal symptoms, inflammation and complications. We randomly assigned 118 late preterm infants with FI to a treatment group (n = 56) or a control group (n = 62). The treatment group received intravenous phentolamine and intramuscular B vitamins, whereas the control group received basic treatment only. We measured the time of disappearance of gastrointestinal symptoms, the time of basal at-tainment, the time of hospitalisation, the incidence of complications, the concentrations of inflammatory markers and the overall effective rate of treatment. The treatment group had a shorter duration of gastrointestinal symptoms than did the control group (p < 0.01). The treatment group also had lower concentrations of inflammatory markers and a higher overall effective rate than did the control group (p < 0.05). There was no difference between the two groups in the time of hospitalisation, basal attainment, weight re-covery and the incidence of complications (p > 0.05). Phentolamine and B vitamins can reduce gastrointestinal symptoms and inflammation in late preterm infants with FI but do not affect the occurrence of complications.

Type 1 diabetes human enteroid studies reveal major changes in the intestinal epithelial compartment

Lack of understanding of the pathophysiology of gastrointestinal (GI) complications in type 1 diabetes (T1D), including altered intestinal transcriptomes and protein expression represents a major gap in the management of these patients. Human enteroids have emerged as a physiologically relevant model of the intestinal epithelium but establishing enteroids from individuals with long-standing T1D has proven difficult. We successfully established duodenal enteroids using endoscopic biopsies from pediatric T1D patients and compared them with aged-matched enteroids from healthy subjects (HS) using bulk RNA sequencing (RNA-seq), and functional analyses of ion transport processes. RNA-seq analysis showed significant differences in genes and pathways associated with cell differentiation and proliferation, cell fate commitment, and brush border membrane. Further validation of these results showed higher expression of enteroendocrine cells, and the proliferating cell marker Ki-67, significantly lower expression of NHE3, lower epithelial barrier integrity, and higher fluid secretion in response to cAMP and elevated calcium in T1D enteroids. Enteroids established from pediatric T1D duodenum identify characteristics of an abnormal intestinal epithelium and are distinct from HS. Our data supports the use of pediatric enteroids as an ex-vivo model to advance studies of GI complications and drug discovery in T1D patients.

Acute and Long COVID Intestinal Changes in an Experimental Model of Coronavirus in Mice

The COVID-19 pandemic, which emerged in early 2020, has had a profound and lasting impact on global health, resulting in over 7.0 million deaths and persistent challenges. In addition to acute concerns, there is growing attention being given to the long COVID health consequences for survivors of COVID-19 with documented cases of cardiovascular abnormalities, liver disturbances, lung complications, kidney issues, and noticeable cognitive deficits. Recent studies have investigated the physiological changes in various organs following prolonged exposure to murine hepatitis virus-1 (MHV-1), a coronavirus, in mouse models. One significant finding relates to the effects on the gastrointestinal tract, an area previously understudied regarding the long-lasting effects of COVID-19. This research sheds light on important observations in the intestines during both the acute and the prolonged phases following MHV-1 infection, which parallel specific changes seen in humans after exposure to SARS-CoV-2. Our study investigates the histopathological alterations in the small intestine following MHV-1 infection in murine models, revealing significant changes reminiscent of inflammatory bowel disease (IBD), celiac disease. Notable findings include mucosal inflammation, lymphoid hyperplasia, goblet cell hyperplasia, and immune cell infiltration, mirroring pathological features observed in IBD. Additionally, MHV-1 infection induces villous atrophy, altered epithelial integrity, and inflammatory responses akin to celiac disease and IBD. SPIKENET (SPK) treatment effectively mitigates intestinal damage caused by MHV-1 infection, restoring tissue architecture and ameliorating inflammatory responses. Furthermore, investigation into long COVID reveals intricate inflammatory profiles, highlighting the potential of SPK to modulate intestinal responses and restore tissue homeostasis. Understanding these histopathological alterations provides valuable insights into the pathogenesis of COVID-induced gastrointestinal complications and informs the development of targeted therapeutic strategies.

Nutritional Issues in Children with Dysphagia

(1) Background: Pediatric dysphagia presents significant nutritional challenges, often impacting growth and development due to reduced oral intake, increased nutritional needs, and gastrointestinal complications; (2) Methods: This prospective quasi-experimental study assessed 117 children under 14 years old (20 patients were under 1 year old, 80 were aged 1–7 years, and 17 were older than 7 years), diagnosed with swallowing disorders, to analyze their caloric, macro-, and micronutrient intake and identify potential deficiencies. The severity of dysphagia was established using functional oral intake scales, and dietary records were reviewed over a 3-day period; (3) Results: The study revealed that 39.8% of participants did not meet their total energy expenditure (TEE), highlighting a high prevalence of malnutrition among these children. Furthermore, patients using feeding devices exhibited a significantly lower caloric intake, and over half required significantly modified food textures. After individualized speech therapy and nutritional rehabilitation, participants showed significant improvements in caloric intake, with their energy coverage increasing from 958% to 1198% of the daily requirement. Rehabilitation also improved tolerance to a broader range of food textures; (4) Conclusions: This research underscores the importance of multidisciplinary, individualized nutritional strategies to address the specific challenges of pediatric dysphagia, emphasizing the role of enteral nutrition and therapeutic interventions in improving the quality of life and nutritional outcomes of these children. Further studies are recommended to assess the long-term impact of such strategies.

#2986 Patiromer for hyperkalemia in the early post-transplant period

Abstract Background and Aims Hyperkalemia is a serious condition among kidney transplant (KT) recipients, which can lead to life-threatening complications such as cardiac arrhythmias. Following kidney transplantation, the causes of hyperkalemia are multifactorial owing to graft function, excess potassium repletion, comorbidities, and medications used in the peri- and post-operative setting. The risk for hyperkalemia is increased immediately post-transplantation, particularly in those with suboptimal graft function and higher calcineurin inhibitors levels. A rapidly rising potassium refractory to medical therapy can be an indication for dialysis. Managing hyperkalemia after kidney transplantation is associated with increased morbidity and healthcare costs. In that manner, newer alternatives such as patiromer and sodium zirconium cyclosilicate have emerged due to their potentially superior efficacy and safety profiles. Method This is an observational, retrospective, single-center study aimed to evaluate the efficacy and safety of patiromer for hyperkalemia management in adult transplant recipients over the first 3 months post-transplant period, between January and December 2022 (since patiromer is available in our hospital pharmacy). We included all the kidney transplant recipients of our hospital, with the exception of those with primary graft failure. Information concerning the donor, recipient, graft, drugs pre and post-transplant, fluid therapy, transfusions, and blood tests (ions, blood gases, glycemia, kidney function measurements, anticalcineurin inhibitors levels) were collected. Patiromer was administered in a single-daily dose, diluted in 250 cc of water, in the afternoon, at least 2 hours separated of other drugs. Results In total, 69 recipients were included in the analysis. 94% were from deceased donors and 54% from donation after cardiac death. The average age of the entire cohort was 55 years and 66% were male. Medical history of each KT recipients reveal that 89% has hypertension, 32% diabetes, and 35% previous cardiopathy. Hypertension treatment before the KT included beta-blockers (39%) and angiotensin-converting enzyme inhibitors (37%). The incidence of hyperkalemia (K ≥ 5.5 mmol/L) was 29.7% in the first three months, mostly in the first week (21.6%). Patiromer was administered to 37% of them. For the 88.5% an initial dose of 8.4 g/day was enough. Although, 27% required an increase of the dose to 16.8 g/day and 8% to 25.2 g/day. The changes in serum potassium levels following the first patiromer dose are shown in Graphic 1. The mean time duration of the patiromer treatment was 14.5 days (3.7-36.7). However, 27% continue with patiromer beyond three months. There was no significant difference in the dose/levels of tacrolimus neither in the serum magnesium levels between patients with or without patiromer. No gastrointestinal complications were observed following the use of patiromer. Conclusion Patiromer may play an important role in the management of hyperkalemia over the first weeks after KT, allowing a significant and sustained reduction of the serum potassium levels, although additional long-term studies are necessary to confirm these effects.

Recent Progress in Innate Immune Responses to Enterovirus A71 and Viral Evasion Strategies

Enterovirus A71 (EV-A71) is a major pathogen causing hand, foot, and mouth disease (HFMD) in children worldwide. It can lead to severe gastrointestinal, pulmonary, and neurological complications. The innate immune system, which rapidly detects pathogens via pathogen-associated molecular patterns or pathogen-encoded effectors, serves as the first defensive line against EV-A71 infection. Concurrently, the virus has developed various sophisticated strategies to evade host antiviral responses and establish productive infection. Thus, the virus–host interactions and conflicts, as well as the ability to govern biological events at this first line of defense, contribute significantly to the pathogenesis and outcomes of EV-A71 infection. In this review, we update recent progress on host innate immune responses to EV-A71 infection. In addition, we discuss the underlying strategies employed by EV-A71 to escape host innate immune responses. A better understanding of the interplay between EV-A71 and host innate immunity may unravel potential antiviral targets, as well as strategies that can improve patient outcomes.

The prevalence and severity of upper gastrointestinal complications among patients with chronic diseases: a cross-sectional study from Palestine

BackgroundMany old people have at least one chronic disease. As a result, multiple drugs should be used. Gastrointestinal complications may occur because of the harmful effects of these chronic drugs on the stomach. The study aimed to assess the prevalence of upper gastrointestinal complications in patients taking chronic medications, the severity of these symptoms, and whether they take any gastro-protective drugs or not.MethodologyThis was a cross-sectional study through face-to-face questionnaires from internal outpatient clinics at a specialized hospital. Patients with chronic diseases who were taking at least one chronic medication were included in the study. Data Collection Form was used to gather information. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to evaluate the severity of the upper gastrointestinal symptoms. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21.ResultsA total of 400 patients with chronic diseases and using multiple medications were included. Among them, 53.8% were females and 56% were married, 58.5% were unemployed, 70% were not smokers, the mean age was 54.7 ± 17.5 years. The most common comorbid diseases among the patients were diabetes, hypertension, and arthritis, with percentages of 44.3%, 38%, and 27.3%, respectively. The mean number of chronic medications used was 3.36 ± 1.6 with a range of 1 to 9. The most commonly used was aspirin with a percentage of 50%, followed by atorvastatin, bisoprolol, and insulin with percentages of 29.5%, 25%, and 20.3%, respectively. Among the 400 participants, 362 (90.5%) suffered from upper gastrointestinal side effects like indigestion (65.8%), heartburn (78.3%), nausea (48.8%), and regurgitation (52.0%). Based on SF-LDQ scoring, of the 400 respondents, 235(58.8%), 109(27.3%) and 18(4.5%) suffered from mild, moderate and severe dyspepsia, respectively. A high percentage 325 (81.3%) of participants were prescribed gastro-protective medications. Proton pump inhibitors were the most prescribed group in 209 (52.3%) patients. Dyspepsia was significantly associated with older age (p-value = 0.001), being educated (p-value = 0.031), not being single (p-value < 0.001), having health insurance (p-value = 0.021), being a smoker (p-value = 0.003), and using ≥ 5 medications (p-value < 0.001).ConclusionUpper gastrointestinal complications among patients with chronic diseases were very common. Fortunately, the symptoms were mild in most cases. The risk increased with age and using a higher number of medications. It is important to review patients’ medications and avoid overuse of them, in addition to use gastro-protective agents when needed.

Epidemiological Study of the Causes of Alcohol Drinks in Cases of Alcohol Poisoning among Patients who Referred to Amir Al-Momenin Hospital in Zabol in 2016-2019

Background: Abuse of substances such as alcohol as a social issue affects the health of human life. In this study, we decided to address the prevalence of alcohol poisoning and its effective factors among patients referred to Amir Al-Momenin Hospital in Zabol. Methods: In this cross-sectional study, 110 patients with alcohol poisoning who had referred to Amir Al-Momenin Hospital in Zabol in 2016-2019 participated. Necessary information was collected through a questionnaire. Finally, the obtained data were statistically analyzed by T-test, Chi-square and Fisher's exact tests. Results: In the present study, 110 patients with alcohol poisoning were included in the study, of which 91 (82.72%) had ethanol poisoning and 19 (17.27%) had methanol poisoning. The mean age of patients was 27.08 ± 3.2 years and 95.45% of them were male. Unemployment and lack of entertainment, mental disorders, alcoholic friends, psychological dependence were the most common causes of alcohol consumption in patients. In this study, decreased level of consciousness (57.27%) and gastrointestinal complications (43.63%) were the most common symptoms of alcohol poisoning in the studied patients. Conclusion: In the present study, male gender was significantly associated with alcohol poisoning (P). While the variables of age, sex and marital status were not significantly associated with the type of ethanol or methanol poisoning. The results of the study showed that male gender, social status and low education of parents, psychological problems and alcohol friends were risk factors and influential factors in alcohol poisoning.

Nutritional Challenges and Treatment After Bariatric Surgery.

Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, common clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcer, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.

Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.

As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function. We prospectively randomized ASA-1 and -2 pediatric spine fusion patients to either a pre-anesthesia carbohydrate drink 2h prior to surgery or to a control group (standard 8h NPO), blinded to surgical team. We documented time to return to flatus, bowel movement, GI symptoms, and comfort scores for 72h post-operatively or until discharge. 62 patients were randomized. There was no significant differences between the groups' pre-operative characteristics, surgical details, nor post-operative morphine dose equivalents, except for EBL (405cc control, 340cc CHO drink, p = 0.044). There were no perioperative complications related to ingestion of the CHO drink. CHO group had a positive trend for earlier return of flatus (21% vs. 3% return at 12h), and comfort scores for anxiety and abdominal pain, but no statistically significant differences. There was no difference in length of stay or time to first bowel movement. There were no complications related to ingestion of a CHO drink 2h prior to pediatric spinal fusion surgery. Further studies are needed to develop a study blinded to the participants with larger sample size. Level of evidenceI.

Effectiveness of a Preoperative Bowel Preparation Protocol for Patients With Adolescent Idiopathic Scoliosis to Decrease Postoperative Gastrointestinal Morbidities and the Hospital Length of Stay.

Randomised controlled trial. This study aimed to determine the effectiveness of a preoperative bowel preparation protocol comprising bisacodyl to minimize postoperative gastrointestinal morbidities and the hospital length of stay for patients with adolescent idiopathic scoliosis. Patients who undergo scoliosis correction surgery frequently experience postoperative gastrointestinal morbidities and a prolonged hospital length of stay. Emesis, paralytic ileus and constipation are the most common gastrointestinal morbidities. Opioid medication is a well-known risk factor for gastrointestinal complications after scoliosis correction surgery. Eighty-seven patients (22 boys [25.3%] and 65 girls [74.7%]) with a mean age of 17.7years (standard deviation [SD], ±2.2 years) diagnosed with adolescent idiopathic scoliosis were enrolled in this study and randomized into 2 groups. Group A comprised 44 patients who received a preoperative bowel preparation comprising bisacodyl. Group B comprised 43 patients who did not receive any preoperative medication. Demographic data, height, weight, medical and surgical comorbidities, Risser status, number of instrumented levels and preoperative opioid consumption of all patients were evaluated. Group A experienced fewer postoperative abdominal symptoms than group B. The mean hospital length of stay was 4.1 days (SD, ±.6 days; median, 4days; range, 3-5days) for group A; however, it was 5.3days (SD, ±.8 days; median, 5days; range, 4-7days) for group B (P = .01). The use of a bowel preparation protocol before scoliosis correction surgery for patients with adolescent idiopathic scoliosis can effectively decrease postoperative gastrointestinal morbidities and the hospital length of stay.

Results of open prosthetics of abdominal aortic aneurysms using laparotomic and retroperitoneal approaches

The OBJECTIVE was to evaluate the results of surgical treatment of abdominal aortic aneurysm using laparotomic and retroperitoneal approaches.METHODS AND MATERIALS. The study included 206 patients operated on at the Department of Vascular Surgery of the Novgorod Regional Clinical Hospital from 2010 to 2018. All patients were divided into 2 groups. The first – 112 people, whose surgical intervention was performed through laparotomic approach. The second – 94 patients, approach to the aorta was made by the retroperitoneal technique according to Rob. comparison of non-specific life-threatening complications included the development of myocardial infarction and acute cardiovascular failure, acute respiratory distress syndrome and respiratory failure, the development of ischemic colitis and small bowel obstruction, which required repeated interventions. The development of acute renal injury was characterized as an increase in creatinine by 50 % from baseline or a decrease in glomerular filtration rate (GFR) by more than 25 %. This group of complications also included ischemic stroke, sepsis, and multiple organ failure. Wound complications included insolvency of postoperative wounds of retroperitoneal and laparotomic approaches, cases of eventration.RESULTS. When analyzing the incidence of nonspecific complications, it was found that in group I their frequency was 41 (46.6 %) clinical cases, and in group II – 26 (27.6 %) (p=0.173*). In group I, the incidence of cardiovascular complications significantly exceeded those in group II – 17 (15.2 %) vs 6 (6.4 %) (p*=0.046). The incidence of gastrointestinal complications was also significantly higher in group I – 9 (8 %) vs 1 (1.06 %) (p*=0.021). The frequency of deaths in groups I and II did not differ significantly in 7 (6.25 %) and 5 (5.3 %) cases (p*=0.77).CONCLUSION. As our study showed, retroperitoneal approach is a worthy alternative to laparotomy, mainly in case of repeated interventions, as well as in the presence of signs of visceral obesity of the patient. At the same time, laparotomic approach is associated with a higher risk of developing cardiovascular and gastrointestinal complications in the treatment of abdominal aortic aneurysms.

"Brain-First" Total Body Retrograde Perfusion and Retrograde Cerebral Perfusion in Hemi-Arch Replacement

Objective: The purpose of this study is to compare the early outcomes of brain-first total body retrograde perfusion (Bf-TBRP) in comparison with reverse cerebral perfusion (RCP) under moderate hypothermia circulatory arrest (MHCA) for hemi-arch replacement surgery. Methods: We analyzed the data of 88 patients who underwent hemi-arch replacement with Bf-TBRP (n = 18) or RCP (n = 70) under MHCA at West China Hospital of Sichuan University between 1 January 2020, and 31 July 2022. In-hospital mortality, neurological deficits, and other adverse events were recorded, which were evaluated with logistic regression to determine risk factors. Results: There was no significant difference between the Bf-TBRP and RCP groups in in-hospital mortality, cardiac events, neurological deficits, dialysis, gastrointestinal complications, and paralysis (p &gt; 0.05). The Bf-TBRP group was associated with significantly shorter hospital stay [Bf-TBRP: 8 d (interquartile range (IQR), 7–10) vs. RCP: 10 d (IQR, 8–13), p = 0.03] and fewer platelet transfusions [Bf-TBRP: 1.0 (IQR, 0–1.0) vs. RCP: 1.0 (IQR, 1.0–2.0), p = 0.05] than the RCP group. On multivariable logistic regression analysis, emergency surgery (p = 0.05) and surgery duration (p = 0.03) were determined to be risk factors. Conclusions: The study showed that Bf-TBRP is a safe technique for patients undergoing hemi-arch replacement with MHCA.

Sigmoid Volvulus: A Rare Complication of Atropine Therapy in a Patient with Organophosphorus Poisoning: A Case Report

Various complications of atropine therapy in cases of organophosphorus poisoning have been reported. Among them, atropine induced paralytic ileus is a serious gastrointestinal complication with very few cases published worldwide. The tendency of over atropinization in organophosphorus poisoning despite regular monitoring is common and may develop life threatening complications as well. This necessitates knowledge, thorough examination, and an experienced approach to aid in treatment and complications management. We have discussed a case of organophosphorus poisoning, with symptoms of atropine toxicity and acute abdominal complication treated with surgical approach in our setting.

Incidence and risk factors of postoperative delirium following hepatic resection: a retrospective national inpatient sample database study

BackgroundPostoperative delirium (POD) is a common complication after major surgery and can cause a variety of adverse effects. However, no large-scale national database was used to assess the occurrence and factors associated with postoperative delirium (POD) following hepatic resection.MethodsPatients who underwent hepatic resection from 2015 to 2019 were screened using the International Classification of Diseases (ICD) 10th edition clinical modification code from the National Inpatient Sample (NIS) Database. Peri-operative factors associated with delirium were screened and underwent statistical analysis to identify independent predictors for delirium following hepatic resection.ResultsA total of 80,070 patients underwent hepatic resection over a five-year period from 2015 to 2019. The overall occurrence of POD after hepatic resection was 1.46% (1039 cases), with a slight upward trend every year. The incidence of elective admission was 6.66% lower (88.60% vs. 81.94%) than that of patients without POD after hepatic resection and 2.34% (45.53% vs. 43.19%) higher than that of patients without POD in teaching hospitals (P < 0.001). In addition, POD patients were 6 years older (67 vs. 61 years) and comprised 9.27% (56.69% vs. 47.42%) more male patients (P < 0.001) compared to the unaffected population. In addition, the occurrence of POD was associated with longer hospitalization duration (13 vs. 5 days; P < 0.001), higher total cost ($1,481,89 vs. $683,90; P < 0.001), and higher in-hospital mortality (12.61% vs. 4.11%; P < 0.001). Multivariate logistic regression identified hepatic resection-independent risk factors for POD, including non-elective hospital admission, teaching hospital, older age, male sex, depression, fluid and electrolyte disorders, coagulopathy, other neurological disorders, psychoses, and weight loss. In addition, the POD after hepatic resection has been associated with sepsis, dementia, urinary retention, gastrointestinal complications, acute renal failure, pneumonia, continuous invasive mechanical ventilation, blood transfusion, respiratory failure, and wound dehiscence / non-healing.ConclusionAlthough the occurrence of POD after hepatic resection is relatively low, it is beneficial to investigate factors predisposing to POD to allow optimal care management and improve the outcomes of this patient population.

Studying the cellular basis of small bowel enteropathy using high-parameter flow cytometry in mouse models of primary antibody deficiency.

Primary immunodeficiencies are heritable defects in immune system function. Antibody deficiency is the most common form of primary immunodeficiency in humans, can be caused by abnormalities in both the development and activation of B cells, and may result from B-cell-intrinsic defects or defective responses by other cells relevant to humoral immunity. Inflammatory gastrointestinal complications are commonly observed in antibody-deficient patients, but the underlying immune mechanisms driving this are largely undefined. In this study, several mouse strains reflecting a spectrum of primary antibody deficiency (IgA-/-, Aicda-/-, CD19-/- and JH -/-) were used to generate a functional small-bowel-specific cellular atlas using a novel high-parameter flow cytometry approach that allows for the enumeration of 59 unique cell subsets. Using this cellular atlas, we generated a direct and quantifiable estimate of immune dysregulation. This estimate was then used to identify specific immune factors most predictive of the severity of inflammatory disease of the small bowel (small bowel enteropathy). Results from our experiments indicate that the severity of primary antibody deficiency positively correlates with the degree of immune dysregulation that can be expected to develop in an individual. In the SI of mice, immune dysregulation is primarily explained by defective homeostatic responses in T cell and invariant natural killer-like T (iNKT) cell subsets. These defects are strongly correlated with abnormalities in the balance between protein (MHCII-mediated) versus lipid (CD1d-mediated) antigen presentation by intestinal epithelial cells (IECs) and intestinal stem cells (ISCs), respectively. Multivariate statistical approaches can be used to obtain quantifiable estimates of immune dysregulation based on high-parameter flow cytometry readouts of immune function. Using one such estimate, we reveal a previously unrecognized tradeoff between iNKT cell activation and type 1 immunity that underlies disease in the small bowel. The balance between protein/lipid antigen presentation by ISCs may play a crucial role in regulating this balance and thereby suppressing inflammatory disease in the small bowel.

Surgical treatment of multiple magnet ingestion by children: A single-center experience from China.

The incidence of magnet ingestion in children has escalated concurrent with the rise in popularity of magnetic playthings, bearing the capacity to induce substantial morbidity. The objective of this study was to encapsulate our accumulated expertise in handling pediatric cases featuring multiple magnetic foreign bodies within the gastrointestinal tract sometimes necessitating surgical intervention, as well as to formulate a clinical management algorithm. This was a retrospective review of patients with multiple magnetic foreign bodies in the digestive tract, admitted to Shenzhen Children's Hospital, between January 2018 and December 2022. A total of 100 cases were included in this study, including 66 males and 34 females. The main clinical manifestation ns were abdominal pain and vomiting. All patients had abdominal x-ray, all of which indicated foreign bodies in the digestive tract. 33 patients had to undergo a surgical intervention. Among these cases, the gastrointestinal complications occurred in 31 patients, including gastric rupture (n = 9), intestinal obstruction (n = 11) and intestinal perforation (n = 30). Postoperative intestinal obstruction occurred in 6 children. There was no statistical significant difference in age and gender between the Surgical group and Non-surgical group, but the Surgical group had a higher number of magnets ([7.5(2-44) vs 4(2-20)], p = 0.009), a longer interval between time of misingestion to clinical visit ([48(7.2-480) vs 5(2-336)]hours, p < 0.001), and a longer length of hospital stay ([10(6-19) vs 2(1-8)]days, p < 0.001). Multiple magnet ingestion in children can lead to serious complications and carry severe risks. Timely diagnosis and effective treatment are crucial for managing such patients.

The effect of abdominal massage and in-bed ROM exercise on gastrointestinal complications and comfort in intensive care unit patients receiving enteral nutrition: A randomized controlled trial.

Abdominal massage facilitates gastric and colonic motility, reduces intra-abdominal distension and increases circulation. In-bed range of motion (ROM) exercise has effects on muscle strength, cardiac parameters and excretion. The aim of this study was to assess the effects of abdominal massage and in-bed ROM exercise on gastrointestinal complications and patient comfort in intensive care patients receiving enteral nutrition. This randomized controlled trial was conducted in the internal intensive care units of two tertiary public hospitals. The sample consisted of 130 patients randomly assigned to three groups (abdominal massage = 44, in-bed ROM exercise = 43, control = 43). The individuals received abdominal massage and in-bed ROM exercises every morning before enteral feeding for 3 days. We assessed gastrointestinal complications and comfort levels of the patients 24 h after each intervention. While the differences in abdominal distention, defecation status, constipation, and gastric residual volume complications were significant (p < .05), there was no significant difference in diarrhea and vomiting (p > .05). Comfort level showed a statistically significant change in the experimental groups in the in-group comparison (p < .05). Abdominal massage and in-bed ROM exercise reduce abdominal distention, constipation and gastric residual volume. Abdominal massage affects the frequency of defecation; and, both interventions increase the comfort while reducing the pain level over time.

Managing gastrointestinal challenges: Diarrhea in sickle cell anemia.

Sickle cell anemia (SCA), a hereditary hemoglobinopathy, is characterized by the presence of abnormal hemoglobin and has long been associated with a wide range of complications. While much attention has been given to the condition hematological aspects, gastrointestinal complications, particularly diarrhea, have been relatively understudied and often overlooked. This publication delves into the management of gastrointestinal challenges, with a focus on diarrhea, in individuals living with SCA. The pathophysiology of SCA is intrinsically linked to gastrointestinal complications, and diarrhea is a common manifestation of this condition. This abstract publication outlines the key elements discussed in the full-length work, which includes the clinical presentation of diarrhea in these patients, the diagnostic tools used to evaluate the condition, and various management strategies to alleviate symptoms and enhance the overall quality of life for affected individuals. The paper emphasizes the importance of patient education, offering healthcare professionals valuable insights into how to inform and support patients in managing their conditions effectively. It also highlights the need for continued research to further our understanding of gastrointestinal challenges in SCA and to identify potential areas for future therapeutic interventions. Ultimately, the comprehensive management of diarrhea in individuals with SCA is vital for their overall well-being. This publication serves as a valuable resource for healthcare providers, researchers, and caregivers in addressing the gastrointestinal challenges that accompany SCA, ultimately working toward a better quality of life for those affected by this condition.