Ileum Of Group Research Articles

Diet replacement with whole insect larvae affects intestinal morphology and microbiota of broiler chickens

Insect-based diets are gaining interest as potential ingredients in improving poultry gut health. This study assessed the dietary treatment with whole dried Tenebrio molitor larvae (TM) on broiler chickens’ gut microbiota and morphology. 120 Ross-308 broilers received treated diets with 5% (TM5) and 10% (TM10) replacement ratio in a 35-day trial. Intestinal histomorphometry was assessed, as well as claudin-3 expression pattern and ileal and caecal digesta for microbial community diversity. Null hypothesis was tested with two-way ANOVA considering the intestinal segment and diet as main factors. The TM5 group presented higher villi in the duodenum and ileum compared to the other two (P < 0.001), while treated groups showed shallower crypts in the duodenum (P < 0.001) and deeper in the jejunum and ileum than the control (P < 0.001). Treatments increased the caecal Firmicutes/Bacteroidetes ratio and led to significant changes at the genus level. While Lactobacilli survived in the caecum, a significant reduction was evident in the ileum of both groups, mainly owed to L. aviarius. Staphylococci and Methanobrevibacter significantly increased in the ileum of the TM5 group. Results suggest that dietary supplementation with whole dried TM larvae has no adverse effect on the intestinal epithelium formation and positively affects bacterial population richness and diversity.

Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis

BackgroundHematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear.MethodsWe here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame.ResultsA total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%.ConclusionIn patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.

Serum homocysteine is a valuable marker for predicting aggravation of infection in intestinal obstruction patients.

The aim of this study was to investigate the expression of serum homocysteine (HCY), procalcitonin (PCT), and C-reactive protein (CRP) in abdominal infectious disease and analyze their relationship with the degree of abdominal infection. We conducted a retrospective study involving 157 patients with abdominal infections at Xuzhou Central Hospital between January 2016 and October 2019. The patients were composed of intestinal obstruction (73 cases), appendicitis (45 cases), perforation of the digestive tract (25 cases), and cholecystitis (14 cases). The HCY, PCT, and CRP levels of patients with abdominal infections were detected using enzyme-linked immunosorbent assay (ELISA), and correlation analysis between the HCY, PCT, and CRP levels and abdominal infection was performed using Pearson's correlation analysis. Compared with before treatment, the HCY, PCT, and CRP levels in the four groups decreased significantly after treatment. The levels in the patients in the intestinal obstruction group decreased more markedly than in those in the other groups. There were positive correlations among the HCY level, PCT, and CRP before treatment only in patients with intestinal obstruction (P < 0.001). The difference was statistically significant in the HCY level between the non-operation and the operation groups in patients with intestinal obstruction (P < 0.001). Serum HCY may be a valuable marker for predicting aggravation of infection in patients with intestinal obstruction.

The impact of different inclusion levels of whole barley in feed on growth performance, carcass, and gastrointestinal traits of broiler chickens

The aim of the present research was to evaluate the effect of feeding graded levels of whole barley (WB) on broiler chicken growth and carcass performance, gastrointestinal morphology, and function. A total of 800 male Ross 308 broiler chickens (1-day-old) were randomly assigned to four treatment groups with four replicate pens of 50 birds each. Diets differed in their WB dosage: without WB (NO-WB); low WB amount (LOW-WB) dosages: 4% (1–7 days of age), 8% (8–21 days of age), 15% (22–35 days of age); medium WB amount (MEDIUM-WB) dosages: 6% (1–7 days of age), 12% (8–21 days of age), 20% (22–35 days of age); high WB amount (HIGH-WB) dosages: 8% (1–7 days of age) 16% (8–21 days of age), 25% (22–35 days of age). Body weight, average daily gain, and mortality of chickens did not statistically differ between treatments (P &amp;gt; 0.05). The feed conversion ratio was higher in the treatments diluted with WB. There were no differences in ammonia nitrogen concentration except for increased butyrate concentration in the caecum and reduced digesta viscosity in the broiler ileum in groups fed LOW-WB, MEDIUM-WB, and HIGH-WB diets (P &amp;lt; 0.05). The high WB amount in the diets increased Lactobacillus spp. in the ileal contents and improved ileum morphology (P &amp;lt; 0.05). The inclusion of graded levels of WB in the diets had no effect on carcass performance but it seemed to enhance the gastrointestinal tract development.

Effects of Antimicrobial Peptides Gal-13 on the Growth Performance, Intestinal Microbiota, Digestive Enzyme Activities, Intestinal Morphology, Antioxidative Activities, and Immunity of Broilers.

To evaluate the application effect of antimicrobial peptides Gal-13 (AMP Gal-13) instead of antibiotic feed additives, 90 7-day-old Ross 308 broilers were randomly divided into 3 groups. Group A was fed a basic diet as the control, and Groups B and C were supplemented with AMP Gal-13 (100mg/kg and 200mg/kg, respectively). After a 35-day feeding experiment, the weight and average daily gain (ADG) of the broilers in Group B were significantly higher than those of the broilers in Group A. The Enterococcus sp. and Escherichia coli counts in the ileum and cecum in Group A were significantly higher than those in Groups B and C, while the Lactic acid bacteria (LAB) and Bifidobacterium sp. counts were significantly lower. The amylase activity of the jejunum in Group B was significantly higher than that in Group A. The villus length (VL): crypt depth (CD) ratios of the jejunum and ileum in Group B were significantly higher than those in Group A. The glutathione peroxidase (GSH-Px) activities in the liver and serum in Groups B and C were significantly higher than those in Group A, while the malondialdehyde (MDA) activity was significantly lower. The titers of Newcastle disease virus (NDV)-specific antibodies were elevated significantly in Group B at the age of 42days. Additionally, the weights of the spleen and thymus were significantly increased. The expression levels of Il-2, Il-6, Tgf-β4, Tnf-α, and Mif in the spleen in Groups B and C were significantly downregulated to different degrees; Il-4 expression in Group B was significantly upregulated, while Ifn-γ expression in Group C was significantly upregulated. The results suggested that adding AMP Gal-13 to the diet could improve intestinal digestion, the antioxidant capacity, and immune function, ultimately promoting the growth of broilers.

Effects of N-acetylcysteine on the inflammatory response and bacterial translocation in a model of intestinal obstruction and ischemia in rats.

To evaluate effect of N-acetylcysteine (NAC) associated with Ringer lactate or hypertonic saline in inflammation and bacterial translocation on experimental intestinal obstruction (IO). Wistar rats was subjected to IO. Six or 24 hours after, rats were subjected to enterectomy and fluid resuscitation: IO, RL (subjected to the same procedures but with fluid resuscitation using Ringer's lactate solution); RLNAC (added NAC to Ringer's solution); and HSNAC (surgical procedure + fluid reposition with 7.5% hypertonic saline and NAC). After 24 h, tissues were collected to cytokines, bacterial translocation, and histological assessments. In kidney, interleukin-1beta (IL-1beta) was lower in the groups with fluid resuscitation compared to IO group. The RLNAC showed lower levels compared to the RL. Interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), and (IFN-gamma) were lower in the treatment groups than in IO. In lung, IL-1beta and IL-6 were lower in RLNAC compared to IO. IL-10 was lower in RL, RLNAC and HSNAC compared to IO. TNF-alpha was higher in HSNAC compared to both RL and RLNAC. Bacterial translocation was observed in all animals of IO group. In kidneys, inflammation and congestion degrees were lower in HSNAC compared to RL. In lungs, inflammation levels were higher in RLNAC compared with the sham group. The data indicates that NAC associated with RL can promote a decrease in the inflammatory process in the kidneys and lungs in rats, following intestinal obstruction and ischemia in rats.

The Diagnostic Value of Coagulation Indicators and Inflammatory Markers in Distinguishing Between Strangulated and Simple Intestinal Obstruction.

Background:Intestinal obstruction with strangulation can be life-threating, and it is critical to make an accurate and timely diagnosis for emergency surgery.Objective:This was aimed to investigate the value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction.Materials and Methods:Fifty-four patients with intestinal obstruction were retrospectively studied. The correlation between coagulation indicators and inflammatory markers with intestinal obstruction was analyzed. Receiver operating characteristic curves were created to assess their ability in discriminative diagnosis.Results:Levels of fibrinogen (Fib), C-reactive protein (CRP), neutrophil ratio, and D-Dimer were significantly greater, while thrombin time was significantly shorter in strangulated intestinal obstruction compared with simple intestinal obstruction. Furthermore, Fib levels in the necrosis subgroup of strangulated intestinal obstruction were significantly higher than those in the ischemia subgroup and simple intestinal obstruction group. The areas under the receiver operating characteristic curve were 0.58 for white blood cells, 0.78 for CRP, and 0.80 for Fib. Using the optimal cutoff values of Fib (3.71 g/L) and CRP (14.54 mg/L), the sensitivity, specificity, positive predictive value, and negative predictive value in discriminating between strangulated intestinal obstruction and simple intestinal obstruction were 51.43%, 100%, 100%, and 52.78% for Fib, and 56.25%, 94.44%, 94.74%, and 54.84% for CRP, respectively.Conclusions:Fib and CRP demonstrate good performance in predicting strangulation and are indicative of intestinal necrosis and ischemia. The combination of this coagulation indicator and inflammatory marker holds potential for better discrimination between strangulated and simple intestinal obstruction.

A COMPARATIVE STUDY BETWEEN THE INCIDENCE OF WOUND INFECTION AND BURST ABDOMEN BETWEEN DELAYED ABSORBABLE (VICRYL) AND MEDICATED VICRYL (VICRYL PLUS) SUTURE MATERIAL IN PATIENTS UNDERGOING MIDLINE INCISION LAPAROTOMY IN ACUTE ABDOMEN CASES IN THE EMERGENC

Midline laparotomy is frequently done in the emergency setting of any hospital and type of suture material used for the fascial closure of the abdominal wall influences the incidence of the postoperative complications. The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications. In addition, the effect of various risk factors on burst abdomen and wound infection was also evaluated. &#x0D; Methods: 100 patients who have visited the emergency department of the hospital and underwent midline laparotomy were enrolled in this study.&#x0D; Results: Patients were divided into two groups depending on whether they have an intestinal perforation (group A, n=60) or intestinal obstruction (Group B, n=40). These two groups were further divided into two groups depending on the type of suture material used (plain Vicryl: group A1, B1 and medicated Vicryl: group A2, B2). Both these groups had an equal number of patients. The analysis of the data showed that compared to the non medicated suture material the rate of wound infection is considerably less in the cases of medicated polyglactin suture material. In addition, older age, diabetes, anemia, and malnutrition are the significant risk factor for wound infection (p&lt;0.001s) while Older age, malnutrition, and cough were found to be highly significant risk factors for burst abdomen.&#x0D; Conclusion: The medicated suture material was proved to be more effective in preventing the burst abdomen and postoperative wound infections compared to the plain delayed absorbable Vicryl suture material.&#x0D; Keywords: delayed absorbable Vicryl, medicated Vicryl, burst abdomen, wound infection, a midline laparotomy

Exploring the evidence-practice gap in the use of plain radiography for acute abdominal pain and intestinal obstruction: a systematic review and meta-analysis.

Previous studies, some dating back several decades, have recommended that the use of plain abdominal radiography should be curbed, particularly with the growth of more accurate imaging modalities. However, evidence from referral data suggests that plain abdominal radiography continues to be a commonly requested examination. The aim of this review was to explore the gap between evidence and practice by re-examining the evidence using a robust methodology, investigating the diagnostic accuracy of plain abdominal radiography. Studies were identified from electronic databases and reference lists. Eligible studies provided data as to the sensitivity and specificity of plain abdominal radiography for either acute abdominal pain (Group A) or suspected intestinal obstruction (Group B). Version 2 of the Quality Assessment of Diagnostic Accuracy Studies was used to assess the quality of studies and hierarchical summary receiver operator characteristic curves and coupled forest plots were generated. Four studies evaluated plain abdominal radiography for acute abdominal pain (Group A) and 10 for suspected intestinal obstruction (Group B). Two studies investigated both presentations and were included in both groups. Methodological quality of studies was moderately high, though incorporation bias was a common limitation. Sensitivity for Group A studies ranged from 30 to 46%, with specificity from 75 to 88%. For Group B, the range of sensitivity was 48 to 96% and specificity from 50 to 100%. The results suggest that use of plain abdominal radiography could be substantially reduced, particularly for patients with undifferentiated acute abdominal pain. While some guidelines exist, there is sound argument for clinical decision rules for abdominal imaging to inform evidence-based clinical decision-making and radiology referrals.

The relationship between the levels of plasma cytokine procalcitonin, C-reactive protein and tumor necrosis factor-alpha with postoperative intestinal obstruction in patients with colorectal cancer after operation

Objective To investigate the relationship between plasma levels of procalcitonin(PCT), C-reactive protein(CRP) and tumor necrosis factor-alpha(TNF-α) and postoperative intestinal obstruction in patients with colorectal cancer. Methods From December 2014 to December 2017, 60 patients with colorectal cancer and 60 patients who had no intestinal obstruction after operation in the Third Hospital of Shanxi Datong Coal Mine Group Limited Company were selected.The patients were divided into intestinal obstruction group and non-intestinal obstruction group.All the patients received blood examination, and the levels of PCT, CRP and TNF-α were measured.The levels of PCT, CRP and TNF-α were compared between the obstruction group and the non-intestinal obstruction group before operation, 1 day after operation and 5 days after operation.The levels of PCT, CRP and TNF-α in patients with intestinal obstruction were compared at different time points after operation.According to the outcome on the 5th day after operation, the patients in the intestinal obstruction group were divided into effective group and ineffective group, and the levels of PCT, CRP and TNF-α were compared between the effective group and the ineffective group.Pearson correlation analysis was used to analyze the correlation between the levels of PCT, CRP and TNF-α with postoperative intestinal obstruction in patients with colorectal cancer. Results At preoperative 1d and postoperative 1d, the PCT, CRP and TNF-α levels between the intestinal obstruction group and non-intestinal obstruction group had no statistically significant differences(preoperation t=0.706, 0.459, 0.249, postoperative 1 day t=0.874, 0.434, 1.460, all P>0.05). At 5 days after surgery, the levels of PCT[(1.89±0.53)ng/mL], CRP[(10.06±2.50)mg/L], TNF-α[(1.95±0.59)ng/L]in the intestinal obstruction group were higher than those in the non-intestinal obstruction group[(1.05±0.32)ng/mL, (7.27±2.06)mg/L, (1.15±0.28)ng/L, t=10.510, 6.671, 9.489, all P<0.05]. The levels of PCT, CRP and TNF-α at the fifth day after intestinal obstruction were higher than those at the first day after operation (t=12.762, 6.708, 6.973, all P<0.05). The levels of PCT[(2.13±0.48)ng/mL], CRP[(11.24±2.37)mg/L], TNF-α[(2.16±0.40)ng/L] of the ineffective group were higher than those of the effective group[(1.64±0.31)ng/mL, (8.86±1.65)mg/L, (1.77±0.32)ng/L, t=4.757, 4.507, 4.052, all P<0.05]. Correlation analysis showed that PCT, CRP and TNF-α levels were closely related to postoperative intestinal obstruction in colorectal cancer patients, and all of them were positively correlated(r=0.892, 0.817, 0.835, all P<0.05). Conclusion The levels of PCT, CRP and TNF-α in the patients with postoperative intestinal obstruction of colorectal cancer are higher than those of the control group.It can predict the occurrence of postoperative intestinal obstruction of colorectal cancer and can be used as a reference index for diagnosis and treatment of postoperative intestinal obstruction in colorectal cancer. Key words: Colorectal neoplasms; Colorectal surgery; Postoperative complications; Intestinal obstruction; Inflammation mediators; Procalcitonin; C-Reactive protein; Tumor necrosis factor-alpha

Values of the leukocyte count, D-dimer, histidine decarboxylase and intestinal fatty acid binding protein for diagnosing acute intestinal obstruction

Objective To investigate the clinical values of the leukocyte count, D-dimer, histidine decarboxylase(HDC) and intestinal fatty acid binding protein(I-FABP) for diagnosing acute intestinal obstruction. Methods Sixty patients who treated in China-Japan Union Hospital of Jilin University from January 2017 to January 2018 were collected prospectively, and were divided into strangulated intestinal obstruction(STR-IO) group(n=20), simple intestinal obstruction(SIM-IO) group(n=20) and peritonitis group(n=20). Twenty healthy volunteers were collected as control group. Automatic blood cell analyzer was used to detecting the leukocyte count. The concentration of plasma D-dimer was detected by immune turbidimetry method. The concentration of serum HDC and I-FABP were measured by enzyme linked immunosorbent assay (ELISA) method. Compared the above indicators of four groups of samples. The measurement data are expressed as mean±standard deviation (Mean±SD). Tamhane′s T2 and Dunnett′s T3 methods were used to comparison between groups. Estimation of receiver operating characteristic curve(ROC) and area under curve(AUC) used logistic regressive model. Results The leukocyte count in control group, SIM-IO group, peritonitis group, and STR-IO group were (6.97±1.68)×109/L, (8.24±2.78)×109/L, (11.33±4.75)×109/L, and(12.53±5.96)×109/L respectively. STR-IO group and peritonitis group were significantly higher than those of control group(F=12.74, P=0.01), but there was no significant difference between SIM-IO group and control group(P>0.05). The concentration of plasma D-dimer in control group, SIM-IO group, peritonitis group, and STR-IO group were (0.44±0.30) μg/ml, (1.17±0.67) μg/ml, (1.20±0.72) μg/ml, and (1.67±0.67) μg/ml respectively. The concentration of D-dimer in STR-IO group was significantly higher than those of control group (F=57.08, P=0.00), and there was no significant difference among other group(P>0.05). The concentration of serum HDC in control group, SIM-IO group, peritonitis group, and STR-IO group were (5.51±4.30) ng/ml, (14.33±3.71) ng/ml, (11.53±4.67) ng/ml, and (35.65±21.15) ng/ml respectively. The concentration of HDC in STR-IO group was significantly higher than those of other three groups (F=39.03, P=0.00). The concentration of serum I-FABP in control group, SIM-IO group, peritonitis group, and STR-IO group were (0.20±0.06) ng/ml, (0.31±0.17) ng/ml, (0.22±0.03)ng/ml, and (0.81±0.56) ng/ml respectively. The concentration of I-FABP in STR-IO group was significantly higher than those of other three groups (F=23.07, P=0.01). The AUC of HDC, I-FABP, D-dimer, and leukocyte count were 0.998, 0.868, 0.730, and 0.704 respactively. Conclusion Leukocyte count, D-dimer, and HDC or I-FABP combined detection may be a more effective index for diagnosing acute intestinal obstruction. Key words: Intestinal obstruction; Diagnosis; Histidine decarboxylase; Intestinal fatty acid binding protein; D-dimer

Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy.

Background There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy. Methods A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4). Results Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy. Conclusion This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.

Analysis of related risk factors of functional intestinal obstruction in general surgical patients after open abdominal surgery

Objective To analyze the related risk factors of functional intestinal obstruction in general surgical patients and to discuss the feasible nursing and prevention measures. Methods The clinical data of totally 658 patients after abdominal surgery who received open abdominal surgery in the Department of General Surgery of the First People's Hospital of Huzhou in Zhejiang Province from January 2015 to January 2017 were retrospectively analyzed. These patients were divided into the intestinal obstruction group and the non-intestinal obstruction group based on the occurrence of postoperative functional intestinal obstruction. The single factor analysis was then conducted over the age, gender, operation time, anesthesia, postoperative analgesic use (opioids and non-opioids) , abdominal operation history, smoking history, alcohol drinking history, diabetes mellitus history and history of hypertension; and Logistic regression analysis was also performed on the influencing factors to determine the impact of functional intestinal obstruction in patients who received open abdominal surgery. Results Totally 47 out of the 658 patients receiving open abdominal surgery developed functional intestinal obstruction, with an incidence of 7.14%. The univariate analysis showed that there were statistically significant differences between the two groups in gender, age, operation time, postoperative analgesic use, history of abdominal surgery and history of diabetes mellitus (P<0.05) . According to the multivariate Logistic regression analysis, gender, age, operation time, history of abdominal surgery and history of diabetes were the risk factors of postoperative functional intestinal obstruction (P<0.01) . Conclusions The relevant risk factors for postoperative functional intestinal obstruction in general surgical patients after abdominal surgery include gender, age, operation time, history of abdominal surgery and diabetes mellitus. Corresponding nursing and prevention measures should be taken according to the relevant risk factors of patients. Key words: Intestinal obstruction, functional; Risk factor; Open abdominal surgery; Prevention

BACKGROUND: Value of plasma C-reactive protein and lactate dehydrogenase levels in the diagnosis of intestinal obstruction in an emergency department

Background. Intestinal obstruction is one of the most frequent surgical emergencies. Its diagnosis is essentially based on clinical history, physical exploration and image tests. The aim of this study was to analyze the diagnostic value of acute phase reactants in patients with benign versus malign intestinal obstruction. Method. Historical cohort study of 53 patients who underwent surgery because of intestinal obstruction and/or non-obstructive colorectal cancer. The patients were placed in three groups: group 1 (colorectal cancer with intestinal obstruction) (n=23), group 2 (benign intestinal obstruction) (n=10) and group 3 (non-obstructive cancer of the colon) (n=20). We determined the initial plasma values of the C-reactive protein (CRP) and the lactate dehydrogenase (LDH) enzyme. Results. CRP was quantitatively higher in patients with benign intestinal obstruction (group 2) (p=0.001), while LDH was quantitatively higher in group 1 (patients with obstructive cancer). The plasma levels of LDH were significantly greater in the groups with intestinal obstruction (groups 1 and 2) than in patients without obstruction (p 24 ng/l (CI 95 % = 30-82%) and 52% (CI 95% = 29-74%) for levels of LDH > 359 U/L. Conclusion. Determination of plasma concentrations of CRP can help in the diagnosis of intestinal obstruction and indicate its benign or malign origin in emergency services. Key words. Intestinal obstruction. C reactive protein (CRP). Lactate dehydrogenase (LDH). Colorectal cancer. Emergency.

Value of plasma C-reactive protein and lactate dehydrogenase levels in the diagnosis of intestinal obstruction in an emergency department

Intestinal obstruction is one of the most frequent surgical emergencies. Its diagnosis is essentially based on clinical history, physical exploration and image tests. The aim of this study was to analyze the diagnostic value of acute phase reactants in patients with benign versus malign intestinal obstruction. Historical cohort study of 53 patients who underwent surgery because of intestinal obstruction and/or non-obstructive colorectal cancer. The patients were placed in three groups: group 1 (colorectal cancer with intestinal obstruction) (n=23), group 2 (benign intestinal obstruction)(n=10) and group 3 (non-obstructive cancer of the colon)(n=20). We determined the initial plasma values of the C-reactive protein (CRP) and the lactate dehydrogenase (LDH)enzyme. CRP was quantitatively higher in patients with benign intestinal obstruction (group 2) (p=0.001), while LDH was quantitatively higher in group 1 (patients with obstructive cancer). The plasma levels of LDH were significantly greater in the groups with intestinal obstruction (groups 1 and 2) than in patients without obstruction (p<0.001). Plasma levels of CRP above 11 mg/l and of LDH above 317 U/L showed an acceptable diagnostic value for differentiating patients with intestinal obstruction, with areas under the ROC curve of 80% (CI 95% = 68-92%) and 86% (CI 95%= 75-96%)respectively. Their diagnostic value for differentiating benign or malign origin is lower, with areas under the ROC curve of 56% for levels of CRP > 24 ng/l (CI 95% = 30-82%) and 52% (CI 95% = 29-74%) for levels of LDH > 359 U/L. Determination of plasma concentrations of CRP can help in the diagnosis of intestinal obstruction and indicate its benign or malign origin in emergency services.

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study.

IntroductionMechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology.Materials and MethodsFifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min.ResultsSignificant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours.ConclusionThe mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

Analysis of predictive factors of intestinal obstruction in acute myocardial infraction patients afterprimary percutaneous coronary intervention

Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model. Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed. And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts: model derivation cohort (MDC) and model validation cohort (MVC). MDC was divided into intestinal obstruction group and control group. predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC. Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure. Results Total of 1 025 patients, 103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0%. Low position intestinal obstruction, incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients. logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction: age >65 years old (OR =1.44, 95%CI∶1.26-4.63, P =0.000) , diabetes mellitus (OR =3.37, 95% CI∶2.39- 9.47, P =0.000) , habitual constipation (OR =4.75, 95% CI∶3.58-11.24, P =0.024) , inferior and extensive anterior wall myocardial infarction (OR =2.16, 95% CI∶1.94-4.79, P =0.017) , cardiac function grade≥3 class (Killip classification) (OR =2.86, 95% CI∶1.98-5.67, P=0.002) , femoral approach (OR =2.76, 95%CI∶1.38-6.12, P =0.002) , K+<3.5 mmol/L (OR=1.86, 95%CI∶1.11- 5.47, P=0.005) , taking laxative (OR =3.59, 95% CI∶2.99-10.21, P =0.000) , using morphine (OR=1.98, 95%CI∶1.07-3.12, P=0.021) and estimated glomerular filtration rate (eGFR) <60 mL·min-1·1.73m-2 (OR=1.19, 95%CI∶1.10-3.22, P=0.031). and areas under the ROC cure was 0.815 (95% CI∶0.802-0.883, P =0.000) and indicating the accuracy of predicting intestinal obstruction. Conclusions age> 65 years old, diabetes mellitus, habitual constipation, inferior and extensive anterior parts of myocardial infarction, cardiac functiongrade≥3class (Killip classification), femoral approach, K+<3.5mmol/L, taking laxative, using morphine and eGFR <60 ml. min-1.1.73m-2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients. Key words: Acute myocardial infraction; Primary percutaneous coronary intervention; Intestinal obstruction; Forecasting

Intraventricular hemorrhage as a comorbid factor for intestinal obstruction in very low-birthweight infants.

In very low-birthweight infants (VLBWI), intestinal obstruction (IO) tends to increase in severity due to the immaturity of the intestine and perinatal events. We examined the clinical comorbid factors related to IO in VLBWI. Clinical data of 160 VLBWI admitted to the neonatal intensive care unit in 2006-2011 were retrospectively reviewed. Patients were divided into two groups: IO group (n = 62) and non-IO group (n = 98). IO was defined as bile excretion via the mouth or nasogastric tube within 30 days after birth. The relationship between clinical factors and the incidence of IO was analyzed. On univariate analysis, gestational age, birthweight, and the incidence of chronic lung disease, patent ductus arteriosus, intraventricular hemorrhage (IVH), retinopathy of prematurity, and the postnatal use of mechanical ventilation, catecholamines, steroids, and sedatives were associated with IO. On multivariate analysis, only IVH was strongly associated with IO (OR, 4.74; P < 0.01). IVH is a significant comorbid factor of IO in VLBWI.

Arginine Supplementation Induces Arginase Activity and Inhibits TNF-α Synthesis in Mice Spleen Macrophages After Intestinal Obstruction.

The purpose of this study was to assess the effect of arginine supplementation on arginase activity, tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) synthesis in cultured splenic macrophages from a murine model of intestinal obstruction (IO). The effects of nitric oxide synthase (iNOS) inhibition were also studied using iNOS knockout animals. Male C57BL6/J wild-type (WT) and iNOS knockout (iNOS-/-) mice were randomized into 6 groups: Sham and Sham-/- (standard chow), IO and IO-/- (standard chow + IO), and Arg and Arg-/- (standard chow supplemented with arginine + IO). After 7 days of treatment with standard or supplemented chow, IO was induced. Arginase activity as well as TNF-α and IL-10 levels were analyzed in splenic macrophage cultures. Arginine supplementation and the absence of iNOS increased arginase activity in splenic macrophages (Arg, IO-/-, and Arg-/- groups vs the Sham group; P < .05). Arginine was also related to a decrease in TNF-α levels (Arg vs IO group, P < .05) and maintenance of IL-10 levels (Arg vs other groups, P > .05). The inhibition of iNOS did not result in effects on the concentration of cytokines (Sham-/-, IO-/-, and Arg-/- vs other, P < .05). Arginine supplementation and iNOS inhibition led to increased arginase activity. Arginine availability decreased plasma TNF-α levels, which may be directly related to nitric oxide derived from arginine.

The role of l-arginine-nitric oxide pathway in bacterial translocation

This study investigated the nitric oxide (NO) role as a mediator of arginine on bacterial translocation (BT) and gut damage in mice after intestinal obstruction (IO). The effects of pretreatment with arginine with or without NO inhibition on the systemic and local immunological response were also assessed. Mice were categorized into four groups. Group ARG received chow containing 2 % arginine, while group ARG + L-NAME received the same diet plus L-NAME (N-nitro-L-arginine methyl ester) by gavage. The IO and Sham groups were fed standard chow. After 7 days, animals were gavaged with radiolabeled Escherichia coli, anesthetized and subjected to IO, except the Sham group. Animals were euthanized after 18 h, and BT was evaluated in the mesenteric lymph nodes, blood, liver, spleen and lungs. In another experiment, the intestinal injury was assessed regarding intestinal permeability and ileum histological analyses. Intestinal secretory immunoglobulin A (sIgA) levels, serum IFN-γ and IL-10 cytokines were assessed. Arginine reduced BT, but NO inhibition enhanced BT compared with the ARG group (p < 0.05). Intestinal permeability in the ARG and ARG + L-NAME groups was similar but decreased when compared with the IO group (p < 0.05). Histological preservation was observed. Arginine treatment increased IL-10 and sIgA levels when compared with the Sham and IO groups (p < 0.05). The cytokines and sIgA concentrations were similar in the ARG + L-NAME and Sham groups. Arginine appeared to reduce BT and its effects on the modulation of cytokines and secretory IgA in mice after IO are mediated by NO production.