Healthy Bowel Research Articles

Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae

BackgroundIleal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180–360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.MethodsPatients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%).ResultsOver a 12-year period, nine patients were identified; the median age at CPA was 41 (36–44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1–2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn’s disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6–24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up.ConclusionsTransanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.

Association between weight-adjusted-waist index and bowel habits

Obesity has become a global public health issue and is closely related to bowel habits. The Weight-Adjusted-Waist Index (WWI), a new indicator of obesity, provides a more accurate assessment of central obesity. This study aims to investigate the relationship between WWI and bowel habits. The 2005–2010 National Health and Nutrition Examination Survey (NHANES) dataset was used for the cross-sectional survey. Bowel habits were defined by self-report. Multiple logistic regression models were used to test the linear association of WWI with chronic diarrhea and constipation. Fitted smoothed curves and threshold effects analysis were used to characterize nonlinear relationships. Subgroup analyses and interaction tests were used to determine the heterogeneity and stability of the study. This population-based study included 14,238 adults (≥ 20 years). After adjusting for covariates, there was a significant positive association between WWI and chronic diarrhea (OR [95% CI] 1.27 [1.14, 1.41]). There was a non-linear association between WWI and chronic constipation, and we found a breakpoint of 9.77, with a positive correlation on the left side of the breakpoint and no statistical significance on the right side. Subgroup analyses and interaction tests showed stable and consistent results between WWI and bowel habits across the stratification factors. Elevated levels of WWI are associated with an increased risk of chronic diarrhea. A range of WWI < 9.77 is associated with an increased risk of chronic constipation. WWI is a stable valid indicator for assessing intestinal health in U.S. adults, and we should be mindful of the importance of maintaining good levels of body fat in our daily lives to maintain healthy bowel habits.

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease.

Evidence suggests inflammatory mesenteric fat is involved in post-operative recurrence (POR) of Crohn's disease (CD). However, its prognostic value is uncertain, in part, due to difficulties studying it non-invasively. To evaluate the prognostic value of pre-operative radiographic mesenteric parameters for early endoscopic POR (ePOR). We conducted a retrospective cohort study of CD subjects ≥ 12 years who underwent ileocecal or small bowel resection between 1/1/2007 to 12/31/2021 with computerized tomography abdomen/pelvis ≤ 6 months pre-operatively and underwent ileocolonoscopy ≤ 15 months post-operatively. Visceral adipose tissue (VAT) volume (cm3), ratio of VAT:subcutaneous adipose tissue (SAT) volume, VAT radiodensity, and ratio of VAT:SAT radiodensity were generated semiautomatically. Mesenteric lymphadenopathy (LAD, largest lymph node > 10 mm) and severe vasa recta (VR) engorgement (diameter of the VR supplying diseased bowel ≥ 2 × VR supplying healthy bowel) were derived manually. The primary outcome was early ePOR (Rutgeert's score ≥ i2 on first endoscopy ≤ 15 months post-operatively) and the secondary outcome was ePOR severity (Rutgeert's score i0-4). Regression analyses were performed adjusting for demographic and disease-related characteristics to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI). Of the 139 subjects included, 45% of subjects developed early ePOR (n = 63). VAT radiodensity (aOR 0.59, 95%CI: 0.38-0.90) and VAT:SAT radiodensity (aOR 8.54, 95%CI: 1.48-49.28) were associated with early ePOR, whereas, VAT volume (aOR 1.23, 95%CI: 0.78-1.95), VAT:SAT volume (aOR 0.80, 95%CI: 0.53-1.20), severe VR engorgement (aOR 1.53, 95%CI: 0.64-3.66), and mesenteric LAD (aOR 1.59, 95%CI: 0.67-3.79) were not. Similar results were observed for severity of ePOR. VAT radiodensity is potentially a novel non-invasive prognostic imaging marker to help risk stratify CD patients for POR.

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

BackgroundAcute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia.MethodsData from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed.Results59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060–1.888) and surgical time (OR = 1.014, 95% CI: 1.001–1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2).ConclusionsOur analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications’(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.

Laparoscopic Double Discoid Colorectal Resection for the Treatment of Two Distinct Deep Endometriotic Nodules

To show the surgical steps used to perform a laparoscopic double discoid colorectal resection for the excision of 2 distinct deep endometriotic nodules (DENs). Stepwise demonstration of the technique with narrated video footage. To date there is agreement that discoid resection should be the first choice procedure in patients eligible for surgical treatment with rectal, unifocal DENs measuring ≤ 3 cm [1-3]. For surgical management of lesions of the sigmoid colon, current international guidelines suggest to perform segmental resections [3]. Data on surgical treatment of multiple colorectal DENs separated by a great distance from each other are very limited, mostly owing to the rarity of such a diagnosis. In particular, there is paucity of data concerning the efficacy and safety of a double discoid resection for surgical management of distinct DENs found in the sigmoid colon and rectum [4]. In a context of multiple colorectal DENs, the decision-making process with respect to a double discoid excision must take into consideration both the distance between the 2 nodules and the nodules' distance from anal verge. When technically feasible, such organ-sparing surgery allows preserving the healthy bowel interposed between the endometriotic lesions, seeming to offer advantages in terms of quicker return of bowel function and better rectal functional outcomes than segmental colorectal resection. The patient was a 36-year-old woman experiencing drug treatment failure and presenting with refractory constipation, dyschezia, dysmenorrhea, dyspareunia, cyclical abdominal bloating, and chronic pelvic pain. Preoperative ultrasonography revealed the presence of an endometriotic nodule of 19×6×16 mm deeply infiltrating the tunica muscularis of the sigmoid colon. A second DEN was found at the level of the rectum, the latter measuring 19×5×12 mm and having a distance of 9 cm from the anal verge. Both the intestinal lesions resulted to have a circumferential extent of 30%. The distance between the 2 nodules was 15 cm. A 3-dimensional laparoscopy was performed. Sigmoid colon and rectal mobilization were performed according to our standardized technique [5-7]. A 31-mm circular stapler was used to excise first the nodule of the sigmoid colon. The stapler, in its closed position, was gently introduced into the rectum via the anus and then progressively advanced inside the large bowel up to the level of the sigmoid nodule. After correct positioning, the stapler was completely opened and the nodule was imbricate between the anvil and staple housing of the stapler. Then, the stapler was closed and fired. The procedure was repeated using a second 31 mm circular stapler to resect the rectal endometriotic nodule. The overall operative time was 90 minutes. The estimated blood loss was 5 mL. Neither intra- nor postoperative complications occurred. The patient was discharged 3 days after surgery. The sigmoid colon and rectal endometriotic nodules measured, respectively, 20×6×15 mm and 20×5×12 mm on fresh unfixed specimens. Both nodules were found to have endometriosis-free surgical margins on definitive pathology. The operative technique displayed in this video may contribute to the standardization of a procedure, which could be included among the options available in the surgical armamentarium, to be used in selected cases of multiple colorectal DENs each having 3 cm or less in diameter. Surgeon experience and an adequate preoperative evaluation are of utmost importance to plan the operative strategy and have the best chance of surgical success.

MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL

You have accessJournal of UrologyCME1 Apr 2023MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL Amanda Raines, Jennifer Ahn, Nicolas Fernandez, Mark Cain, Byron Joyner, Kathleen Kieran, Margarett Shnorhavorian, and Paul Merguerian Amanda RainesAmanda Raines More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While we know blood supply to catheterizable channels is important to their long term success, there is currently no objective means to assess perfusion. Indocyanine green has a well established use in the evaluation of bowel perfusion, however, use has not been reported in catheterizable channels. Our aims were to develop a standardized protocol for using ICG in the creation of catheterizable channels and establish perfusion patterns of the channels. METHODS: A standardized protocol for the use of ICG in catheterizable channel creation was developed in an adaptive process in this single institution pilot study. Stryker’s SPY PHI system and SPY-QP quantification system were used. SPY-QP allowed for quantification of ICG uptake in the channel relative to healthy bowel. The standardized protocol is described in figure 1. RESULTS: ICG was used in the creation of 3 new appendicovesicostomies and 1 channel revision. Overall, perfusion to the channel decreased with increasing mobilization, but degree of decrease varied between patients. The median ICG uptake went from 85.5% immediately after stapling the appendix to 63.5% when examining the subfascial channel after maturing and 27% at the stoma. In the one revision, ICG clearly delineated an area of poor perfusion in the distal channel after complete mobilization of the channel off the skin and fascial attachments. CONCLUSIONS: The standardized protocol for use in catheterizable channels was successfully implemented. In the channel revision, ICG clearly delineated the area of distal hypoperfusion after channel takedown. ICG can provide surgeons with an objective assessment of channel perfusion rather than relying on subjective assessment alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e228 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Jennifer Ahn More articles by this author Nicolas Fernandez More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Margarett Shnorhavorian More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...

Generation of human colon organoids from healthy and inflammatory bowel disease mucosa.

Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases (IBD) of unknown cause characterized by a relapsing-remitting behavior. Growing evidence supports the idea that the epithelial barrier plays a central role in the pathogenesis of IBD as well as in its evolution over time, thus representing a potential target for novel therapeutic options. In the last decade, the introduction of 3D epithelial cultures from ex vivo-expanded intestinal adult stem cells (ASCs) has impacted our ability to study the function of the epithelium in several gastrointestinal disorders, including IBD. Here, we describe in detail a reproducible protocol to generate Matrigel-embedded epithelial organoids from ASCs of non-IBD and IBD donors using small colonic biopsies, including steps for its optimization. A slightly modified version of this protocol is also provided in case surgical samples are used. With this method, epithelial organoids can be expanded over several passages, thereby generating a large quantity of viable cells that can be used in multiple downstream analyses including genetic, transcriptional, proteomic and/or functional studies. In addition, 3D cultures generated using our protocol are suitable for the establishment of 2D cultures, which can model relevant cell-to-cell interactions that occur in IBD mucosa.

Gut Microbiome-Wide Search for Bacterial Azoreductases Reveals Potentially Uncharacterized Azoreductases Encoded in the Human Gut Microbiome.

The human gut is home to trillions of microorganisms that are responsible for the modification of many orally administered drugs, leading to a wide range of therapeutic outcomes. Prodrugs bearing an azo bond are designed to treat inflammatory bowel disease and colorectal cancer via microbial azo reduction, allowing for topical application of therapeutic moieties to the diseased tissue in the intestines. Despite the inextricable link between microbial azo reduction and the efficacy of azo prodrugs, the prevalence, abundance, and distribution of azoreductases have not been systematically examined across the gut microbiome. Here, we curated and clustered amino acid sequences of experimentally confirmed bacterial azoreductases and conducted a hidden Markov model-driven homolog search for these enzymes across 4644 genome sequences present in the representative Unified Human Gastrointestinal Genomes collection. We identified 1958 putative azo-reducing species, corroborating previous findings that azo reduction appears to be a ubiquitous function of the gut microbiome. However, through a systematic comparison of predicted and confirmed azo-reducing strains, we hypothesize the presence of uncharacterized azoreductases in 25 prominent strains of the human gut microbiome. Finally, we confirmed the azo reduction of Acid Orange 7 by multiple strains of Fusobacterium nucleatum, Bacteroides fragilis, and Clostridium clostridioforme Together, these results suggest the presence and activity of many uncharacterized azoreductases in the human gut microbiome and motivate future studies aimed at characterizing azoreductase genes in prominent members of the human gut microbiome. SIGNIFICANCE STATEMENT: This work systematically examined the prevalence, abundance, and distribution of azoreductases across the healthy and inflammatory bowel disease human gut microbiome, revealing potentially uncharacterized azoreductase genes. It also confirmed the reduction of Acid Orange 7 by strains of Fusobacterium nucleatum, Bacteroides fragilis, and Clostridium clostridioforme.

Kadukkai- Terminalia chebula Retz. (Elixir of Rejuvenation) – A Gift of Siddha Medicine

Aim: Natural products which are gradually gaining importance because of its medicinal value in clinical research due to their well-known property of fewer or no side effects as compared to synthetic drugs. World Health Organization also advised the general public to focus on enhancing their immune system to prevent from getting affected by pandemic diseases.&#x0D; Methodology: In the traditional Siddha system of Medicine, there is a concept known as, ‘Yegha Mooligai Prayogam’ (Yega – single, Mooligai – herb, and Prayogam – application) which deals with single herb and their clinical application. Polyherbal formulation were consisting of herbs, metals, and minerals but, single herb therapy is safe, convenient and economical. The concept of Single herb as a therapeutic agent is widely recognized nowadays. Kadukkai (Terminalia chebula Retz., Family: Combretaceae) possesses a great therapeutic value and it is widely distributed in all over the India. Siddha Kayakarpam (rejuvenation) therapy has been traditionally used in India for its immunomodulatory and adaptogenic effects and more recently has been included as a therapeutic adjuvant for several maladies. Amongst several other herbs, Kadukkai plays an important role in Kayakarpam therapy which balances the three bodily humors (Vatham, Pitham, and Kabam) or doshas that are the main reasons for illness. Kadukkai properties are known to support healthy bowel movements and gut health. Nowadays modern science also recognizes the gut as “the second brain” -perhaps the ancients recognized the relationship between a healthy gastrointestinal (GI) tract and clarity of mind.&#x0D; Conclusion: Thereby, the single herb Kadukkai finds a special place, which has been compared as superior to the nursing mother. This study concluded that the consumption of Kadukkai in a certain way with various adjuvant in respective seasons will boost our immunity and helps to prevent diseases.

758 Unique Case of Recurrent Non-Neutropenic Typhlitis

Abstract Tacrolimus is an important component of the immunosuppressive regime used after solid organ transplantation. It is known to predispose patients to typhlitis also known as neutropenic enterocolitis, which presents with the characteristic triad of abdominal pain, fever, and neutropenia. A 66-year-old lady was referred with vomiting, abdominal pain, and passage of blood per ileostomy. The patient had an extensive medical history including a panproctocolectomy for Crohn's disease, cholecystectomy and a liver transplant. Her immunosuppressive regime included prednisolone, azathioprine, and tacrolimus. Based on her presentation, a presumptive diagnosis of ischemic bowel was made, and non-contrast (due to AKI) CT scan demonstrated evidence of intramural gas with marked mesenteric and portal venous gas. The decision was made to proceed to laparotomy, the findings of which included dense adhesions but with normal healthy small bowel. After several investigations, it was concluded that her symptoms were caused by typhlitis secondary to her tacrolimus therapy. In 2020, the patient presented with similar symptoms. She was able to undergo a contrast-enhanced CT scan during this episode as she had presented early with preserved renal function. Her radiological findings were similar to the previous episode. However, owing to her known past history, she was managed conservatively. To the authors knowledge, no similar cases have been reported so far, which makes this case unique and makes a strong motion for the clinicians to maintain a high suspicion for typhlitis inmmunocompromised patients, even in absence of classical feature of neutropenia

Survey on Untethering of the Spinal Cord and Urological Manifestations among Spina Bifida Patients in Malaysia.

The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood.

Bowel Obstruction Caused by Broad Ligament Hernia Successfully Repaired by Laparoscopy in an Elderly Patient: A Case Report

The most common causes of small bowel obstruction (SBO) are adhesions, Crohn’s disease, neoplasms, and hernias. Internal hernias are rare, and they occur when the small bowel herniates through a defect in the abdominal cavity. The occurrence of internal hernias due to a broad ligament defect is very rare and accounts for 4%-7% of cases of internal hernia.We present a case of a 71-year-old female who was previously healthy with no significant past medical or surgical history and who presented with symptoms of small bowel obstruction. Imaging with X-ray and computed tomography (CT) confirmed the diagnosis, but not the etiology. A decision was made to perform a laparoscopy to manage the obstruction, which revealed a healthy small bowel loop that herniated through a defect in the right broad ligament.Acute abdominal pain due to intestinal obstruction is a relatively common surgical emergency. Internal hernias are the consequence of the herniation of a bowel loop, most commonly the small bowel, through a peritoneal or mesenteric defect into a compartment in the abdominal and pelvic cavity, and they have a high mortality rate than can be higher than 50%. CT imaging is very useful in the diagnosis of internal hernias, although it may not always reveal the etiology. To facilitate wider recognition, broad ligament hernia should be in the differential diagnosis of internal hernias evident in the pelvis on CT imaging.Early recognition of small bowel obstruction caused by broad ligament internal hernia allows for prompt surgical management and vastly facilitates postoperative recovery. Although most surgeons opt for a laparotomy approach to manage such cases, a laparoscopic approach is feasible.

Gastrointestinal reconstruction by intestinal auto-transplantation after radical resection of neoplasms involving superior mesenteric artery: a preliminary consideration

When abdominal neoplasms originating from the pancreas or nearby organs locally involving the superior mesenteric artery (SMA), complete resection is still the only hope for cure. However, SMA resection and reconstruction is a complex surgical procedure associated with high postoperative morbidity and mortality. Intestinal autotransplantation has recently emerged in clinical practice as a treatment option for selected patients with neoplasms involving the SMA. The original procedure involved en bloc removal of a tumor together with the intestine, ex vivo resection and reconstruction of gastrointestinal tract by an intestinal autograft. To further refine this complex procedure, a modified method was developed in which a segmental bowel autograft is selected and harvested first during the initial stage of the operation, and radical resection of the neoplasm is carried out thereafter. The modification would better protect a healthy bowel autograft from potential damage due to prolonged warm ischemia and allow the subsequent lengthy process of dissection to be performed in an unrushed manner. Furthermore, this alteration would better adhere to the general principles of minimal tumor manipulation during operation and potentially decrease the risks of tumor implantation during in vitro organ perfusion. Although intestinal autotransplantation has expanded eligibility for resection of otherwise unresectable lesions involving the SMA, its operative complexity, high risks, and post-operative complications largely limit its clinical applications.

A novel method for measuring bowel motility and velocity with dynamic magnetic resonance imaging in two and three dimensions.

Increasingly, dynamic magnetic resonance imaging (MRI) has potential as a noninvasive and accessible tool for diagnosing and monitoring gastrointestinal motility in healthy and diseased bowel. However, current MRI methods of measuring bowel motility have limitations: requiring bowel preparation or long acquisition times; providing mainly surrogate measures of motion; and estimating bowel-wall movement in just two dimensions. In this proof-of-concept study we apply a method that provides a quantitative measure of motion within the bowel, in both two and three dimensions, using existing, vendor-implemented MRI pulse sequences with minimal bowel preparation. This method uses a minimised cost function to fit linear vectors in the spatial and temporal domains. It is sensitised to the spatial scale of the bowel and aims to address issues relating to the low signal-to-noise in high-temporal resolution dynamic MRI scans, previously compensated for by performing thick-slice (10-mm) two-dimensional (2D) coronal scans. We applied both 2D and three-dimensional (3D) scanning protocols in two healthy volunteers. For 2D scanning, analysis yielded bi-modal velocity peaks, with a mean antegrade motion of 5.5 mm/s and an additional peak at ~9 mm/s corresponding to longitudinal peristalsis, as supported by intraoperative data from the literature. Furthermore, 3D scans indicated a mean forward motion of 4.7 mm/s, and degrees of antegrade and retrograde motion were also established. These measures show promise for the noninvasive assessment of bowel motility, and have the potential to be tuned to particular regions of interest and behaviours within the bowel.

Intraoperative colon perfusion assessment using multispectral imaging.

In colorectal surgery an anastomosis performed using poorly-perfused, ischaemic bowel segments may result in a leak and consequent morbidity. Traditional measures of perfusion assessment rely on clinical judgement and are mainly subjective, based on tissue appearance, leading to variability between clinicians. This paper describes a multispectral imaging (MSI) laparoscope that can derive quantitative measures of tissue oxygen saturation (SO2). The system uses a xenon surgical light source and fast filter wheel camera to capture eight narrow waveband images across the visible range in approximately 0.3 s. Spectral validation measurements were performed by imaging standardised colour tiles and comparing reflectance with ground truth spectrometer data. Tissue spectra were decomposed into individual contributions from haemoglobin, adipose tissue and scattering, using a previously-developed regression approach. Initial clinical results from seven patients undergoing colorectal surgery are presented and used to characterise measurement stability and reproducibility in vivo. Strategies to improve signal-to-noise ratio and correct for motion are described. Images of healthy bowel tissue (in vivo) indicate that baseline SO2 is approximately 75 ± 6%. The SO2 profile along a bowel segment following ligation of the inferior mesenteric artery (IMA) shows a decrease from the proximal to distal end. In the clinical cases shown, imaging results concurred with clinical judgements of the location of well-perfused tissue. Adipose tissue, visibly yellow in the RGB images, is shown to surround the mesentery and cover some of the serosa. SO2 in this tissue is consistently high, with mean value of 90%. These results show that MSI is a potential intraoperative guidance tool for assessment of perfusion. Mapping of SO2 in the colon could be used by surgeons to guide choice of transection points and ensure that well-perfused tissue is used to form an anastomosis. The observation of high mesenteric SO2 agrees with work in the literature and warrants further exploration. Larger studies incorporating with a wider cohort of clinicians will help to provide retrospective evidence of how this imaging technique may be able to reduce inter-operator variability.

Alteration of Gut Microbiota of a Food-Storing Hibernator, Siberian Chipmunk Tamias sibiricus.

Hibernation represents a state of fasting because hibernators cease eating in the torpid periods. Therefore, food deprivation during hibernation is expected to modify the gut microbiota of host. However, there are few reports of gut microbiota in food-storing hibernators that feed during the interbout arousals. Here we collected fecal samples of Siberian chipmunk T. sibiricus to character and examine changes in the gut microbiota at various stages relative to hibernation: pre-hibernation, early-hibernation, mid-hibernation, late-hibernation, and post-hibernation. Compared to the pre-hibernation state, alpha-diversity of gut microbiota was significantly increased during the interbout arousal periods. In addition, beta-diversity of the fecal communities from pre-hibernation and interbout arousal periods grouped together, and post-hibernation gut microbiota resembled the counterpart at late-hibernation. Hibernation significantly decreased the relative abundance of Firmicutes but increased Bacteroidetes, reflecting a shift of microbiota toward taxa in favor of host-derived substrates. The increased abundance of Ruminococcaceae_UCG-014, Lactobacillus, and Christensenellaceae_R-7_group in gut microbiota may help the chipmunks reduce intestinal inflammation and then maintain healthy bowel during hibernation. KEGG pathway indicated that hibernation altered the metabolic function of gut microflora of T. sibiricus.Our study provides evidence that the gut microbiota of food-storing hibernators, despite feeding during the interbout arousals, shows similar response to hibernation that has well documented in fat-storing counterparts, suggesting the potential for a core gut microbiota during hibernation of mammals. Importantly, these results will broaden our understanding of the effects of hibernation on gut microbiota of mammal hibernators.

Assessment of Nerve Fiber Density and Expression of Hormonal Receptors Within Rectosigmoid Endometriosis Nodules

To assess nerve fiber density and expression of hormone receptors in bowel endometriosis. Cross-sectional study. Private hospital. Women with endometriosis undergoing laparoscopic segmental bowel resection (n=54). Tissue samples were obtained from patients with surgically treated rectosigmoid endometriosis. The rectosigmoid specimen containing the endometriosis nodule was manually sectioned and divided into 3 areas: core of the nodule, margin of the nodule, and healthy bowel tissue. The intensity of expression of estrogen and progesterone receptors was evaluated by immunohistochemistry and measured according to the Allred score. Nerve fibers were stained by immunohistochemistry using Protein Gene Product 9.5, and the density of nerve fillets was counted and expressed in number/mm². All glandular and stromal cells stained for estrogen; however, glandular cells stained more strongly than stromal cells (61.1% vs 35.2%; p=.01). Most of glandular and stromal cells stained strongly for progesterone receptors (90.7% vs 98.1%; p=.2). The density of nerve fibers was very high in the margin of the nodule (172.22±45.66/mm²), moderate in healthy bowel tissue (111.48±48.57/mm²), and very low in the core of the nodule (7.31±4.9/mm²); p=.01. Both glandular and stromal cells within the rectosigmoid endometriosis nodule express estrogen and progesterone receptors. Higher intensity of expression of estrogen receptors occurs in glandular cells. The density of nerve fibers is extremely high at the nodule margin and very low in the center of the nodule.

Evaluation of physiochemical characteristics of fresh and osmotic dehydrated fig (Ficus carica L.)

Fig (Fiscus carica L.) fruits being the rich source of phytochemicals, particularly anti-oxidants serve as a powerhouse of nutrients and has many medicinal properties. Fig promoting healthy bowel function due to the high level of fiber. Rich in vitamins A,C,E, and minerals like calcium useful to improve the health status and to balance the pH of the body. Due to its short-lived nature, it cannot be stored for longer period (2-3 days) because higher postharvest losses. The lag in processing of fig is mainly attributed to the highly perishable nature of the fig as it posses high moisture content. The objective of the work was to improve the shelf life and reduce the perishability of fig. Two varieties, namely Local and Timla (Yercud - 1) variety were selected and osmotically dehydrated with different concentration (30, 40 and 50 °brix) of sugar solution. Timla variety contained lower percentage of seeds (21%) and fibre (2.05 g/100g), higher pulp thickness (1.0 cm), maximum colour values (L - 70.30, a - 4.65 and b - 12.37), TSS (19°brix) and vitamin C (39.0 mg/100g) than the local variety. Timla variety treated with 50° brix osmotic solution was found better nutrient retention, drying characteristics and organoleptic properties. The resultant products had improved shelf life and increased concentration of nutrients, making it suitable for processing and value addition.

A nursing innovation to promote healthy bowel functioning in children

<h2>ABSTRACT</h2><h3>Background</h3> Constipation affects up to 30% of children world-wide and if not managed effectively, this condition can progress into adult years. Constipation in children can result in physical and psychosocial concern. One way to help reduce constipation in children is for nurses and health care professionals, who are working with children, to put strategies in place that enable children to gain an awareness of their own bowel functioning and ways to promote healthy stools. <h3>Aim</h3> The aim of this study was to design and implement an educational resource for children between the ages of four and -8 years about healthy bowel functioning and to evaluate its effectiveness from a parent/ caregiver's perspective. <h3>Methods</h3> This study used a convergent mixed methods approach to evaluate the effectiveness of the intervention ‘The Poop it Kit'. Following ethical approval, 15 parents/caregivers were recruited for the study. After a period of 2-4 weeks of using ‘The Poop it Kit' with children, participants were asked to complete a survey as well provide open-ended feedback. <h3>Findings</h3> Results of the survey revealed that ‘The Poop it Kit' was a fun and engaging resource for children. The kit improved children and parents'/caregivers' knowledge about healthy bowel habits and it influenced positive behavioural changes for children in ways to promote healthy bowel functioning. <h3>Discussion</h3> Education to address constipation and ultimately the promotion of healthy bowel functioning begins with parents, caregivers and children feeling open to discuss the topic of poo (faeces) and what makes healthy poo. Nurses play a part in providing that education. Constipation is challenging for the child, and if not managed early can lead to problems such as overflow faecal incontinence. The design of ‘The Poop it Kit' focused on ways to engage children and the resources were beneficial in educating children about healthy bowel habits. <h3>Conclusion</h3> The creation of a resource for children relating to bowel functioning has been a step in the right direction. Improving bowel functioning begins with education. Empowering children with knowledge about their bowels begins with the creation of aged appropriate, fun and engaging resources that children and their caregivers can become immersed in.

Role of dietary fiber in safeguarding intestinal health after pelvic radiotherapy.

Damage to healthy bowel tissue during pelvic radiotherapy can produce devastating and life-long changes in bowel function. The surging interest in microbiota and its importance for our wellbeing has generated a bulk of research highlighting how the food we consume impacts bowel health and disease. Dietary fiber is known to promote bowel health, yet there is a limited number of studies on dietary fiber in connection to pelvic radiotherapy. Here, we review some of the literature on the subject and present the most recent publications in the field. Advice given concerning dietary fiber intake during and after pelvic radiotherapy are inconsistent, with some clinics suggesting a decrease in intake and others an increase. Recent animal studies provide a solid support for a protective role of dietary fiber with regards to intestinal health after pelvic radiotherapy, mainly through its impact on the microbiota. No clinical study has yet provided unambiguous evidence for a similar function of dietary fiber in humans undergoing pelvic radiotherapy. There is a lack of evidence behind the dietary advice given to cancer survivors suffering from radiation-induced bowel dysfunction, and high-quality and well powered studies with long follow-up times are needed.