Intestinal Complications Research Articles

Retrospective Cohort Study of Associated Factors for Intestinal Complications in Pediatric Liver Transplantation.

Intestinal complications (IC) represent serious adverse events after liver transplantation (LT), however limited research has been conducted in pediatric cohorts. This study aims to describe IC after pediatric LT and to identify associated factors. Retrospective review of 153 patients having undergone LT, aged 0-18 years, treated in the Swiss Pediatric Liver Center in Geneva. Pre-, per- and postoperative data were analyzed. IC were defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure. 16/153 (11%) patients developed IC: 10/16 mechanical obstructions, 4/16 intestinal perforations and 2/16 sub-mesocolic abscesses. IC patients had a significantly lower Body Mass Index (BMI) (15.5 vs. 16.4, p = 0.019). Children with IC had significantly higher incidence of previous Kasai hepatoportoenterostomy associated with Ladd procedure (13% vs. 2%, p = 0.055), a history of intraoperative iatrogenic intestinal perforation(s) (31% vs. 5%, p = 0.003) and prolonged LT surgery duration (536 vs. 415 min, p = 0.007). Significantly more children with IC had received basiliximab (69% vs. 40%, p = 0.048). Patients with IC exhibited a higher incidence of post-LT sub-occlusions (p < 0.001) and an increased requirement for post-LT parenteral nutrition (p = 0.027). Additionally, IC patients underwent significantly more reoperations (p < 0.001). One in 10 children post-LT experiences IC, which are associated with significant morbidity. Pre-LT nutritional status appears as an associated factor with IC, along with the necessity for adhesiolysis during LT, often leading to prolonged operative time. These associated factors should alert medical teams to promote early IC diagnosis in patients after LT.

STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial

PurposeThe STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA).MethodsInfants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression.ResultsEighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36–4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher’s Exact test).ConclusionAt laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes.

Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn’s Disease and Ocular Involvement

ABSTRACT Purpose Patients with Crohn’s disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease. Methods In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities. Results Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48–2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15–1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89–2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31–1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29–1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33–1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65–2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37–1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11–2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14–1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18–1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22–1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37–1.71, p < 0.001). Conclusions Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

Ulcerative colitis and concomitant arterial hypertension (literature review)

ulcerative colitis is a complex disease that results from a complex interaction of genetic predisposition, environmental factors, which leads to dysregulation of the immune system, chronic intestinal inflammation with damage to the mucous membrane. Systemic chronic inflammation can cause the development of arterial hypertension, thereby complicating the course of the primary disease. However, the cause-and-effect relationship between these diseases is not fully understood. Early detection of high blood pressure in patients with ulcerative colitis, a multidisciplinary approach to diagnosis makes it possible to achieve optimal treatment results in a timely manner and prevent the occurrence of intestinal complications. The aim of this study was to provide a comprehensive review of diagnostic procedures such as colonoscopy, inflammatory biomarkers (faecal calprotectin, faecal lactoferrin, serum zonulin), and to study the features of the colon structure in ultrasound diagnostics in patients with ulcerative colitis and concomitant hypertension. The data from PubMed and Ukrainian scientific sources on the comorbidity of these diseases, the possibility of using non-invasive diagnostic methods to assess the condition of the intestine in patients with ulcerative colitis and arterial hypertension were analysed. The literature review includes 50 scientific sources. The main focus is on the pathophysiological relationships of diseases, peculiarities of non-invasive diagnosis of ulcerative colitis during follow-up and early detection of arterial hypertension, which makes it possible to prevent complications in ulcerative colitis. Given the literature review, it can be concluded that the problem of timely diagnosis of hypertension in patients with ulcerative colitis is relevant today. For a rational approach to the management of patients with ulcerative colitis and concomitant hypertension, it is necessary to carry out a set of diagnostic procedures, including outpatient blood pressure measurement, ultrasound examination of the intestinal wall, and the use of non-invasive inflammatory biomarkers.

Ulcerative colitis: definition, epidemiology, pathogenesis, clinic, diagnosis, follow-up. Lecture. Part I

Inflammatory bowel diseases (IBD) are currently one of the most difficult problems in modern global internal medicine in general and in gastroenterology in particular. The diseases demonstrate a relapsing, progressive nature, significant decrease in the quality of life, physical activity of patients, complications from other organs and systems of the human body, a decrease or even loss of working capacity, difficulties in socialization and creating a family. An insufficiently predicted course of the disease, acute or chronic intestinal complications can lead to surgical interventions. According to the severity of the course, the frequency of disability, complications, including those, that require surgical intervention; in terms of the economic costs of the health care system, IBDs are ahead of a number of other widespread diseases of digestive organs. The variety of clinical, anatomical (in particular, localization and extend of damage to the Gut), endoscopic signs of the disease in combination with different degrees of severity and activity of the disease, the presence of local and systemic extraintestinal manifestations determine difficulties in early establishing the diagnosis, in differential diagnosis and in choosing an effective and safe therapy, which is prescribed for the purpose of not only achieving, but also further maintaining a stable remission of the disease.In the vast majority of patients, the disease is characterized by a chronic relapsing course and requires long­­term, constant, often life­­long drug treatment with the use of drugs from various pharmacological groups, including combination therapy. An active search for predictably effective drugs for the treatment for IBD continues at the present time. According to the new International Classification of Diseases, 11th revision (2022), three diseases are included in the IBD group: ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis, i.e. a disease in which it is impossible to clearly determine whether it is UC or CD of the colon. In modern medicine, there is a tendency towards greater clarity and conciseness in the formulation of diagnoses, examination algorithms and treatment regimens. Inflammatory bowel disease remains diseases with many unknowns, both in terms of establishing a clear diagnosis and in terms of prognosis and predictability of the consequences of drug therapy.

Effect of enhanced recovery after surgery on postoperative outcomes in children undergoing robot-assisted laparoscopic pyeloplasty

To assess the effects of the enhanced recovery after surgery (ERAS) perioperative protocol on the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients. A total of 57 children who underwent RALP at our center between November 2021 and December 2023 were included in the study. They were randomly assigned to either the ERAS (intervention) group or the non-ERAS (control) group. The analysis focused on comparing the length of hospital stay, recovery of gastrointestinal function, incidence of complications within 90 days post-surgery, postoperative extubation time (urinary tube and double-J tube), postoperative auxiliary examinations, and readmission rates within 30 days. Additionally, the patients were divided into two age groups: <4 years old and ≥4 years old, to assess pain severity. There were no significant differences in preoperative general information, preoperative auxiliary examination findings, or intraoperative conditions between the ERAS and non-ERAS groups. The ERAS group had a significantly shorter postoperative hospital stay compared to the non-ERAS group. Furthermore, the time to the first postoperative bowel movement was shorter, and the incidence of postoperative complications was significantly lower in the ERAS group. Among children <4 years old, there was no significant difference in pain severity between the two groups. However, in children ≥4 years old, the ERAS group experienced significantly lower pain levels at 6 and 24h post-surgery compared to the non-ERAS group. The findings of this prospective randomized controlled trial should determine if ERAS is superior to traditional perioperative management in children undergoing RALP, particularly regarding postoperative hospital stay, intestinal function recovery, pain response, and complication rates. We anticipate that our data will offer valuable clinical insights and guidance for the implementation of ERAS in pediatric robotic surgery for urinary diseases. The ERAS protocol can reduce the length of hospital stay, aid in the recovery of gastrointestinal function, and lower postoperative complication rates. It also has the potential to lessen postoperative pain to varying degrees in certain pediatric patients. ERAS is a safe and effective protocol for pediatric patients undergoing RALP.

Obesity and the gut microbiota: implications of neuroendocrine and immune signaling.

Obesity is a major health challenge due to its high prevalence and associated comorbidities. The excessive intake of a diet rich in fat and sugars leads to a persistent imbalance between energy intake and energy expenditure, which increases adiposity. Here, we provide an update on relevant diet-microbe-host interactions contributing to or protecting from obesity. In particular, we focus on how unhealthy diets shape the gut microbiota and thus impact crucial intestinal neuroendocrine and immune system functions. We describe how these interactions promote dysfunction in gut-to-brain neuroendocrine pathways involved in food intake control and postprandial metabolism and elevate the intestinal proinflammatory tone, promoting obesity and metabolic complications. In addition, we provide examples of how this knowledge may inspire microbiome-based interventions, such as fecal microbiota transplants, probiotics, and biotherapeutics, to effectively combat obesity-related disorders. We also discuss the current limitations and gaps in knowledge of gut microbiota research in obesity.

Laparoscopic cholecystectomy for chronic stone cholecystitis in a patient with situs inversus totalis managed at the Delfina Torres De Concha Hospital in Esmeraldas; case report

Situs Inversus Totalis (SIT) is when all the organs of the body are inverted towards the opposite side. Its incidence varies between 1 in 5.000 and 1 in 20.000 people, and it is due to an autosomal recessive gene. This disorder is characterized by the mirror arrangement of the thoracic and abdominal viscera, and can lead to cardiac, intestinal and vascular complications. Although laparoscopic cholecystectomy is the standard treatment for cholelithiasis, it can present technical challenges in cases of situs inversus, especially for right-handed surgeons, and it is preferable to be performed by a left-handed surgeon, although this is not strictly essential. Although there is no evidence of a higher incidence of cholelithiasis in patients with situs inversus totalis, more variations and abnormalities are expected in these patients. This report presents the case of a female patient with SIT who underwent laparoscopic cholecystectomy, demonstrating that the procedure can be performed safely with minimal adaptations, such as in this case the variant of using an 11 mm trocar in the third port for the handling of the clipper for skilled surgeons in any health home that has the equipment and trained personnel, given the rarity of this condition, these cases provide valuable information and challenge to the conventional understanding of organ positioning

Factors of poor prognosis in newborns with a prenatal diagnosis of gastroschisis in Bogota, Colombia.

To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. The study included 101 patients. Preterm newborns under 32weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Observation of therapeutic effect of lamp irradiation combined with purple gromwell oil gauze on alleviating intestinal colic in patients.

Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer. Traditional Chinese medicine has advantages, including safety and stability, for the treatment of intestinal colic. Lamp irradiation for abdominal ironing has been applied in the treatment of many gastrointestinal diseases. Purple gromwell oil has the effects of clearing heat, cooling blood, reducing swelling, and relieving pain. To investigate the impact of lamp irradiation combined with purple gromwell oil gauze on ameliorating intestinal colic in patients after radical surgery for colorectal cancer. A total of 120 patients who experienced postoperative intestinal colic complications after radical surgery for colorectal cancer and who were admitted to Foshan Traditional Chinese Medicine Hospital between June 2019 and March 2023 were enrolled as study subjects. The patients were divided into a control group (60 patients) and an observation group (60 patients) based on treatment method. The control group was treated with lamp irradiation, while the observation group was treated with lamp irradiation and external application of purple gromwell oil gauze. The clinical efficacy, Numeric Rating Scale (NRS) score, duration of symptoms, and rate of adverse reaction occurrence were further compared between the two groups. The general effective rate in the observation group was 95.00%, which was significantly higher than that in the control group (86.67%, P < 0.05). Before treatment, there was no significant difference in the duration of symptoms between the groups (P > 0.05). After 1, 2, 3, and 4 d of treatment, the duration of symptoms in both groups were decreased, and the duration in the observation group was significantly lower than that in the control group (96.54 ± 9.57 vs 110.45 ± 11.23, 87.26 ± 12.07 vs 104.44 ± 11.68, 80.45 ± 16.21 vs 99.44 ± 14.95, 73.18 ± 15.58 vs 92.17 ± 14.20; P < 0.05). After 1, 3, 5, and 7 d of treatment, the NRS scores in both groups were decreased, and the NRS scores in the observation group were significantly lower than those in the control group (3.56 ± 0.41 vs 4.04 ± 0.58, 3.07 ± 0.67 vs 3.74 ± 1.02, 2.52 ± 0.76 vs 3.43 ± 0.85, 2.03 ± 0.58 vs 3.03 ± 0.82; P < 0.05). There was no significant difference in the rate of adverse reaction occurrence between the groups (P > 0.05). The use of lamp irradiation combined with purple gromwell oil gauze in patients with intestinal colic after radical surgery for colorectal cancer can reduce symptom duration, alleviate intestinal colic, and improve treatment efficacy, and this approach is safe. It is worth promoting the use of this treatment in clinical practice.

Outcome of an Accelerated Treatment Algorithm for Patients Developing Diarrhea as a Complication of Ipilimumab-Based Cancer Immunotherapy in a Community Practice.

Immune-mediated diarrhea represents a serious complication of checkpoint inhibitor therapy, especially following ipilimumab-based treatment. Efficient diagnosis and control of diarrhea remains an ongoing challenge. We developed an accelerated management paradigm for patients with ipilimumab-induced diarrhea. Patients who developed significant diarrhea (>five loose stools/day) were presumed to be developing immune colitis. Therapy was interrupted and patients were treated with a methylprednisolone dose pack. If diarrhea was not completely resolved, high-dose steroids and infliximab were promptly added. Only non-responding patients underwent further evaluation for infection or other causes of diarrhea. A total of 242 patients were treated with ipilimumab-based regimens. Forty-six developed significant diarrhea (19%) and thirty-four (74.4%) had a rapid resolution of diarrhea following glucocorticosteroid and infliximab treatment. The median time to resolution of diarrhea was only 8.5 ± 16.4 days. Accelerated treatment for presumed immune-mediated diarrhea resulted in the rapid control of symptoms in the majority of patients. There were no intestinal complications or deaths. Immunosuppressive therapy for diarrhea did not appear to decrease the remission rate or survival. After the control of diarrhea, most patients were able to continue their planned immunotherapy. Further testing in 11/46 patients with unresponsive diarrhea revealed additional diagnoses, allowing their treatment to be adjusted.

Standardized procedure for preventing late intestinal complications following minimally invasive total gastrectomy for gastric cancer: a single-center retrospective cohort study.

Although minimally invasive total gastrectomy for gastric cancer is commonly performed, reports regarding late complications are limited. We have made several improvements each time we experienced severe late complications since 2009. This study aimed to evaluate the clinical efficacy of these improved procedures in preventing late complications. Between January 2009 and December 2019, 302 patients who underwent laparoscopic or robotic total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups: Period-I (2009-2013, before established standardization of procedure, 166 patients) and Period-II (2014-2019, after established standardization of procedure, 136 patients). The standardized procedure comprised four major steps, including closure of the mesentery defects and diaphragm crus, circumferential fixation of the anastomotic site into the diaphragm, and linearization around the anastomotic site of esophagojejunostomy. The incidence of late complications was retrospectively compared between the two groups. Late overall complications that occurred over 30days after surgery were observed in 19 (6.3%) patients. In all, 14 of 24 (58.3%) patients admitted due to late intestinal complications eventually required reoperation for treatment. The most frequent complication was nonstenotic outlet obstruction of the distal jejunal limb. The incidence of late overall complications was significantly lower in Period-II than in Period-I (2.9 vs 9.0%, p = 0.030). Intestinal complications were reduced considerably in Period-II. The 3-year cumulative incidence rate of late overall complications was significantly lower in Period-II than in Period-I (0.03 vs 0.10, p = 0.035). Period-I as the only independent risk factor for the development of late intestinal complications. Late complications after laparoscopic total gastrectomy sometimes occurred, and more than half of the patients with intestinal complications required reoperation. Our standardized procedure was associated with a lower risk of late intestinal complications after minimally invasive total gastrectomy followed by intracorporeal esophagojejunostomy using linear staplers in a cohort of patients with gastric cancer.

Early predictors of intestinal complications in pediatric-onset Crohn's disease: A long-term cohort study in Taiwan

PurposeIdentifying reliable prognostic factors for pediatric-onset Crohn's disease (CD) is important for guiding early treatment. This study aimed to evaluate the validity of various clinical parameters for predicting long-term intestinal complications in pediatric-onset CD patients with CD in Taiwan. MethodsThis was a single-center, retrospective study. Patients diagnosed with CD under 18 years of age at our hospital between January 1999 and December 2021 were enrolled. The baseline clinical variables and the Pediatric Crohn's Disease Activity Index (PCDAI) were obtained. Patients were categorized into low-, medium-, or high-risk groups based on the 2020 European Crohn's and Colitis Organization and European Society for Pediatric Gastroenterology Hepatology and Nutrition (ECCO-ESPGHAN) guidelines. The primary endpoint was the occurrence of new intestinal complications. ResultsAmong 53 enrolled patients (33 males and 20 females), 8 patients (33.96%) developed intestinal complications during the follow-up period (median 6.42 years, 3.17–9.75 years). Patients in the initial ECCO-ESPGHAN medium- or high-risk group had a 4.71-fold higher risk of intestinal complications than those in the low-risk group [hazard ratio = 4.71, p = 0.023] after adjusting for PCDAI in the multivariate Cox proportional hazard analysis. The other clinical variables did not reach statistical significance in predicting intestinal complications. The positive and negative predictive values of the ECCO-ESPGHAN stratification method for intestinal complications were 48.15% and 80.77%, respectively. ConclusionsECCO-ESPGHAN risk stratification is an effective early predictor of long-term intestinal complications in the Taiwanese population and may be used in clinical practice to guide early advanced therapy.

Hybrid Double-Sided Tape with Asymmetrical Adhesion and Burst Pressure Tolerance for Abdominal Injury Treatment.

Patients with open abdominal (OA) wounds have a mortality risk of up to 30%, and the resulting disabilities would have profound effects on patients. Here, we present a novel double-sided adhesive tape developed for the management of OA wounds. The tape features an asymmetrical structure and employs an acellular dermal matrix (ADM) with asymmetric wettability as a scaffold. It is constructed by integrating a tissue-adhesive hydrogel composed of polydopamine (pDA), quaternary ammonium chitosan (QCS), and acrylic acid cross-linking onto the bottom side of the ADM. Following surface modification with pDA, the ADM would exhibit characteristics resistant to bacterial adhesion. Furthermore, the presence of a developed hydrogel ensures that the tape not only possesses tissue adhesiveness and noninvasive peelability but also effectively mitigates damage caused by oxidative stress. Besides, the ADM inherits the strength of the skin, imparting high burst pressure tolerance to the tape. Based on these remarkable attributes, we demonstrate that this double-sided (D-S) tape facilitates the repair of OA wounds, mitigates damage to exposed intestinal tubes, and reduces the risk of intestinal fistulae and complications. Additionally, the D-S tape is equally applicable to treating other abdominal injuries, such as gastric perforations. It effectively seals the perforation, promotes injury repair, and prevents the formation of postoperative adhesions. These notable features indicate that the presented double-sided tape holds significant potential value in the biomedical field.

Outcomes and risk factors for mortality in clostridioides difficile infection in patients with NAFLD and NASH

Introduction and ObjectivesNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and can progress to non-alcoholic steatohepatitis (NASH) and, ultimately, cirrhosis. Clostridioides difficile is the most common nosocomial cause of diarrhea and is associated with worse clinical outcomes in other liver diseases, including cirrhosis, but has not been extensively evaluated in concomitant NAFLD/NASH. Materials and MethodsWe conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2017. Patients with a diagnosis of CDI, NAFLD, and NASH were identified using International Classification of Diseases (Tenth Revision) codes. The outcomes of our study include length of stay, hospitalization cost, mortality, and predictors of mortality. ResultsThe CDI and NASH cohort had a higher degree of comorbidity burden and prevalence of peptic ulcer disease, congestive heart failure, diabetes mellitus, and cirrhosis. Patients with NASH and CDI had a significantly higher mortality rate compared to the CDI only cohort (mortality, 7.11 % vs. 6.36 %; P = 0.042). Patients with CDI and NASH were at increased risk for liver-related complications, acute kidney injury, and septic shock (P < 0.001) compared to patients with CDI only. Older age, intestinal complications, pneumonia, sepsis and septic shock, and liver failure conferred an increased risk of mortality among the CDI and NASH cohort. ConclusionsPatients with NASH had a higher rate of liver-related complications, progression to septic shock, and mortality rate following CDI infection compared to the CDI only cohort.

Neonatal Gut and Immune Responses to β-Casein Enriched Formula in Piglets

Backgroundβ-casein is the main casein constituent in human milk (HM) and a source of bioactive peptides for the developing gastrointestinal tract and immune system. Infant formulas contain less β-casein than HM, but whether different concentrations of β-casein affect tolerability and gut and immune maturation in newborns is unknown. ObjectivesUsing near-term piglets as a model for newborn infants, we investigated whether increasing the β-casein fraction in bovine-based formula is clinically safe and may improve gut and immune maturation. MethodsThree groups of near-term pigs (96% gestation) were fed formula with bovine casein and whey protein (ratio 40:60): 1) standard skim milk casein (BCN-standard, 35% β-casein of total casein, n = 18); 2) β-casein enrichment to HM concentrations (BCN-medium, 65%, n = 19); and 3) high β-casein enrichment (BCN-high, 91%, n = 19). A reference group was fed 100% whey protein concentrate (WPC) as protein (WPC, n = 18). Intestinal and immune parameters were assessed before and after euthanasia on day 5. ResultsClinical variables (mortality, activity, body growth, and diarrhea) were similar among the groups, and no differences in intestinal or biochemical parameters were observed between BCN-standard and BCN-medium pigs. However, pigs receiving high amounts of β-casein (BCN-high) had lower small intestine weight and tended to have more intestinal complications (highest gut pathology score, permeability, and interleukin-8) than the other groups, particularly those receiving no casein (WPC pigs). Blood lymphocyte, thrombocyte, and reticulocyte counts were increased with higher β-casein, whereas eosinophil counts were reduced. In vitro blood immune cell responses were similar among groups. Conclusionsβ-casein enrichment of bovine-based formula to HM concentrations is clinically safe, as judged from newborn, near-term pigs, whereas no additional benefits to gut maturation were observed. However, excessive β-casein supplementation, beyond concentrations in HM, may potentially induce gut inflammation together with increased blood cell populations relative to natural β-casein concentrations or pure whey-based formula.

Transplanting Livers in Young Children - Looking Back at 100 Cases.

Despite advances in medical therapy, liver replacement continues to be the only definitive mode of therapy for children with end-stage liver disease (ESLD). However, its acceptance in India has been discouraging more due to financial and logistic reasons than the availability of expertise. This report outlines our journey and highlights issues pertinent to circumstances in an emerging economy like India. The aim is to review a single center's 100 case experience with liver transplantation (LT). A prospective analysis of all children who underwent LT since 2005 at our institute was done. The data were collated from a maintained structured database. Hundred children underwent LT. Sixty-four were boys. Age ranged from 5 to 144 months, with a median of 17 months. The mean weight of the cohort was 7.5 kg (ranging from 3.7 to 31.5 kg), with 60% of our children weighing between 5 and 10 kg. Biliary atresia is the most common indication (57%); others include metabolic disorders, progressive familial intrahepatic cholestasis, and hepatoblastoma. Two patients were for acute liver failure. Ninety-one children underwent live donor LT (mothers being the majority of the donors). None of the donors had any major postoperative complications. Major intraoperative complications include sepsis (39%), vascular complications (17%), biliary leak (11%), and intestinal complications (11%). Early postoperative deaths occurred in 18% of patients with sepsis being most common cause. The mean follow-up was 8.5 years and the overall survival is 70%. The mean survival is time (months) = 176.1. All surviving patients were followed up and had achieved good catch up growth by 3rd and 5th years posttransplant. The long-term sequalae include recurrent intercurrent infections, graft rejection (9%), posttransplant lymphoproliferative disease (5%), and portal vein stenosis (5%). Our experience demonstrates the feasibility of LT in children with ESLD in India. With longer-living grafts, patients often struggle with other issues such as compliance with follow-up, financial issues, recurrent infections, and neurological problems. Close monitoring with regular follow-up of patients helps in early recognition and treatment of late-onset complications, thus helping the overall long-term outcomes.

Oxylipin profile of human milk and human milk-derived extracellular vesicles

BackgroundSmall Extracellular Vesicles (sEVs) are nano-sized vesicles that are present in all biofluids including human milk (HM) playing a crucial role in cell-to-cell communication and the stimulation of the neonatal immune system. Oxylipins, which are bioactive lipids formed from polyunsaturated fatty acids, have gained considerable attention due to their potential role in mitigating disease progression and modulating the inflammatory status of breastfed infants. This study aims at an in-depth characterization of the oxylipin profiles of HM and, for the first time, of HM-derived sEVs (HMEVs) employing an ad-hoc developed and validated ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method. ResultsThe UPLC-MS/MS method covered a panel of 13 oxylipins for quantitation and 93 oxylipins for semi-quantitation. In 200 μL of HM and HMEV isolates of 15 individuals, 42 out of 106 oxylipins were detected in either HM or HMEVs, with 38 oxylipins being detected in both matrices. Oxylipins presented distinct profiles in HM and HMEVs, suggesting specific mechanisms responsible for the encapsulation of target molecules in HMEVs. Ten and eight oxylipins were quantified with ranges between 0.03 – 73 nM and 0.30 pM–0.07 nM in HM and HMEVs, respectively. The most abundant oxylipins found in HMEVs were docosahexaenoic acid derivatives (17-HDHA and 14-HDHA) with known anti-inflammatory properties, and linoleic acid derivatives (9-10-DiHOME and 12,13-DiHOME) in HM samples. Significance and noveltyThis is the first time a selective, relative enrichment of anti-inflammatory oxylipins in HMEVs has been described. Future studies will focus on the anti-inflammatory and pro-healing capacity of oxylipins encapsulated in HMEVs, with potential clinical applications in the field of preterm infant care, specifically the prevention of severe intestinal complications including necrotizing enterocolitis.

A case of acute intestinal obstruction caused by Burkitt’s lymphoma

Acute intestinal obstruction is a multifactorial disease. Its causes may be intra-abdominal adhesions, volvulus, bezoar, gallstones, foreign bodies, intestinal tumors, etc. In rare cases, acute intestinal obstruction may be associated with intussusception, which is relatively rare in adults. The purpose of this work is to demonstrate a clinical case of acute small bowel obstruction caused by Burkitt lymphoma. During treatment for a herpetic infection, the patient underwent surgical treatment — ileostomy because of acute intestinal obstruction. In the postoperative period, the patient was hospitalized due to intestinal bleeding; during diagnostic colonoscopy, intussusception of the ileum into the ascending colon was detected; diagnostic laparoscopy, laparotomy, right-sided hemicolectomy with resection of the greater omentum, restoration of intestinal continuity with elimination of the stoma,and formation of an anastomosis were performed. The material obtained intraoperatively was sent for pathomorphological examination, including the method of fluorescent hybridization, which revealed a rearrangement of the 8th chromosome in the region of localization of the MYC gene in tumor cells, and a diagnosis of Burkitt lymphoma was established. The oncological council determined the chemotherapy treatment protocol. According to the literature, Burkitt lymphoma can debut in the cutaneous form, and it is necessary to carry out a differential diagnosis, including chickenpox. There is currently no information about intestinal complications occurring in the cutaneous form of Burkitt lymphoma. It is possible that in the described case, the initially established diagnosis of herpetic infection was incorrect, and Burkitt lymphoma occurred in the cutaneous form.

Nutritional support in patients with acute pancreatitis. Review of published studies

Acute pancreatitis is a common disease that occurs in 5—10% of patients with urgent pathology of the abdominal cavity. The most prevalent metabolic disorders affecting this group of patients are hypermetabolism and hypercatabolism syndromes, which are accompanied by excessive consumption of carbohydrates, fats, and amino acids, increased oxygen intake, and carbon dioxide production.&#x0D; Objective — to analyse the current state of the problem of nutritional support for patients with acute pancreatitis.&#x0D; The degree of nutritional disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease, necessitating a differential approach to their correction. Patients with acute pancreatitis experience disruption of the intestinal microflora due to the antibiotic therapy, nutrient and fiber deficiency, and lack of microbial antagonism. This disruption leads to excessive growth of bacteria, particularly gram‑negative microflora. The effectiveness and safety of enteral tube feeding are determined by a complex of factors: the timing of recovery of peristalsis and the absorption function of the intestinal wall, the type of mixture, and the method of its administration. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 hours after the start of complex conservative therapy. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum and reduce the frequency of intestinal complications on the 7th day by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications (χ2=4.59, 95% CI 2.43—45.53, p=0.03), length of hospital stay by 16 days (p=0.04), and deaths by 21.4% (χ2=4.13, 95% CI 0.81—39.68, p=0.04) in comparison with parenteral nutrition. Nutritional support should be started with nasogastric administration of a food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.&#x0D;