Mesenteric Vessels Research Articles

The Impact of Biomarkers on the Early Detection of Acute Mesenteric Ischemia.

acute mesenteric ischemia (AMI) is a life-threatening condition that is caused by inadequate blood flow through the mesenteric vessel and is related to high mortality rates due to systemic complications. This study aims to systematically review the available literature concerning the major findings of possible biomarkers for early detection of acute mesenteric ischemia in the human population. studies that measured the performance of biomarkers during acute mesenteric ischemia were identified with the search of PubMed, Embase, Medline, and Cochrane library. from a total of 654 articles, 46 articles examining 14 different biomarkers were filtered, falling within our inclusion criteria. Intestinal fatty acid-binding protein (I-FABP) was the most commonly researched biomarker regarding AMI, with sensitivity ranging from 61.5% to 100% and specificity ranging from 40% to 100%. The second most commonly researched biomarker was D-dimer, with a sensitivity of 60-100% and a specificity of 18-85.71%. L-lactate had a sensitivity of 36.6-90.91% and a specificity of 64.29-96%. Several parameters within the blood count were examined as potential markers for AMI, including NLR, PLR, MPV, RDW, DNI, and IG. Citrulline, interleukin 6 (IL-6), and procalcitonin (PCT) were the least-researched biomarkers. different biomarkers showed different accuracies in detecting AMI. I-FABP and D-dimer have been the most researched and shown to be valuable in the diagnosis of AMI, whereas L-lactate could be used as an additional tool. Ischemia-modified albumin (IMA), alpha glutathione S-transferase (αGST), interleukin 6 (IL-6), and citrulline showed potential use in their respective studies. However, further research needs to be done on larger sample sizes and with controls to reduce bias. Several studies showed that neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), red-cell distribution width (RDW), delta neutrophil index (DNI), and immature granulocytes (IGs) might be useful, as well at the same time be widely distributed and affordable in combination with other markers presenting higher specificity and sensitivity.

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.

Propensity Score Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta: Zone-1 Versus Zone-3 Resuscitative Endovascular Balloon Occlusion of the Aorta Odds of Mortality

IntroductionThere are two zones for the placement of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma patients: above the mesenteric vessels (Zone-1) or below the renal arteries (Zone-3). Zone-1 REBOA diverts blood away from the visceral organs which leads to a systemic inflammatory response and reperfusion injury. We hypothesized that patients undergoing Zone-1 REBOA placement had a higher odds of mortality. MethodsThe 2017-2019 Trauma Quality Improvement Program database was queried for patients undergoing either Zone-1 or Zone-3 REBOA. We excluded all patients with prehospital cardiac arrest. We compared Zone-1 versus Zone-3 REBOA using a 1:2 propensity-score model, matching for age, mechanism, sex, hypotension, tachycardia, blunt solid organ injury grade, pelvic fracture, and injuries to the aorta, iliac artery, iliac vein, and inferior vena cava. ResultsWe matched 130 Zone-1 REBOA patients to 260 Zone-3 REBOA patients. There were no statistically significant differences in the matched variables (P > 0.05). Compared to Zone-3 REBOA, patients with Zone-1 REBOA who survived ≥48 h had similar rates of acute kidney injury (18.6% versus 10.9%, P = 0.19). Zone-1 REBOA patients had a higher mortality rate (71.4% versus 48.8%, P = 0.002) and mortality odds ratio (OR) (OR 1.85, OR 1.18-2.89, P = 0.007). Zone-1 REBOA remained associated with a higher odds of mortality after controlling for traumatic brain injury and injury severity score (OR 1.86, OR 1.18-2.92, P = 0.007). ConclusionsCompared to Zone-3, using a REBOA in Zone-1 is associated with higher odds of mortality. The use of REBOA Zone-1 deployment should be done with caution.

PE-Net: a parallel framework for 3D inferior mesenteric artery segmentation.

The structural morphology of mesenteric artery vessels is of significant importance for the diagnosis and treatment of colorectal cancer. However, developing automated vessel segmentation methods for this purpose remains challenging. Existing convolution-based segmentation methods have limitations in capturing long-range dependencies, while transformer-based models require large datasets, making them less suitable for tasks with limited training samples. Moreover, over-segmentation, mis-segmentation, and vessel discontinuity are common challenges in vessel segmentation tasks. To address these issues, we propose a parallel encoding architecture that combines transformers and convolutions to retain the advantages of both approaches. The model effectively learns position deviations and enhances robustness for small-scale datasets. Additionally, we introduce a vessel edge capture module to improve vessel continuity and topology. Extensive experimental results demonstrate the improved performance of our model, with Dice Similarity Coefficient and Average Hausdorff Distance scores of 81.64% and 7.7428, respectively.

Not just fibrotic: endothelial-derived TGFβ maintains contractile function and lymphatic muscle phenotype during homeostasis.

Cell-cell communication within the lymphatic vasculature during homeostasis is incompletely detailed. Although many discoveries highlight the pathological roles of transforming growth factor-beta (TGFβ) in chronic vascular inflammation and associated fibrosis, only a small amount is known surrounding the role of TGFβ-signaling in homeostatic lymphatic function. Here, we discovered that pharmacological blockade of TGFβ receptor 1 (TGFβR1) negatively impacts rat mesenteric lymphatic vessel pumping, significantly reducing vessel contractility and surrounding lymphatic muscle coverage. We have identified mesenteric lymphatic endothelial cells themselves as a source of endogenous vascular TGFβ and that TGFβ production is significantly increased in these cells via activation of a number of functional pattern recognition receptors they express. We show that a continuous supply of TGFβ is essential to maintain the contractile phenotype of neighboring lymphatic muscle cells and support this conclusion through in vitro analysis of primary isolated lymphatic muscle cells that undergo synthetic differentiation during 2-D cell culture, a phenomenon that could be effectively rescued by supplementation with recombinant TGFβ. Finally, we demonstrate that lymphatic endothelial production of TGFβ is regulated, in part, by nitric oxide in a manner we propose is essential to counteract the pathological over-production of TGFβ. Taken together, these data highlight the essential role of homeostatic TGFβ signaling in the maintenance of lymphatic vascular function and highlight possible deleterious consequences of its inhibition.NEW & NOTEWORTHY The growth factor TGFβ is commonly associated with its pathological overproduction during tissue fibrosis rather than its homeostatic functions. We expose the lymphatic endothelium as a source of endogenous TGFβ, the impact of its production on the maintenance of surrounding lymphatic muscle cell phenotype, and internally regulated mechanisms of its production. Overall, these results highlight the intricate balance of TGFβ-signaling as an essential component of maintaining lymphatic contractile function.

Flow-dependent regulation of rat mesenteric lymphatic vessel contractile response requires activation of endothelial TRPV4 channels.

The objective of our study is to evaluate the involvement of the transient receptor potential vanilloid 4 (TRPV4) in the alteration of lymphatic pumping in response to flow and determine the signaling pathways involved. We used immunofluorescence imaging and western blotting to assess TRPV4 expression in rat mesenteric lymphatic vessels. We examined inhibition of TRPV4 with HC067047, nitric oxide synthase (NOS) with L-NNA and cyclooxygenases (COXs) with indomethacin on the contractile response of pressurized lymphatic vessels to flow changes induced by a stepwise increase in pressure gradients, and the functionality of endothelial TRPV4 channels by measuring the intracellular Ca2+ response of primary lymphatic endothelial cell cultures to the selective agonist GSK1016790A. TRPV4 protein was expressed in both the endothelial and the smooth muscle layer of rat mesenteric lymphatics with high endothelial expression around the valve sites. When maintained under constant transmural pressure, most lymphatic vessels displayed a decrease in contraction frequency under conditions of flow and this effect was ablated through inhibition of NOS, COX or TRPV4. Our findings demonstrate a critical role for TRPV4 in the decrease in contraction frequency induced in lymphatic vessels by increases in flow rate via the production and action of nitric oxide and dilatory prostanoids.

Celastrol ameliorates energy metabolism dysfunction of hypertensive rats by dilating vessels to improve hemodynamics.

The impact of hypertension on tissue and organ damage is mediated through its influence on the structure and function of blood vessels. This study aimed to examine the potential of celastrol, a bioactive compound derived from Tripterygium wilfordii Hook F, in mitigating hypertension-induced energy metabolism disorder and enhancing blood perfusion and vasodilation. In order to investigate this phenomenon, we conducted in vivo experiments on renovascular hypertensive rats, employing indirect calorimetry to measure energy metabolism and laser speckle contrast imaging to evaluate hemodynamics. In vitro, we assessed the vasodilatory effects of celastrol on the basilar artery and superior mesenteric artery of rats using the Multi Wires Myograph System. Furthermore, we conducted preliminary investigations to elucidate the underlying mechanism. Moreover, administration of celastrol at doses of 1 and 2mg/kg yielded a notable enhancement in blood flow ranging from 6 to 31% across different cerebral and mesenteric vessels in hypertensive rats. Furthermore, celastrol demonstrated a concentration-dependent (1 × 10-7 to 1 × 10-5M) arterial dilation, independent of endothelial function. This vasodilatory effect could potentially be attributed to the inhibition of Ca2+ channels on vascular smooth muscle cells induced by celastrol. These findings imply that celastrol has the potential to ameliorate hemodynamics through vasodilation, thereby alleviating energy metabolism dysfunctions in hypertensive rats. Consequently, celastrol may hold promise as a novel therapeutic agent for the treatment of hypertension.

Diffusely Invasive Mucormycosis of the Small Bowel in a Patient with Microbiologic Cultures and Tissue Biopsies Negative for Fungal Organisms

Abstract Introduction/Objective Invasive mucormycosis can be a swiftly fatal medical emergency occurring in patients with uncontrolled diabetes. This angioinvasive fungus causes tissue necrosis, hemorrhage, and thrombosis and often develops in the sinonasal cavities where it can extend directly to the CNS or spread systemically to visceral sites like the GI tract. Here, we describe a patient whose small bowel resection shortly before death, revealed diffusely invasive mucormycosis despite that blood and body fluid cultures and tissue biopsies were negative for fungal organisms. Methods/Case Report Our patient is a 39 year old male with a history of uncontrolled diabetes, brought to our hospital in cardiac arrest and found to have fentanyl in his system. His labs showed severe metabolic and electrolyte derangements including diabetic ketoacidosis. His blood cultures revealed bacteremia but no fungal growth, and he was placed on antibiotics for sepsis. The patient developed compartment syndrome of his bilateral forearms, which were amputated and showed necrotic skeletal muscle but no fungal infection. The patient also developed facial necrosis concerning for mucormycosis, but nasal endoscopic and facial skin biopsies were negative for mucor. However, his abdominal CT showed diffuse mural thickening of his small bowel concerning for bowel ischemia, which prompted an exploratory laparotomy that revealed large segments of necrotic jejunum and ileum. While peritoneal fluids collected during the surgery yielded no fungal growth on culture, resected segments of necrotic small bowel showed massive presence of mucor with broad, pauci-septate, ribbon-like hyphae branching at right angles. Small bowel and mesenteric vessels showed angioinvasion by mucor with vasculitis and fibrin thrombi causing ischemic enteritis. Mucor was also noted diffusely invading small bowel muscularis propria, adventitia, and mesenteric fat, and small bowel also showed ulceration, hemorrhage, and transmural and mesenteric fat necrosis. Unfortunately, a few days after his surgery, the patient expired from multi-organ failure and septic shock before he could receive anti-fungal therapy for mucormycosis. Results (if a Case Study enter NA) NA Conclusion Mucormycosis is a rapidly growing, angioinvasive, and potentially lethal fungal infection that must be promptly recognized. This report documents an unusual case of invasive mucormycosis of the small bowel that went undetected in a severely ill patient whose blood and peritoneal cultures and tissue biopsies were all negative for fungal organisms.

Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound

BackgroundTo assess the frequency of appearance of various signs (isolated and grouped) in emergency imaging tests in patients with anisakiasis, according to the location of gastrointestinal tract involvement.MethodsRetrospective review by two experienced radiologists of emergency ultrasounds and CTs performed on patients admitted in the Emergency Department of our hospital with later confirmed anisakiasis (2010–2021), assessing the presence of signs suggesting anisakiasis. Calculation of the frequency of appearance according to the gastric or intestinal location, as well as the most common grouped signs.ResultsOut of 231 total patients with anisakiasis, imaging studies were performed in 144: abdominopelvic ultrasound in 43 cases and CT in 111 (both techniques in 31). In cases with gastric occurrence (34), in CT the wall stratification (100%), wall thickening (97%), fat stranding (91%) and ascitic fluid (82%) were predominant. In the intestinal cases (105), in CT (95) the wall thickening (100%), fat stranding (92%) and mesenteric vessel engorgement (83%) were usual; in ultrasound (40), ascitic fluid and wall thickening (70% in both cases) were frequently observed. The frequency of grouped appearance of the mentioned signs was 82% in gastric cases, 80% in intestinal cases and 50% in ultrasounds. Multisegment involvement in CT reached 28% (gastric + intestinal) and 11% (only intestinal) of cases.ConclusionsThe most frequent CT findings in patients with gastric anisakiasis are wall stratification and thickening, fat stranding and ascitic fluid. In the intestinal cases, wall thickening, fat oedema and vessel engorgement are the most often observed findings.Critical relevance statementThe presence of different radiological signs makes it advisable to include anisakiasis in the differential diagnosis of acute abdomen. Intestinal and multifocal involvement rates are greater than previously reported.Key points• In gastric anisakiasis, CT frequently shows wall stratification and thickening, fat stranding and ascitic fluid.• In intestinal anisakiasis, CT often presents wall thickening, fat stranding and vessel engorgement.• In intestinal anisakiasis, ultrasounds most frequently show ascitic fluid and wall thickening.Graphical

Trombosis venosa mesentérica y portal como causa infrecuente de obstrucción e isquemia intestinal en paciente joven. Reporte de un caso

Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis.

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.

Complete mesocolic excision for colon cancer: current status and controversies.

According to Hohenberger's original description, complete mesocolic excision for colon cancer involves precise dissection of the avascular embryonic plane between the parietal retroperitoneum and visceral peritoneum of the mesocolon. This ensures mesocolic integrity, access to high ligation of the supplying vessels at their origin and an associated extended lymphadenectomy. Results from centres which have adopted this approach routinely have demonstrated that oncological outcomes can be improved by the rigorous implementation of established principles of cancer surgery. Meticulous anatomical dissection along embryonic planes is a well-established principle of precision cancer surgery used routinely by the specialist colorectal surgeon. Therefore, the real question concerns the need for true central vascular ligation and associated extended (D3) lymphadenectomy or otherwise, particularly along the superior mesenteric vessels when performing a right colectomy. Whether this approach results in improved overall or disease-free survival remains unclear and its role remains controversial particularly given the potential for significant morbidity associated with a more extensive central vascular dissection. Current literature is limited by considerable bias, as well as inconsistent and variable terminology, and the results of established randomized trials are awaited. As a result of the current state of equipoise, various national guidelines have disparate recommendations as to when complete mesocolic excision should be performed if at all. This article aims to review the rationale for and technical aspects of complete mesocolic excision, summarize available short and long term outcome data and address current controversies.

Management Strategies and Outcomes for Small Intestinal Neuroendocrine Tumours with Involvement of the Superior Mesenteric Vessels: A Systematic Review.

Small intestinal neuroendocrine tumours (SI-NETs) are the most common small intestinal tumours. A particularly challenging subset of these tumours is those that involve the superior mesenteric artery or vein for which the role and feasibility of surgery are often questioned. This systematic review aimed to identify and evaluate the management strategies used for these complex SI-NETs. The identified studies showed positive outcomes with surgery and multimodality therapy.

POSSIBILITIES OF USING THE ANALYSIS OF OXIDANT-ANTIOXIDANT METABOLIC PROCESSES AND ION EXCHANGE IN PREDICTING THE DEVELOPMENT OF POSTOPERATIVE COMPLICATIONS IN SMALL BOWEL SURGERY

Summary. Introduction. The work is devoted to the study of the possibilities of using the analysis of oxidant-antioxidant metabolic processes and ion exchange in predicting the development of postoperative complications during operations on the small intestine in conditions of a compromised abdominal cavity.
 The aim of the study. To determine the peculiarities of the flow of oxidant-antioxidant metabolic processes and ion exchange during operations on the small intestine in conditions of intra-abdominal infection and to study the clinical effectiveness of their assessment.
 Materials and methods. Research was conducted at the Institute of General and Emergency Surgery of the State University named after V.T. Zaitsev National Academy of Sciences of Ukraine”. The study properly included 88 patients who were divided into three groups: a control group (20 patients), a study group (50 patients).
 Results and discussion. The most common criteria for assessing the viability of an ischemic intestine are subjective assessments of color, motility, and pulsation of mesenteric vessels both during examination and after physical or pharmacological effects. However, such an assessment is subjective, does not always correspond to the actual condition of the intestinal wall, which leads either to an unjustified expansion of the scope of the intervention, or to an erroneous overestimation of the vital function of the damaged intestine.
 As a result of the research, a decrease in the phagocytic activity of neutrophils was found in patients who underwent resection of intestinal segments. In these patients, the development of endogenous intoxication was characterized by a decrease in the level of platelets and indicators of the blood anticoagulation system, leukopenia and methemoglobinemia, which requires antioxidant, antitoxic, as well as anticoagulant and immunological correction.
 The study of the exchange of metal ions in the blood serum of operated patients revealed dynamic changes in their content, iron ions (Fe2+); zinc (Zn2+); copper (Cu2+). The study of ion exchange of metals in the serum of the studied patients revealed significantly (p<0.05) higher levels of iron and copper, which can have an important diagnostic and prognostic value when justifying the scope of surgical intervention.
 The results of studying the state of oxidant-antioxidant processes in the studied patients revealed an increase in the level of lipid peroxidation products: malondialdehyde (secondary products) and diene conjugates (end products); since the LPO system is a primary predictor of future immunodeficiency.
 The correlation analysis revealed a direct correlation between the initial content of cryoglobulins and the presence of postoperative complications (r=0.56, p=0.07 and r=0.53, p=0.052). Detection of high concentrations of cryoglobulins in the blood serum of operated patients already in the first hours allowed us to assume the presence of maximal autoimmune changes in intra-abdominal infection.
 The study of the spectrum of serum protein fractions, lipid peroxidation, the state of antioxidant protection, the activity of liver enzymes, factors of humoral and cellular immunity, revealed pronounced endotoxicosis, functional damage to hepatocytes, a violation of the immune status of the body, which correlated with the severity of pathological changes against the background of intra-abdominal infection.
 Conclusions. Analysis of oxidant-antioxidant metabolic processes, bioenergetic state testified to the stimulation of free radical processes, activation of lipid peroxidation, inhibition of antiradical protection in the studied patients, which in the complex stimulates the development of membrane pathology against the background of endogenous intoxication and inhibition of bioenergetics; there are processes of primary inhibition of non-specific resistance of the organism, in combination with a violation of the regeneration of individual links of the immune system.

Neoadjuvant Stereotactic MR-Guided Ablative Radiation Therapy (SMART) and Surgical Outcomes in Patients with Pancreatic Cancer

The benefit of neoadjuvant radiation therapy for patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Stereotactic MR-guided adaptive radiation therapy (SMART) treatment to ablative doses is a newer technique that is well tolerated and has increased local control in unresectable pancreatic cancer. For resectable pancreatic cancer, neoadjuvant SMART has the potential to decrease local recurrence risk and positive margin rates. However, there is concern for perioperative risks associated with ablative dose treatments. We report the efficacy and safety of surgical resection in patients who have received neoadjuvant SMART at our institution. We conducted a retrospective analysis of all consecutive patients diagnosed with PDAC who had noted vascular involvement of the celiac axis, superior mesenteric, and/or portal vessels between January 2016 and December 2022 at a single, high-volume, academic institution. Perioperative events were defined according to the Clavien-Dindo classification. The Kaplan Meier method was applied to estimate disease free survival (DFS) and overall survival (OS). Seventeen patients with PDAC and vessel involvement at time of diagnosis who received SMART were included. Median follow-up time was 14.3 months; all patients underwent surgery, at a median time after radiation of 28 days (range: 15 - 90). Median length of postoperative stay was 7 days (range: 3 - 15). Five patients (29%) underwent vascular resection. Fifteen patients (88%) achieved R0 resection, with two R1 resections noted at the SMA and pancreatic neck respectively. Seven patients (41%) had adverse events attributable to surgery, with the majority being defined as abscess or infection (n = 5; 29%). One (6%) Clavien-Dindo grade III or higher toxicity was observed - a cortical cerebrovascular event following surgery. No major bleeding events requiring surgical intervention were noted. At time of event censorship, there were no observable locoregional failures. The median DFS and OS were not reached; however, 1-year DFS and OS were 62% and 87%, respectively. Neoadjuvant SMART appears to be safe, with low rates of surgical complications and promising outcomes. Further identification of patients for this approach requires additional investigation.

Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding

BackgroundSegmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure. MethodsPatients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes. ResultsThirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit. ConclusionDuodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.

Effects of epicatechin on cardiovascular function in middle-aged diet-induced obese rat models of metabolic syndrome.

The current study aimed to investigate the cardiovascular effects of epicatechin, a flavonoid found in green tea and cocoa, in attenuating complications associated with metabolic syndrome in diet-induced obese rats. Male Wistar-Kyoto (WKY) rats aged 16 weeks were fed either standard rat chow or given a high-fat-high-carbohydrate (HFHC) diet for 20 weeks. Epicatechin treatment (5 mg/kg/d) was administered to a subset of WKY rats commencing at week 8 of the 20 week HFHC feeding period. Body weights, food, water and energy intakes, blood pressure, heart rate and glucose tolerance were measured throughout the treatment period. Oxidative stress and inflammatory markers, lipid levels, cardiac collagen deposition, cardiac electrical function, aortic and mesenteric vessel reactivity were examined after the treatment. Twenty weeks of HFHC feeding in WKY rats resulted in the development of metabolic syndrome indicated by the presence of abdominal obesity, dyslipidaemia, glucose intolerance and increased blood pressure. Epicatechin treatment was found to enhance the oxidative stress status in HFHC groups through an increase in serum nitric oxide levels and a decrease in 8-isoprostane concentrations. Furthermore, WKY-HFHC rats displayed a decrease in IL-6 levels. The lipid profiles in HFHC groups showed improvement, with a decrease in LDL-cholesterol and TAG and an increase in HDL-cholesterol levels observed in WKY-HFHC rats. However, epicatechin was not effective in preventing weight gain, glucose intolerance or hypertension in HFHC fed rats. Overall, the results of this study suggest that epicatechin has the potential to improve the underlying mechanisms associated with metabolic syndrome in obese rats.

Functional State of the Mesenteric Arteries and Vessels of the Skin Microcirculation Bed in Rats with Experimental Kidney Dysfunction

Chronic kidney disease is accompanied by cardiovascular complications, including endothelial dysfunction, arterial hypertension, and atherosclerosis. The aim of this work is to compare the reactivity of the vessels of the microcirculatory bed (MCR) of the skin, assessed by laser Doppler flowmetry (LDF) and mesenteric arteries in rats with resection of 5/6 of the mass of the kidneys, and to evaluate the possibility of using LDF analysis as a method that reflects the functional state of large resistive vessels. Wistar rats were divided into two groups: animals of the NE-group (n = 15) had 5/6 of the mass of kidney tissue removed, control animals of the SO-group (n = 15) underwent a sham operation. After 8 weeks, the reactivity of rat skin microvessels to acetylcholine (ACh) and sodium nitroprusside (NP) iontophoresis was assessed. A week later, in rats, the effect of NE on the reactivity of mesenteric arteries preconstricted with phenylephrine was evaluated in vivo using microphotographic and video recording of the diameter. It has been shown that NE does not affect the average value of perfusion in the skin of rats at rest, however, it changes the structure of the frequency range of the spectrum of fluctuations in the MCR index, increasing the value of endothelial, neurogenic, and myogenic tone. NE led to the development of endothelial dysfunction of the mesenteric arteries and MCR vessels of the skin, which was expressed in a decrease in vascular reactivity to the action of endothelium-dependent (ACh) and endothelium-independent (NP) vasodilators. Thus, the development of experimental kidney dysfunction led to changes in the spectral components of fluctuations in the MCR index in the skin, indicating an increase in tonic effects of various genesis on the vessels. NE was accompanied by a decrease in the reactivity of microvessels of the skin and mesenteric arteries, however, there was no correlation between an increase in the MCR index and dilatation of the mesenteric arteries under the action of vasodilator agonists.

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.

Functional State of Mesenteric Arteries and Vessels of the Skin Microcirculatory Bed in Rats with Experimental Kidney Dysfunction

Functional State of Mesenteric Arteries and Vessels of the Skin Microcirculatory Bed in Rats with Experimental Kidney Dysfunction