Mesenteric Blood Vessels Research Articles

Efficacy of rituximab therapy for 10 patients suffering from systemic lupus erythematosus with intestinal involvement

We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.

Duration of systemic alteration in vasomotor function of microvascular endothelium caused by the influenza A(H1N1)pdm09 virus

Introduction. The influenza A virus (IAV) can infect vascular endothelial cells and cause activation and/or dysfunction of the endothelium. Previously, we have shown that the influenza A(H1N1)pdm09 virus leads to alteration in functional activity of blood vessels in different vascular beds, and also causes various histopathological changes in pulmonary blood vessels of Wistar rats in the acute period of infection. Aim – to study the duration of systemic alteration in vasomotor function of microvascular endothelium caused by the influenza A(H1N1)pdm09 virus. Materials and methods. The Wistar rats were intranasally infected with the influenza A/St. Petersburg/48/16 (H1N1)pdm09 virus and at 1, 4, 7, 14, 21, 30, 60 and 90 days post infection (dpi) they were anesthetized and necropsied. The expression level of endothelial nitric oxide synthase (eNOS) was determined in mesenteric vascular endothelium by immunohistochemistry. The vasomotor activity of the mesenteric arteries was studied using wire myography. Results. The influenza A(H1N1)pdm09 virus causes a decrease in eNOS expression by 13–39 % within 60 dpi (p<0.05). In addition, the influenza virus also reduces the maximal response of mesenteric arteries to the vasodilator by 74–108 % within 21 days (p<0.0001) and reduces the response by 16–26 % within 30 and 60 dpi (p<0.0001), respectively, and also increases the maximum response of the arteries to the vasoconstrictor by 26–57 % within 30 dpi (p<0.05). It should be noted that such long-term changes are observed while virus is eliminated by the 7th dpi. Conclusion. The influenza A(H1N1) pdm09 virus causes long-term endothelial dysfunction in the Wistar rats which is characterized by the reduced expression of eNOS in mesenteric microvascular endothelium within 60 dpi, decrease of the maximal response of mesenteric microvessels to vasodilator within 60 dpi and increase of the maximal response to vasoconstrictor within 30 dpi. Alterations of systemic functional activity of mesenteric microvessels in rats infected with influenza A(H1N1)pdm09 virus are registered in absence of the reproduction of virus in mesenteric blood vessels while virus is eliminated from pulmonary tissues by the 7th dpi.

412 Awardee Talk: New Insights into Mechanisms of Serotonin Receptor-Mediated Vasoactivity and Complex Interactions with Ergot Alkaloids in Bovine Vasculature

Abstract Ergovaline (ERV), produced in toxic endophyte-infected tall fescue, causes potent vasoconstriction of bovine vasculature by interacting with serotonin (5-HT) receptors. Ergovaline acts as a partial agonist of 5-HT2A-mediated vasoconstriction. The duration of ERV exposure affects 5-HT-mediated vasoactivity of mesenteric blood vessels. If ERV and 5-HT exposure occur simultaneously, ERV can increase 5-HT-mediated vasoconstriction. If 5-HT exposure occurs after blood vessels have had prior ERV exposure, increasing levels of 5-HT can induce vasorelaxation of blood vessels. To better understand mechanisms of 5-HT-mediated vasorelaxation, lateral saphenous veins from steers (n = 5) were assessed for vasoactivity in response to increasing concentrations of selective 5-HT receptor agonists Isolated vessel segments were suspended in chambers of a multi-myograph containing 5 mL of continuously oxygenated Krebs-Henseleit buffer and equilibrated to 1 g tension for 90 min. Vessels were pre-contracted with 1×10-4 M phenylephrine and exposed to increasing concentrations of 5-HT or 5-HT receptor agonists that were selective for 5-HT1B, 5-HT2B, 5-HT4, and 5-HT7. Vasoactive response data were normalized as a percentage of the maximum contractile response induced by the phenylephrine pre-contraction. Increasing concentrations of 5-HT resulted in divergent vasoconstriction and vasorelaxation responses that were dose-dependent. Serotonin caused an 86.3% increase (P < 0.01) in relaxation activity at 1×10-7 M and 5-HT caused a 166% increase (P < 0.01) in contraction activity at 1x10-4 M. Increasing concentrations of the selective 5-HT1B agonist did not result in any vasoactive response. Increasing concentrations of agonists selective for 5-HT2B, 5-HT4, or 5-HT7 resulted in a 27.3%, 91.6%, or 43.9% (P < 0.01) increase in maximal vasorelaxation activity. Of these 5-HT receptor agonists, the selective 5-HT4 receptor agonist resulted in the lowest -log IC50 value (6.30) compared with 5-HT2B and 5-HT7 receptor agonists (4.21 and 4.66, respectively). To confirm the involvement of 5-HT4 in 5-HT-mediated vasorelaxation, blood vessels were exposed to either DMSO (control), a selective 5-HT2A antagonist (1×10-5M), or selective antagonists of 5-HT2A and 5-HT4 simultaneously for 5-min before the pre-contraction with phenylephrine and additions of 5-HT. Antagonism of the 5-HT2A receptor did not result in increased vasorelaxation activity compared with control. Antagonism of the 5-HT2A receptor and 5-HT4 receptor simultaneously inhibited vasorelaxation activity and increased (P < 0.01) the maximal contractile response occurring at 1×10-4 M by 47% compared with control. Approximately 84% of the maximal vasorelaxation activity occurring in response to 5-HT could be accounted for through 5-HT4. These data provide strong evidence that 5-HT4 is the primary receptor involved with 5-HT-mediated vasorelaxation in bovine lateral saphenous vein. More research is needed to determine if 5-HT4-mediated vasorelaxation is responsible for relaxation responses observed in blood vessels with prior ERV exposure. This will aid in the development of strategies for alleviating symptoms of sustained vasoconstriction that occur during fescue toxicosis in ruminants.

CT findings of idiopathic mesenteric panniculitis and analysis of related factors

ObjectivesTo analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease. MethodsThe imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area. ResultsAmong the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22–83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85–331.65 cm2. ConclusionMesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.

Molecular and cellular basis of praziquantel action in the cardiovascular system.

The anthelmintic drug praziquantel (PZQ) causes contraction of parasitic schistosomes as well as constriction of blood vessels within the mesenteric vasculature of the host where the adult blood flukes reside. The contractile action of PZQ on the vasculature is mediated by the activation of host serotonergic 5-HT2B receptors (5-HT2BRs). However, the molecular basis for PZQ interaction with these targets and the location of these 5-HT2B receptors in the vessel wall have not been experimentally defined. Evaluation of a PZQ docking pose within the 5-HT2BR orthosteric site, using both Ca2+ reporter and bioluminescence resonance energy transfer (BRET) assays, identified residues F3406.51 and F3416.52 (transmembrane helix 6, TM6) as well as L209EL2 (extracellular loop 2) as critical for PZQ-mediated agonist activity. A key determinant of PZQ selectivity for the 5-HT2B receptor over the 5-HT2A/2C receptors was determined by M2185.39 in transmembrane helix 5 (TM5) of the orthosteric site. Mutation of this residue to valine (M218V), as found in 5-HT2A and 5-HT2C, decreased PZQ agonist activity, whereas the reciprocal mutation (V215M) in 5-HT2C increased PZQ activity. Two-photon imaging in intact mesenteric arterial strips visualized PZQ-evoked Ca2+ transients within the smooth muscle cells of the vessel wall. PZQ also triggered cytoplasmic Ca2+ signals in arterial smooth muscle cells in primary culture that were isolated from mesenteric blood vessels. These data define the molecular basis for PZQ action on 5-HT2B receptors localized in vascular smooth muscle.

Influenza A Virus Causes Histopathological Changes and Impairment in Functional Activity of Blood Vessels in Different Vascular Beds.

It has been established that blood vessels are a target for influenza virus; however, the mechanism by which virus affects the cardiovascular system remains unknown. The aim of the study is the identification of histological changes and changes in the functional activity of the pulmonary and mesenteric blood vessels of Wistar rats. Wistar rats were intranasally infected with the influenza A(H1N1)pdm09 virus. At 24 and 96 h post infection (hpi), histopathological changes were observed in lung tissues with the absence of histological changes in mesenteric tissues. The functional activity of pulmonary and mesenteric arteries was determined using wire myography. In pulmonary arteries, there was a tendency towards an increase in integral response to the vasodilator and a decrease in the integral response to the vasoconstrictor at 24 hpi (compared with control). At 96 hpi, a tendency towards a decrease in the integral response to the vasoconstrictor persisted, while the response to acetylcholine was slightly increased. The functional activity of the mesenteric blood vessels was inverted: a significant decrease in the integral response to the vasodilator and an increase in the response to the vasoconstrictor at 24 hpi were observed; at 96 hpi, the integral response to the vasoconstrictor persisted, while the response to the vasodilator remained significantly reduced. Obtained data indicate the development of endothelial dysfunction in non-lethal and clinically non-severe experimental influenza virus infection.

Occurrence and distribution of gross and microscopic gastrointestinal lesions in pigs in Northern Kerala

Gastroenteritis in swine herds pose a big constraint in pig farming due to the economic losses accompanying it. The present study utilised 57 pig carcasses to assess the occurrence and distribution of various gastrointestinal lesions in pigs in Northern Kerala. Gross changes in stomach were observed in 84.21 per cent of carcasses in which mucosal congestion (61.40 per cent) was the most frequent lesion. Principal microscopic gastric lesions observed were mucosal necrosis, cellular infiltration in lamina propria, hyperplastic epithelium, hyperkeratinisation and fibrino-necrotic membrane. Gross changes in at least one region of intestine were evident in all the samples. The most common lesions in intestines were engorgement of mesenteric blood vessels (80.70 per cent) followed by catarrhal enteritis (73.68 per cent). Salient gross lesions such as mucosal ulcers were observed only in caecum and colon, diphtheritic membrane formation was observed in ileum, caecum and colon. Major histological lesions observed in intestines were mucosal necrosis (89.47 per cent) followed by cellular infiltration in lamina propria (68.42 per cent). Histologically, the major site-specific lesions observed were Brunner gland hyperplasia in duodenum, necrosis, hyperplasia, and lymphocytic depletion of Peyer’s patches in ileum, granulomatous infiltration in ileum and colon, neutrophilic colitis and goblet cell depletion in colon. The present study observed a higher incidence of gastrointestinal variations in pigs irrespective of age and further research is needed to understand the etiological factors contributing to such heavy burden of gastrointestinal lesions.

Meckel\u2019s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

BackgroundThe most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy.Case presentationAn 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD.ConclusionsWe report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

BackgroundThe THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy.MethodsProspective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days.Results60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups.ConclusionsBoth energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation.ClinicalTrial.gov # NCT02628093.

Current surgical management of duodenal gastrointestinal stromal tumors.

Duodenal gastrointestinal stromal tumors (D-GISTs) are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors. They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater, pancreas, mesenteric blood vessels, biliary and pancreatic ducts. The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved. The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location, size and involvement of surrounding structures such as wedge resection with primary closure, segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy. Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands. The minimally invasive techniques including robotic-assisted approach will likely increase in the future. D-GISTs have a prognosis comparable to gastric and other small bowel GISTs. However, the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs. The use of limited resection when condition allows is recommended due to lower surgical morbidity, less postoperative complications and better oncologic outcomes.

Mesenteric rent, ileal volvulus and ileocolic intussusception in a 3-year-old large-white dry sow: A postmortem report

This report presents a post-mortem (PM) finding of Large-White dry sow which died from complications associated with mesenteric rent, volvulus and intussusception. Other lesions included hydrothorax, ascites, and engorged mesenteric blood vessels, pale and enlarged liver. Helminthological and protozoological examinations of the intestinal samples were negative. Diagnosis of mesenteric rent, ileal volvulus and intussusception was reached. The diagnosis was attributable to the risk factors which include fight, excessive amounts of dry whey concentrate coupled with poor hygiene in the feeding and management system. Familiarizing swine farmers with the symptoms of bowel obstruction and provision of diagnostic facilities in commercial piggery farms will help in facilitating diagnosis and prompt action to prevent mortality and minimize economic loss.
 Keywords: Intussusception, Mesenteric rent, Sow, Volvulus, Whey

Diagnosing Strongylus vulgaris in pooled fecal samples

Strongylus vulgaris is the most pathogenic intestinal helminth parasite infecting horses. The migrating larvae in the mesenteric blood vessels can cause non-strangulating intestinal infarctions, which have a guarded prognosis for survival. Infections are typically diagnosed by coproculture, but a PCR test is available in some countries. While it is ideal to test horses individually, many veterinarians and clients wish to pool samples to reduce workload and cost of the diagnostic method. The purpose of this study was to determine if pooling of fecal samples would negatively impact diagnostic performance of the coproculture and the PCR for determination of S. vulgaris infection. Ten horses with strongylid eggs per gram (EPG) >500 and confirmed as either S. vulgaris positive or negative were selected as fecal donors. Eight pools with feces from five horses were created with 0%, 10 %, 20 %, 30 %, 40 %, 50 %, 80 %, and 100 % S. vulgaris positive feces. From each pool, 20 subsamples of 10 g each were collected and analyzed. Half of these samples were set up for coproculture and the other half for PCR. All pools containing 50 % or greater S. vulgaris positive feces were detected positive by both PCR and coproculture. In the pools with less than 50 % S. vulgaris positive feces, the PCR detected 33 positive samples compared to 24 with the coproculture. Three samples from the 0% pool were detected as low-level PCR positives, but this could be due to contamination. These results indicate that diagnosing S. vulgaris on pooled samples is reliable, when at least 50 % of the feces in a pool are from S. vulgaris positive animals. Since S. vulgaris remains relatively rare in managed horses, however, some diagnostic sensitivity is expected to be lost with a pooled sample screening approach. Nonetheless, pooled sample screening on farms could still be considered useful under some circumstances, and the PCR generally performed better at the lower proportions of S. vulgaris positive feces.

Case report of primary mesenteric leiomyosarcoma

Background: Mesenteric Leiomyosarcoma (LMS) is a rare soft tissue tumor that takes its origin from smooth muscle cells, usually mesenteric blood vessels. Immunohistochemical (IHC) staining is deemed necessary for the diagnosis. Surgical resection with negative microscopic margins is the best treatment available, with limited role of chemo and radiotherapy. Case Presentation: We present a case of 46-year-old male who presented with large abdominal mass and obstructive symptoms. Surgical excision was performed and diagnosis of LMS was established on the basis of IHC stains. Currently, the patient is under follow up and has not developed any recurrence. Conclusion: Due to limited cases recorded globally, definitive guidelines for the management of this tumor are lacking. Work needs to be done to explore further about Primary Mesenteric LMS.

Mesenteric neovascularization during spring-mediated intestinal lengthening

BackgroundShort gut syndrome, a condition characterized by inadequate absorption of nutrients owing to decreased bowel length, has minimal avenues for treatment. We have proposed spring-mediated distraction enterogenesis to lengthen bowel in porcine jejunum as a treatment for short gut. We aim to evaluate the extent of mesenteric neovascularization in segments of lengthened bowel via spring-mediated enterogenesis. MethodsFemale juvenile Yucatan pigs underwent laparotomy and insertion of gelatin-encapsulated compressed nitinol springs, held in place with plication sutures, into the jejunum. At surgery and sacrifice, macroscopic mesenteric blood vessels were counted between the plication sites. Histologic samples of the mesentery were obtained to evaluate microscopic vasculature. ResultsA statistically significant increase in macroscopic mesenteric blood vessels was seen after intestinal lengthening (before: 1.9 ± 0.7 vessels, after: 4.7 ± 1.2 vessels, p = 0.001). A statistical significance is also seen in the density of arterioles (control: 3.0 ± 3.0 vessels/mm, spring: 7.0 ± 9.0 vessels/mm, p = 0.01) and venules (control: 4.0 ± 3.0 vessels/mm, spring: 8.0 ± 8.0 vessels/mm, p = 0.003). ConclusionIntestinal segments lengthened by intraluminal springs demonstrated total greater number of macroscopic vessels and microscopic blood vessels per length of mesentery as compared to control. This suggests local changes within the mesentery to recruit blood supply to growing intestine. Level of evidenceN/A Type of studyTreatment study.

Three cases of non-occlusive mesenteric ischemia that developed after head and neck cancer therapy

Non-occlusive mesenteric ischemia (NOMI) causes intestinal necrosis due to irreversible ischemia of the intestinal tract despite the absence of organic obstruction in the mesenteric blood vessels. The disease has extremely poor prognosis. We report three cases of NOMI hypothesized to have developed after head and neck cancer therapy; thus, we report these cases considering the available literature. Case 1: A 74-year-old man with T2N0M0 stage Ⅱ oropharyngeal carcinoma complained of abdominal pain 5 days after chemoradiotherapy. The patient was diagnosed with NOMI, and an emergency surgery was performed. Case 2: A 69-year-old man with T2N2bM0 stage IVA hypopharyngeal carcinoma complained of abdominal pain during TPF chemotherapy. The patient was diagnosed with NOMI, and he died on the same day. Case 3: A 82-year-old man with T2N2bM0 stage IVA hypopharyngeal carcinoma complained of abdominal pain with reduced level of consciousness, 5 days after total laryngopharyngectomy. The patient was diagnosed with NOMI, and an emergency surgery was performed on the same day. We therefore suggest that ENT physicians must be aware of NOMI as a complication that can develop after head and neck cancer therapy.

Clinical study on the tunnel approach in laparoscopic radical right hemicolectomy.

e16135 Background: The medial to lateral approach Laparoscopic right hemicolectomy complies with the “no-touch” principle, but need a demanding procedure with a steep learning curve. This study was designed to assess the superiority of the tunnel approach compared to traditional medial-to-lateral approach in laparoscopic right hemicolectomy for patients with right-sided colon cancer. Methods: The new method was called Tunnel Approach: The tunnel was formed with Toldt's gap was dissociated upward from the attachment of ileocecal part and retroperitoneum, then the right mesocolon was lifted to expose and divide the superior mesenteric blood vessel. We analyzed retrospectively the patients with resectable right-sided colon cancer confirmed by colonoscope and imaging who received the laparoscopic radical right hemicolectomy. The patients were divided into the tunnel approach (group A) and the traditional medial-to-lateral approach (group B) according to the surgical maneuver performed. Results: A total of 84 patients who received laparoscopic radical right hemicolectomy were assigned to group A (n = 42) or group B (n = 42) between January 2016 to June 2017. There was no difference in baseline characteristics including demographics, body mass index (BMI), tumor stage, tumor location and differentiation. The operation time and intraoperative blood loss in group A were significantly better than group B (137.74±22.7 vs. 153.1±28.8min, p < 0.05; 49.0±40.7 vs. 142.9±87.4ml, p < 0.05, respectively).There was no difference in tumor size(5.7±2.1 vs. 5.7±2.1cm, p>0.05), conversion to laparotomy rate(0 vs. 3, p>0.05), lymph node yield(30.5±14.4 vs. 27.9±12.7, p>0.05), time to first flatus(3.4±1.3 vs. 4.0±1.3d, p>0.05), postoperative hospital stays(10.0±2.2 vs. 12.3±3.0d, p>0.05) and complications(2 vs. 3, p>0.05) between two groups. There was no treatment-related death in both groups. Conclusions: The characteristic of “tunnel” approach is to convert the anatomy from a two-dimensional to a three-dimensional view, it showed the benefits of both speed and safety with low intraoperative conversion to laparotomy rate and mortality. This new tunnel approach right hemicolectomy is worth recommended.

Kefir peptides improve gut and blood vessels function by ameliorating intestinal morphology and enriching intestinal microbiota in salt‐induced spontaneous hypertension rat stroke‐prone (SHRSP) animal model

Kefir peptides are prebiotic products generated by kefir grain fermentation of milk proteins. Effects of kefir peptides for lowered blood pressure, antioxidant and osteoporosis. In this study, we hypothesis that kefir peptides may protect the gut function with microbial dysbiosis changes and decrease the mesenteric blood vessels inflammatory which linked to anti hypertension. The current study found that a high salt diet is considered a cardiovascular risk factor, altered the intestinal bacteria composition and produced gut dysbiosis in rats. Thus, we used the 1% salt (v/w) in drinking water to speed up hypertension of spontaneous hypertension rat stroke‐prone (SHRSP) rats, the rats were assigned to four treatment groups, including normal control group (WKY rat), Untreated group (SHRSP rat fed with normal water), NaCl/Mock group (SHRSP rat fed with 1% salt water) and NaCl/KP group (SHRSP rat fed with 1% salt water+200 mg/kg kefir peptides) for four weeks experiment. Data showed that rats only gave the 1% salt group the gut villus height of small intestine and the diversity of intestinal microbiota were significantly decreased, while supplementation with kefir peptides counteracted the normal control group. In the small intestinal microbiota, the microbiota enriching of 1% salt‐treated Mock group have significantly decreased than the other groups. Oral administrations of kefir peptides could regulate the microenvironment of the intestinal tract for the microbes, provide extra sources of carbon and nitrogen for the microbes to live and grow. Additionally, the genera of Allobaculum, Bifidobacterium and Lactobacillus were found to have a high degree of richness in the kefir peptides group, which are generally considered beneficial taxa with the energy and regulate blood pressure. In conclusion, the results indicated that kefir peptides improve gastrointestinal microenvironment and mesenteric blood vessels function by ameliorating intestinal morphology and enriching intestinal microbiota under the 1% salt‐induced SHRSP rats.

Hepatic Cirrhosis Associated with Ingestion of Cycas revoluta in Canine

Background: Cycas revoluta (“sago palm”) is a toxic ornamental plant which, when ingested, can cause hepatotoxic effects, gastrointestinal signs, and neurological alterations. Albeit rarely, C. revoluta ingestion can culminate with chronic severe hepatitis associated with hepatic fibrosis. The objective of this work is to report a case of hepatic cirrhosis consequent to ingestion of C. revoluta in a dog and describe the clinical and pathological aspects that accompany the development of chronic hepatopathy, as a way to provide information that may help diagnosis of this condition.Case: A 9-month-old male mongrel dog was presented for examination with a history of increased abdominal volume and anorexia 20 days after ingesting the seeds of Cycas revoluta. Laboratory exams revealed hypochromic microcytic anemia, neutrophilic leukocytosis, monocytosis, thrombocytopenia, decreased albumin, and elevation of the enzymes alanine aminotransferase and alkaline phosphatase. Ultrasound scanning showed presence of hepatomegaly, a heterogeneous hepatic parenchyma, and free fluid in the peritoneum. The animal was treated and was discharged from the hospital. Twenty days later, the patient returned to the hospital exhibiting prostration, vomiting, ascites, and pale mucous membranes. The alterations observed in the previous laboratory exams persisted except for thrombocytopenia, which was absent. A new treatment was administered, and the animal was discharged three days later. However, the patient returned once again exhibiting hyporexia, hemorrhagic diarrhea, and slight prostration that progressed to severe prostration, lateral decubitus and death approximately two months after ingesting the plant. Necropsy revealed a markedly poor body condition, slight icterus, limb edema, ascites and hydrothorax, and an atrophied liver with a yellowish color and an irregular, but firm, capsule surface. Additional alterations included portosystemic shunts in mesenteric blood vessels, a dark red content in the lumen of the intestine along with reddened mesenteric lymph nodes, and edema and emphysema in the lungs. Histologically, there was proliferation of fibrous connective tissue in the hepatic parenchyma with the formation of fibrous bridges, regenerative nodules, slight biliary duct proliferation, and moderate, diffuse intracytoplasmic vacuolization in hepatocytes.Discussion: The diagnosis of poisoning by ingestion of Cycas revoluta was based on the observation of the ingestion of the plant in addition to the clinical signs, complementary exams, and pathological findings. The clinical signs were characteristic of involvement of the digestive tract and acute hepatic lesion caused by C. revoluta. The biochemical alterations and the clinicopathological findings observed indicated occurrence of hepatic failure after ingestion of the plant. Anemia, neutrophilia, thrombocytopenia, elevation of hepatic enzymes and hypoalbuminemia as seen in this case are commonly described in cases of poisoning by C. revoluta. Edema, icterus and hemorrhage are consequent to hepatic failure caused by necrosis of hepatocytes and their replacement by proliferation of fibrous connective tissue, which characterizes a chronic histologic pattern. The observation of cirrhosis at the pathological examination indicated occurrence of a chronic hepatopathy that resulted from loss of hepatocytes consequent to acute lesion caused by ingestion of the plant.

Acute oral toxicity studies of methanolic extract and chloroform fraction of methanolic extract of seeds of muricata

Background: Natural products are considered to be safe and efficacious. Adequate proof of the safety of these herbal drugs is lacking. Objectives: The present study was undertaken to evaluate the acute oral toxicity of methanolic extract of seeds of Annona muricata (MAM) and chloroform fraction of MAM and to derive the lethal dose 50 (LD50) of chloroform fraction of methanol extract of seeds of A. muricata (CMAM). Materials and Methods: Acute toxicity studies of MAM and CMAM were conducted as per the Organisation for Economic Co-operation and Development (OECD) guidelines 420. LD50 of CMAM in rats and mice was estimated as per OECD guidelines 425. The toxic response was evaluated in vitro using hemolytic assay in rat and human erythrocytes. Results: The acute toxicity study done using OECD 420 guideline revealed that MAM and CMAM were safe at 300 mg/kg and produced mortality at 2000 and 5000 mg/kg. On gross examination, congestion of cranial, mesenteric, and uterine blood vessels was observed. As per OECD guidelines 425, CMAM was safe up to 980 mg/kg in rats and up to 175 mg/kg in mice and LD50 value was estimated to be 1310 mg/kg in rats and 310 mg/kg in mice. In vitro hemolytic assay showed that the plant fraction produced hemolysis. Conclusion: The present study concluded the toxicity produced by A. muricata seeds in the vascular system might be due to oxidative injury caused by the phytochemical constituents and it is essential to derive the safe pharmacological dose whenever the plant material is tested for efficacy studies.

Neotropical Turtle Blood Flukes: Two New Genera and Species from the Amazon River Basin with a Key to Genera and Comments on a Marine-Derived Parasite Lineage in South America

Two new genera and species of freshwater turtle blood flukes (TBFs) are described herein based on specimens infecting the nephritic and mesenteric blood vessels of "matamatas" (a side-necked turtle, Chelus fimbriata [Schneider, 1783] [Pleurodira: Chelidae]) from the Amazon River Basin, Peru. These taxa comprise the first-named species and the first-proposed genera of freshwater TBFs from the continent of South America. A new comparison of all TBF genera produced 6 morphologically diagnosed groups that are discussed in light of previous TBF classification schemes and a novel phylogenetic hypothesis based on the nuclear large subunit ribosomal DNA (28S). Considering external and internal anatomical features, species of the new genera (Atamatam Bullard and Roberts n. gen., Paratamatam Bullard and Roberts n. gen.) are most similar to each other and are together most similar to those of several marine TBF genera. The 28S phylogenetic analysis supported the monophyly of all 6 morphologically diagnosed groups of genera. Most notably, the freshwater TBFs of South America comprise a derived group nested within the clade that includes the paraphyletic marine TBFs. Not surprisingly in light of morphology, another marine TBF lineage (Neospirorchis Price, 1934) clustered with the freshwater TBFs of Baracktrema Roberts, Platt, and Bullard, 2016 and Unicaecum Stunkard, 1925. Our results, including an ancestral state reconstruction, indicated that (1) freshwater TBFs have colonized marine turtles twice independently and that (2) the South American freshwater TBFs comprise a marine-derived lineage. This is the first evidence that TBFs have twice independently transitioned from a marine to freshwater definitive host. Marine incursion is considered as a possible mechanism affecting the natural history of marine-derived freshwater TBFs in South America. A dichotomous key to accepted TBF genera is provided.