Ileal Segment Research Articles

Simplified magnetic resonance index of activity score versus simple endoscopic score in Crohn's disease: prospective study

BackgroundTo evaluate the correlation between simplified MR index of activity (sMaRIA) score and simple endoscopic score (SES-CD) in Crohn's disease activity assessment. A prospective study was done on established Crohn's disease patients referred to our institution. Magnetic resonance enterography and colonoscopy were performed as an activity assessment protocol searching for activity signs through calculation of sMaRIA score and SES-CD score and correlation between them. One hundred patients were enrolled in the study in period from July 2021 to July 2022. Patients with isolated upper gastrointestinal Crohn's disease (n = 4) or performed surgery before completion of activity assessment protocol (n = 9) or dropout (n = 18) were excluded. Patients with any age group, with ileal or colonic or ileo-colonic Crohn's disease and completed the protocol were eligible for the study (n = 69).ResultsSixty-nine patients with 345 bowel segments (five segments for each patient: ileum, right colon, transverse colon, left colon/sigmoid and rectum) were completely evaluated: 33 males and 36 females with mean age 29.16 ± 11.37 years. sMaRIA and SES-CD scores were calculated for each patient (global), and each bowel segment showed 97.50% sensitivity and 79.31% specificity at the level of global scores as well as significant positive correlation between the two scores at patient level/overall segments (rs = 0.816, p < 0.001), at ileal segments (rs = 0.704, p < 0.001) and colonic segments (right colon rs = 0.661, p ≤ 0.001, transverse colon rs = 0.586, p ≤ 0.001, left colon rs = 0.731, p < 0.001 and rectum rs = 0.786, p < 0.001). There were good inter-rater agreement between the two radiologists for the three parameters (wall thickness > 3 mm, mural edema and fat stranding) and moderate for mucosal ulcer detection with k value 0.666, 0.712, 0.712 and 0.565, respectively.ConclusionssMaRIA score is considered to be a reliable tool for Crohn's disease activity evaluation as compared to SES-CD.

Carcinoma esophagus with small bowel metastasis: a case report with review of literature.

Small intestinal metastasis is extremely rare and only 13 cases have been reported till date and almost all such patients have presented with intestinal obstruction. The 5-year overall survival for metastatic esophageal cancer is as low as 5% while the patients with small intestinal metastasis have a median survival of only 3months (range 1-12months) despite undergoing radical resection of the small bowel. We present a case of a male in his 50's who presented with difficulty in swallowing for 4months. On evaluation, he was found to have squamous cell carcinoma in the mid thoracic esophagus. He underwent radical chemo-radiation up to 60Gy in 25 fractions over 5weeks. One week after completion of treatment he presented with ileal obstruction and omental nodules and surgical resection and evaluation of the respective ileal segment and omental biopsy revealed a metastatic squamous cell carcinoma. The patient expired 3months post-surgery. Carcinoma esophagus with small bowel metastasis has a very grave prognosis that patients rarely survive beyond 1year despite undergoing resection. Hence it is imperative to consider a small bowel metastasis when such patients present with clinical features of intestinal obstruction for early diagnosis and aggressive management.

Management of urinary incontinence in girls with congenital pouch colon.

This study describes the management of urinary incontinence (UI) in eight girls with congenital pouch colon (CPC) associated with anorectal malformation (ARM). From 2013 to 2015, six girls with CPC and UI underwent bladder neck reconstruction (BNR). Four girls had complete UI (CUI) and two girls partial UI (PUI). From 2019 to 2023, four girls, including two with failed BNR, underwent bladder neck closure (BNC) and augmentation cystoplasty (AC) with a continent stoma. Subtypes of CPC were Complete CPC (n = 7) and Incomplete CPC (n = 1). All girls had a double vagina; short, wide urethra; and reduced bladder capacity with an open, incompetent bladder neck (BNI). During BNR, a neourethra was constructed from a 1.5-2cm-wide and 1.5-3-cm-long trigonal strip. During BNC, AC was performed using a 20cm ileal segment (n = 3) and by a colonic pouch segment, preserved during earlier colorraphy (n = 1). Continent stoma included a Monti's channel (n = 3) and appendicovesicostomy (n = 1). BNR produced moderate improvement of UI (n = 2), while UI was still very severe (n = 4). During BNC, intraoperative complications included iatrogenic vaginal tears (n = 4). Early complications included partial dehiscence of the ileocystoplasty (n = 1), partial adhesive small bowel obstruction (n = 1), and difficulty in stomal catheterization with prolonged drainage from the pelvic drain (n = 1). Late complications included unilateral grade II vesicoureteric reflux (n = 2) and vesicovaginal fistula (VVF) (n = 2) needing trans-vaginal closure in one girl. Urinary stones (n = 2) with stomal leakage of urine in one girl needed open cystolithotomy twice (n = 1), and endoscopic lithotripsy (n = 1). At follow-up, all patients have high overall satisfaction with the procedure and their continence status. BNC with AC and a catheterizable stoma satisfactorily achieves continence in girls with CPC and UI, vastly improving quality of life. If lower urinary tract (LUT) anatomy is favorable, BNR with/without AC can be the initial surgical procedure. BNC should be the primary procedure in girls with unfavorable LUT anatomy and for failed BNR. IV.

Preparation and intestinal absorption mechanism of self-assembled nanoparticles of Herpetospermum caudigerum

In this experiment, the micro-precipitation method was used to prepare self-assembled nanoparticles of Herpetospermum caudigerum Wall.(MP-SAN). The process was optimized using average particle size and polydispersity index(PDI)as evaluation indexes. The mean particle size, PDI,zeta potential, and microstructure of MP-SAN were characterized. The intestinal absorption mechanism of dehydrodiconiferyl alcohol(DA)and herpetrione(Her)in MP-SAN was investigated through single-pass intestinal perfusion in rats. The optimized process parameters for producing MP-SAN were a stirring speed of 800 r·min~(-1),stirring time of 5 min, and rotary evaporation temperature of 40℃. The resulting MP-SAN exhibited a spherical-like structure and uniform morphology, with a mean particle size of(267.63±13.27) nm, a PDI of 0.062 0±0.043 9,and a zeta potential of(-46.18±3.66) mV. The absorption rate constant(K_a)and apparent permeability coefficient(P_(app))of DA in the ileal segment were significantly higher than those in the jejunal segment(P&lt;0.05). However, there was no significant difference in the absorption of Her between the ileal and jejunal segments. Intestinal absorption parameters of DA and Her tended to increase with increasing drug concentration. Specifically, the K_a and P_(app) of DA in MP-SAN in the high-concentration group were significantly higher than those in the low-concentration group(P&lt;0.01). The addition of verapamil, a P-glycoprotein inhibitor, did not significantly affect the intestinal absorption of DA and Her. However, the absorption of both DA and Her in MP-SAN was significantly increased by the addition of indomethacin(P&lt;0.05),suggesting that DA and Her may be substrates for multidrug resistance-associated protein 2.

Ileo-caecal doughnut bladder augmentation in children with exstrophy– epispadias complex- a study of 100 cases

The small bladder in failed exstrophy needs to be augmented and also accommodate bladder neck surgery, ureteric re-implantations and a catheterizable channel. We present a novel method of ileocecal bladder augmentation providing a non-implanted, un-detached appendicular channel, rendered non refluxing by an ileal "fundoplication". The colonic segment could receive ureteric reimplantation when bladder plate is unsuitable. Operative technique: Bilateral cephalo-trigonal reimplantation and bladder neck surgery is done. The ileocecal segment is isolated and arranged as a ring (doughnut) around the un-detached appendix which is made to pass behind the terminal ileum, through the ileal mesentery and then in front of the ileum as it exits as a catheterizable channel. The bowel segment is opened on the antimesenteric aspect except for the retro appendiceal ileal segment. The opened ileo-caecum is reconfigured as a de-tubularised augmentation pouch while the retro appendiceal ileal segment is wrapped around the appendix like a fundoplication. The colon segment may receive the ureteric reimplantation if required. 100 children (mean age 6.3 years) with failed exstrophy underwent doughnut augmentation (3 neobladders) in 2006-2021. Ninety eight were incontinent, with 30 open/dehisced bladder plate, 48 units were hydronephrotic (HUN), 105 ureters were refluxing (VUR) and eGFR was subnormal in 20 children. 79 children underwent YDL bladder neck plasty and 23 underwent bladder neck closure (primarily in 18). Three infants with HUN did not undergo bladder neck surgery. 126 ureters were reimplanted into the bladder, 44 into the colon segment while 30 were not reimplanted. 95 children are continent on CIC, which was gradually introduced starting with once or twice daily change of indwelling Mitrofanoff catheter leading to regular 3-4 hourly CIC as the child became confident. The appendicular channel was easily catheterizable without any leak in 95, had minor issues in 4 while one necrosed and replaced by a gastric tube. HUN recovered (25/48) or stabilized with a significant reduction in the grade of hydronephrosis (p=0.001). VUR resolved in 90% of bladder reimplants, 85% of colonic reimplants and 70% of non-reimplanted ureters. In the 20 children with compromised renal function eGFR improved (71-106 ml/m2/min) significantly (p=0.036) at follow up (mean 5 years). Urodynamics study (N=33) showed a mean capacity of 95% of expected bladder capacity (EBC) with end filling pressure less than 25cm of water (Mean end filling cystometric pressure=15cm of water). Complications included adhesive intestinal obstruction (N=16) and bladder calculi (N=12). The doughnut ileocecal augmentation provides a easily catheterizable, non-refluxing, appendicular channel, not requiring isolation of the appendix nor its reimplantation into the bladder. The colonic segment can provide a bed for ureteric reimplantation. Dryness with a good capacity bladder and preserved upper tract is achieved.

Smooth muscle contractile responses to bile acids in mouse ileum require TGR5 but not ASBT.

Many disorders of gut-brain interaction (DGBIs) are more prevalent in women than men and feature alterations in gastrointestinal motility and bile acid homeostasis. Mechanisms by which bile acids regulate gastrointestinal motility are poorly characterized. We recently validated an adapted tissue bath technique using everted mouse ileum, which revealed differential contractile responses to ursodeoxycholic acid (UDCA) and deoxycholic acid (DCA). Here, we aimed to determine whether these responses are dependent on host sex, the plasma membrane bile acid receptor TGR5, or the apical sodium-dependent bile acid transporter ASBT. Ileal segments from male and female mice were everted and suspended in tissue baths. Contractile responses to physiologic concentrations of UDCA and DCA were quantified with or without TGR5 or ASBT inhibitors. Phosphorylation of extracellular signal-regulated kinase (ERK) and myosin light chain (MLC), markers of TGR5 activation and smooth muscle contraction, respectively, were assessed with western blot. There were no sex differences in the dose-dependent contractile responses to bile acids. At 100 μmol/L, UDCA but not DCA increased MLC phosphorylation and increased contractility. TGR5 inhibition decreased ERK phosphorylation and led to decreases in contractility, phosphorylated MLC, and surprisingly, total MLC. ASBT inhibition did not affect contractile responses. Differential effects of UDCA and DCA on ileal smooth muscle contractility are not dependent on host sex or ASBT-mediated transport. Bile acids signal through mucosal TGR5, which regulates smooth muscle contractility by complex mechanisms. Understanding how bile acids differentially regulate gastrointestinal motility could facilitate new therapeutic options for specific DGBIs.

Jejunoileal atresia and multiple ileal diverticulae in a twelve-day-old infant: A Case Report

A twelve-day-old neonate presented with persistent bilious vomiting and dehydration. A transverse supraumbilical laparotomy was done. Later, he died and autopsy was done. A jejunoileal segment and several other ileal segments were collected. The jejunoileal segment was dilated. It measured 11 cm in length and had a blind end. One of the ileal segments measured 16 cm in length. Ileum showed multiple small diverticulae at the mesenteric border and each diverticula measured 3 to 4 mm in length. Lumen of ileum appeared collapsed or strictured. Further, the lumen of diverticulae contained soft eosinophilic material. He was finally diagnosed as a case of jejunoileal atresia associated with multiple terminal ileal diverticulae. Keywords: Jejunoileal dilatation multiple ileal type IV diverticulosis.

P457 Small bowel involvement proximal to the terminal ileum is a major risk factor for intestinal resection in patients with small bowel Crohn’s disease

Abstract Background The current Montreal classification categorizes Crohn's disease (CD) with small bowel involvement into two groups: L1 and L3. The study aimed to investigate the significance of small bowel involvement proximal to the terminal ileum as a significant risk factor for intestinal resection. Methods We conducted a retrospective review of the medical records of Crohn's disease patients diagnosed between January 2001 and December 2020 at Seoul St. Mary's Hospital, St. Vincent Hospital, and Eunpyeong St. Mary's Hospital. The extent of small bowel involvement was independently assessed by two experienced gastrointestinal radiologists using conventional CT, CT enterography, or MR enterography at the time of diagnosis. The terminal ileum was defined as the distal ileal segment within 10 cm from the ileocecal valve and the jejunum was defined as the proximal 1/2 of the small intestine beyond the ligament of Treitz. Radiologic disease activity and fibrostenosis at the time of diagnosis were also scored as 0, 1, and 2 using Maglinte classification, respectively. Results Out of 617 CD patients, 346 were included in the study, while 271 were excluded due to radiologic noninvolvement of the small bowel, inadequate or missing radiologic data, initial diagnosis made at another institution, or diagnosis through surgery. Median age at diagnosis was 24 years (range 10-76) and 250 (72.3%) were male. The median follow-up duration was 53 months (4-201). During the follow-up period, 43 patients (12.4%) underwent intestinal resection. Small bowel involvement proximal to the terminal ileum was significantly associated with a higher cumulative risk of intestinal resection (15.4% vs. 3.5%, P=0.006). Neither jejunal involvement or colonic involvement (L3 vs. L1) showed a significant association with cumulative risk of intestinal resection (16.0% vs. 11.1%, P=0.222; 12.4% vs. 12.4%, P=0.773). Radiologic disease activity and fibrostenotic score at the time of diagnosis were significantly associated with the cumulative risk of intestinal resection, respectively (0% vs. 4.4% vs. 19.7%, P&amp;lt;0.001; 8.5% vs. 16.7% vs. 28.2%, P&amp;lt;0.001). Conclusion Small bowel involvement proximal to the terminal ileum was a major risk factor for requiring intestinal resection in patients with small bowel CD, while jejunal involvement was not. These findings suggest a need for subclassifying small bowel CD.

Preferential meropenem absorption activated by 1α,25-dihydroxyvitamin D3 and shared with foscarnet, a phosphate transporter substrate, in the rat ileum

Meropenem (MEPM) is used for the treatment of serious infectious diseases solely as. InjectableTherefore, the development of an oral formulation would expand its clinical utility. To this end, an exact understanding of the absorption characteristics of MEPM is essential. In this study, MEPM absorption in the rat small intestine was investigated using an in situ loop technique and an in vitro diffusion chamber method. The disappearance ratios of MEPM (0.1 mM) were in the order of ileum > duodenum > jejunum. The extensive MEPM disappearance in the ileum was significantly reduced in the presence of foscarnet, a Na+-dependent phosphate transporter (NaPi-T) substrate, whereas glycylsarcosine, thiamine, taurocholic acid, and biapenem had no effects. The mucosal-to-serosal (M-to-S) permeation of MEPM across the rat ileal segments was very small under normal experimental conditions. However, on addition of 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3) to the experimental medium, the M-to-S permeation of MEPM markedly increased, showing a more than 7-fold greater apparent permeation coefficient. The present results suggest that MEPM is preferentially absorbed in the rat ileum, sharing with foscarnet, and that 1,25(OH)2D3 potentially activates the absorption of MEPM there. A likely candidate for involvement in MEPM absorption was NaPi-T or a related transporter.

Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction

Background:: Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined. Objective:: This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis. Methods:: We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter. Results:: Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity. Conclusion:: Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

Meckel’s diverticulum with varied clinicopathological presentations: A case series at a rural tertiary care center

Meckel’s diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited “rule of 2s” regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally.

Management of Metastatic Primary Renal Synovial Sarcoma with Inferior Vena Cava Thrombus: A Rare Case Report

Synovial sarcomas constitute 5-10% of all soft-tissue sarcomas and tend to occur in the extremities, particularly the lower extremity. Renal sarcoma is a rare entity, constituting approximately 1-5% of all malignant renal tumours. Metastatic large renal synovial sarcoma with Inferior Vena Cava (IVC) thrombus is a rare surgical challenge that demands thorough preoperative evaluation and planning for its management. A 31-year-old young male presented with symptoms of left flank pain for 10 days, with a past history of similar complaints two years prior. On examination, a massively large renal mass was palpable. A Computed Tomography (CT) scan showed an IVC thrombus and metastatic deposits. The patient underwent a radical nephrectomy with ileal segment resection, followed by chemotherapy, which showed near-complete resolution of the metastatic deposits. Renal synovial sarcoma should be considered as a differential diagnosis in young patients presenting with a metastatic, exceptionally large renal mass complicated by an IVC thrombus, necessitating thorough preoperative evaluation for effective management.

Reliability and Responsiveness of Histologic Indices for the Assessment of Crohn’s Disease Activity

The operating properties of histologic indices for evaluating Crohn's disease (CD) activity are poorly characterized. We assessed the reliability and responsiveness of existing histologic indices/items used in CD and ulcerative colitis (UC), in addition to 3 novel items, and developed exploratory ileal, colonic, and colonic-ileal CD instruments. Blinded central readers independently reviewed paired baseline and week 12 image sets from the EXTEND trial. Disease activity was scored using 4 indices (the Global Histologic Activity Score, Geboes Score, Nancy Histological Index, and Robarts Histopathology Index) and 3 items identified by an expert panel (mucin depletion, basal plasmacytosis, and ileal pyloric gland metaplasia). Reliability and responsiveness were quantified using the intraclass correlation coefficient (ICC) and area under the receiver operating curve (AUC), respectively. Exploratory indices were developed using backward stepwise linear regression analysis. Candidate independent variables were items with an inter-rater ICC ≥0.40 and AUC ≥0.56. The dependent variable was histologic disease activity measured by a 100-mm visual analogue scale. Paired image sets were available from 55 patients. Substantial to almost perfect inter-rater reliability (ICC, 0.63-0.87) and some responsiveness (AUC, 0.57-0.94) were observed for all existing indices regardless of whether individual colonic and ileal segments, combined colonic segments, or combined colonic and ileal segments were assessed and the calculation method used. Five items were tested as candidate items, and exploratory colonic, ileal, and colonic-ileal indices were developed. CD and UC indices were similarly reliable and responsive in measuring histologic CD activity. Exploratory index development did not offer benefit over current histologic instruments.

Fish: A Promising Screening Tool for Malignancy After Augmentation Cystoplasty?

IntroductionMalignancy after augmentation cystoplasty (AC) is reported up to 5.5 %. We assessed the use of urine fluorescence in situ hybridization (FISH) screening for bladder malignancy after AC. Patients and methodsIn this study, 36/98 patients under follow-up who have completed tenth year after ileal AC were included prospectively. Twenty-four (66.7 %) patients were tested with FISH initially and overall 28 (77.8 %) patients with conventional cytology (CC). Twenty-four (66.7 %) patients with FISH analysis also had cytology analysis. Blinded from the cytology results, 32 (88.9 %) patients who were consented underwent cystoscopy with random biopsy (native bladder, ileal segment, ileovesical junction). Two patients those were tested with FISH did not consented cystoscopy. This study was registred to the government registry (No: 71146310). ResultsMean follow-up time after AC was 15.4 ± 4.8 years. 2/32 (5.6 %) patients were diagnosed with adenocarcinoma in cyctoscopic biopsy. FISH analysis of 3/24 (12.5 %) patients demonstrated abnormal findings consistent with malignancy. Two FISH malignant patients were patients who had adenocarcinoma. The third patient's biopsy was benign and the third year control cystoscopy was normal. 2/4 patients with malignant CC had adenocarcinoma and 2/4 patients had benign biopsy. The sensitivity and specificity of FISH in our series were 100 % and 95 % respectively. Whereas the sensitivity and specificity of CC was 100 % and 91.6 % respectively. ConclusionDespite limited number of patients in this study, FISH showed higher specificity than CC in this series. FISH is a promising tool for malignancy screening after AC. Type of StudyDiagnostic Studies. Level of EvidenceII.

PSXIII-7 Effect of Dietary Supplementation of Lactobacillus Rhamnosus on Blood Profiles, Intestinal Morphology, Immune Responses, and Gene Expression of Tight Junction Proteins and Cytokines of Weaned Pigs

Abstract Dietary probiotics were used in the animal feeds because of the beneficial effect of improving gut health and immune responses as one of the potential alternatives to antibiotics. This study was conducted to evaluate the effect of dietary supplementation of Lactobacillus rhamnosus (ILDONG Bioscience Co. Ltd., Pyeongtaek, Republic of Korea) on blood profiles, small intestinal morphology, immune responses, and gene expression of tight junction proteins and inflammatory cytokines in ileum of weaned pigs. A total of 40 weaned pigs [6.21 ± 0.55 kg of initial body weight (BW); 28-day old] were allotted to 2 dietary treatments (4 pigs/pen; 5 replicates/treatment) in a randomized complete block design (block: initial BW) and fed for 4 weeks. Dietary treatments were 1) a commercial basal nursery diet (CON), and 2) CON + 0.02% Lactobacillus rhamnosus IDCC 3201 (PRO). The blood samples were collected from randomly selected 1 pig per pen on day 1, 7, 14, and 28 for blood profiles and immune responses. On the last day of experiment, the pigs were euthanized to collect duodenal, jejunal, and ileal segments for intestinal morphology and gene expression analysis. Intestinal morphology was measured villus height, width, area, crypt depth, villus height to crypt depth ratio, and number of goblet cells by hematoxylin and eosin staining method. The blood profiles were measured by using an automated hematology analyzer. The serum samples were used to measure concentrations of cytokines and cortisol by using porcine immunoassay ELISA kits. The gene expression of tight junction proteins and cytokines were measured by qRT-PCR. Data were analyzed by PROC GLM procedure of SAS. Experimental unit was a pen. Statistical model for blood profiles, immune responses, and intestinal morphology included dietary treatment as a main effect and initial BW as a covariate. The t-test was used for ileal gene expression. Pigs fed PRO had lower (P &amp;lt; 0.05) platelet level, crypt depth in duodenum and ileum, serum tumor necrosis factor-α (TNF-α), and interleukin-6 than those fed CON. The pigs fed PRO downregulated (P &amp;lt; 0.05) TNF-α and interleukin-8 genes compared with those fed CON, but upregulated (P &amp;lt; 0.05) claudin-1 and claudin-2 genes. In conclusion, probiotic Lactobacillus rhamnosus supplementation in nursery diet improved gut health through modulating blood profiles and immune responses, enhancing intestinal morphology, and regulating tight junction protein genes expression in ileum of weaned pigs.

Safety of the strategy of minimizing intestinal resection during surgery for pelvic radiation- induced terminal small intestinal stenosis

Objective: To investigate the efficacy of strategies for minimizing small bowel resection during surgery for pelvic radiation-induced terminal small intestinal stenosis in preventing postoperative complications such as anastomotic leakage and short bowel syndrome. Methods: This was a retrospective cohort study. There are two subtypes of chronic radiation enteritis (CRE) with combined intestinal stenosis and intestinal obstruction: (1) Type I: terminal ileal lesions with a normal ileal segment of 2-20 cm between the ileal lesion and ileocecal junction; and (2) Type II: the lesion is located in the small bowel at a distance from the ileocecal region, usually accompanied by extensive damage to the bowel segments outside the lesion. The indications for minimal bowel resection are as follows: (1) diagnosis of Type I small bowel CRE; (2) absence of radiological evidence of rectosigmoid damage; and (3) absence of colonic obstruction. The contraindications are: (1) stenotic, penetrating lesions of the distal cecum; (2) emergency surgery; (3) recurrence of malignant tumor or history of radiotherapy for recurrent malignant tumor; (4) interval between radiotherapy and surgery <6 months; and (5) history of preoperative small bowel resection or abdominal chemotherapy. Case data of 40 patients with Type I CRE who met the above criteria and had undergone minimal bowel resection between April 2017 and December 2019 were retrospectively analyzed (minimal bowel resection group; including 13 patients from Jinling Hospital, 16 from the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and 11 from the Affiliated Hospital of Xuzhou Medical University). Forty patients with Type I CRE who had undergone resection of intestinal stenosis lesions and the ileocecal region between October 2015 and March 2017 were included as historical controls (conventional resection group; all from Jinling Hospital). The specific strategy for minimal bowel resection was one-stage partial ileal resection+ileo anastomosis+protective small bowel stoma. In contrast, conventional resection comprised ileocecal resection+ileocecal-ascending colon anastomosis. Postoperative complications, intraoperative and postoperative recovery, and changes in postoperative quality of life were analyzed in both groups. The severity of postoperative complications was assessed by Clavien-Dindo and the Comprehensive Complication Index (CCI). Karnofsky performance scores (KPS) were used to evaluate the quality of life of patients in the two groups preoperatively and postoperatively. The higher the KPS score, the better the quality of life. Results: Baseline patient characteristics did not differ significantly between the two groups (P>0.05). Compared with the conventional resection group, the length of small bowel resected in the minimal bowel resection group (51 [20-200] cm vs. 91 [60-200] cm, Z=5.653, P<0.001), duration of postoperative total enteral nutrition [9 (3-18) days vs. 12 (4-50) days, Z=2.172, P=0.030], and duration of postoperative hospital stay [17 (9-24) days vs 29 (13-57) days, Z=6.424, P<0.001] were shorter; all of these differences are statistically significant. The overall incidence of postoperative complications was lower in the minimal bowel resection group than in the conventional resection group [20.0% (8/40) vs. 70.0% (28/40), χ2=19.967, P<0.001], These comprised short bowel syndrome [5.0% (2/40) vs. 25.0% (10/40), χ2=6.274, P=0.012], anastomotic leakage or fistula [2.5% (1/40) vs. 22.5% (9/40), χ2=7.314, P=0.014], and pleural effusion [7.5% (3/40) vs. 25.0% (10/40), χ2=4.500, P=0.034], all of which occurred less often in the minimal bowel resection than conventional resection group. The CCI index was also lower in the minimal bowel resection group than in the conventional resection group [CCI>40: 2.5% (1/40) vs. 12.5% (5/40), Z=18.451, P<0.001]. KPS scores were higher in the minimal bowel resection group 1 and 3 months postoperatively than they had been 1 day preoperatively (79.9±4.7 vs. 75.3±4.1, 86.2±4.8 vs. 75.3±4.1, both P<0.05). In the minimal bowel resection group, seven patients were satisfied with their current quality of life and refused to undergo stoma reduction at follow-up and one deferred stoma reduction because of rectal bleeding. The remaining 32 patients underwent stoma reduction 3 to 12 months after surgery, 26 of whom underwent ileo-cecal anastomosis. The remaining six underwent resection of the stoma and anastomosis of the ileum to the ascending colon. Conclusions: The strategy of minimal small bowel resection in patients with radiation-induced bowel injuries reduces the length of resected small bowel, decreases the risk and severity of postoperative complications, and is associated with a better prognosis and quality of life than conventional resection.

Effect of Tangshen formula on the remodeling of small intestine and colon in Zucker diabetic fatty rats

Background and aimPrevious study have demonstrated that Tangshen Formula (TSF) could attenuate colonic histomorphological remodeling in the diabetic rat model induced by high fat diet plus low dosage streptozotocin (STZ). However, it is not clear whether TSF has same effect on small intestine and the effect on biomechanical properties of bowel. The aim of this study is to investigate the effect of TSF on histomorphological and biomechanical remodeling of small intestine and colon by using Zucker Diabetic Fatty (ZDF) Rat model. Materials and methodsZDF rats (obese fa/fa) with blood glucose higher than 11.7 mmol/L were divided into ZDF group (diabetic control group) and ZDF + TSF group (TSF treatment group), the later were intragastrically administered TSF. The ZDF rats (lean fa/+) were served as normal control (ZL) group. The rats in the ZL and ZDF groups were administered with saline. The experimental period covered from 8 weeks to 24 weeks. At the end of experiment, the ileal and colonic segments were studied in vitro. The histomorphometry and biomechanical parameters were measured. ResultsCompared with ZL group histomorphologically, the wet weight per unit length, wall thickness, wall area and fractions of total and type I and type III collagen in different layers for both ileum and colon increased in ZDF group. Those increasing parameters were partially inhibited in ZDF + TSF group. Compared with ZL group biomechanically, ZDF and ZDF + TSF groups had smaller opening angle and residual strain in ileum, and bigger opening angle and residual strain in colon. Whereas the wall became softer in circumferential direction and stiffer in longitudinal direction for both ileum and colon. However, no difference of biomechanical parameters was found between ZDF and ZDF + TSF groups. ConclusionThe histomorphological and biomechanical remodeling of ileum and colon were happened in ZDF rats （obese fa/fa）. TSF could partly attenuate ileal and colonic histomorphological remodeling rather than biomechanical remodeling.

Effect of P-glycoprotein and Cotreatment with Sofosbuvir on the Intestinal Permeation of Tenofovir Disoproxil Fumarate and Tenofovir Alafenamide Fumarate.

We aimed to compare the effects of P-glycoprotein (ABCB1) on the intestinal uptake of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF), and metabolites, tenofovir isoproxil monoester (TEM) and tenofovir (TFV), and to study the molecular mechanism of drug-drug interaction (DDI) between sofosbuvir (SOF) and TDF/TAF. Bidirectional transport experiments in Caco-2 cells and accumulation studies in precision-cut intestinal slices prepared from the ileal segment of rodent (rPCIS) and human (hPCIS) intestines were performed. TDF and TAF were extensively metabolised but TAF exhibited greater stability. ABCB1 significantly reduced the intestinal transepithelial transfer and uptake of the TFV(TDF) and TFV(TAF)-equivalents. However, TDF and TAF were absorbed more efficiently than TFV and TEM. SOF did not inhibit intestinal efflux of TDF and TAF or affect intestinal accumulation of TFV(TDF) and TFV(TAF)-equivalents but did significantly increase the proportion of absorbed TDF. TDF and TAF likely produce comparable concentrations of TFV-equivalents in the portal vein and the extent of permeation is reduced by the activity of ABCB1. DDI on ABCB1 can thus potentially affect TDF and TAF absorption. SOF does not inhibit ABCB1-mediated transport of TDF and TAF but does stabilise TDF, albeit without affecting the quantity of TFV(TDF)-equivalents crossing the intestinal barrier. Our data thus suggest that reported increases in the TFV plasma concentrations in patients treated with SOF and TDF result either from a DDI between SOF and TDF that does not involve ABCB1 or from a DDI involving another drug used in combination therapy.

Totally Intracorporeal Robot-assisted Unilateral or Bilateral Ileal Ureter Replacement for the Treatment of Ureteral Strictures: Technique and Outcomes from a Single Center

BackgroundFew studies on totally intracorporeal robot-assisted ileal ureter replacement (RA-IUR) have been reported. ObjectiveTo report our technique and the outcomes of totally intracorporeal RA-IUR for unilateral or bilateral ureteral reconstruction, involving performing cystoplasty simultaneously. Design, setting, and participantsFifteen patients underwent totally intracorporeal RA-IUR from April 2021 to July 2022 at a single center. The perioperative variables were prospectively collected, and the outcomes were assessed. Surgical procedureThe surgical procedure included dissection of the proximal end of the ureteral stricture or renal pelvis, harvesting of the ileal ureter, rebuilding of intestinal continuity, upper anastomosis of the ileum to the renal pelvis or the ureteral end, and lower anastomosis of the ileum to the bladder. All operations were performed intracorporeally. MeasurementsPatient demographics and perioperative results were prospectively collected and analyzed for perioperative complications and success rates. A descriptive statistical analysis was performed. Results and limitationsAll patients successfully underwent totally intracorporeal RA-IUR without open conversion. Seven patients received unilateral RA-IUR and eight received bilateral RA-IUR. The mean (range) length of the harvested ileal segment was 28.3 (15–40) cm, the operative duration was 261.8 (183–381) min, the estimated blood loss was 64.7 (30–100) ml, and the duration of postoperative hospitalization was 10.5 (7–17) d. At a median (range) follow-up of 14 (8–22) mo, the subjective and functional success rates were 100% and 86.7%, respectively. ConclusionsOur results demonstrate that totally intracorporeal unilateral or bilateral RA-IUR (even with ileocystoplasty) can be performed safely and efficiently with acceptable minor complications and a high success rate. Patient summaryOur study indicates that totally intracorporeal robotic ileal ureter replacement surgery is safe and feasible for ureteral reconstruction, even with ileocystoplasty. The postoperative complications are acceptable. At a median follow-up of 14 (8–22) mo, the subjective and functional success rates were 100% and 86.7%, respectively.

Knockdown of miR-19a suppresses gastrointestinal dysmotility diarrhea after TBI by regulating VIP expression.

Traumatic brain injury (TBI) is the main cause of death and can lead to a variety of physiological complications, including gastrointestinal dysfunction. The present study aimed to confirm the miR-19a-mediated suppression of diarrhea after TBI through the regulation of VIP expression. A rat model of TBI induced by controlled cortical injury was used to observe gastrointestinal morphology by opening the abdomen after TBI. After 72h of injury, the fecal water content of the rats was measured. The end ileal segments were removed, and HE staining was used to observe the histopathological changes in the intestine. The levels of serum miR-19a and VIP mRNA were detected by qRT-PCR. ELISA was performed to detect VIP levels in serum. Immunohistochemistry was used to detect the level of VIP in ileal tissues, and immunofluorescence was used to detect c-kit expression in ileal tissue. CCK-8 assay was used to detect the cell viability of interstitial cells of Cajal (ICCs), and TUNEL assay was used to detect apoptosis of ICCs. miR-19a and VIP were highly expressed in the serum of TBI rats, and the knockdown of miR-19a alleviated TBI-induced diarrhea. In addition, the overexpression of miR-19a or VIP inhibited the proliferation of ICCs, promoted apoptosis, and suppressed intracellular Ca2+ levels, whereas miR-19a suppression had the opposite effects. A nonselective nitric oxide synthase inhibitor (L-NA), PKG inhibitors (KT-5823 and RP-8CPT-cGMPS), and a guanylate cyclase inhibitor (ODQ) restored the inhibitory effects of VIP on ICC proliferation, anti-apoptosis effects, and Ca2+ concentrations. Knockdown of miR-19a inhibits activation of the VIP-NO-cGMP-PKG pathway through suppression of VIP expression, which in turn inhibits diarrhea after TBI.