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This article is from BioMedical Engineering OnLine , volume 13 . Abstract Background: Evaluation of computed tomography (CT) for the diagnosis of intestinal wall abnormalities and ischemia is important for clinical decision making in patients with acute abdominal pain to which if surgery should be performed in the emergency department. Interpretation of such information on CT is usually based on visual assessment by medical professionals and still remains a challenge in a variety of settings of the medical emergency care. This paper reports a pilot study in the implementation of image processing methods for automated detection of intestinal wall abnormalities and bowel ischemia, which can be of a potential application for CT-based detection of the intestinal disease. Methods: CT scans of 3 patients of ischemia, one benign and one control subjects were used in this study. Statistical and geometrical features of the CT scans were extracted for pattern classification using two distance measures and the k-nearest neighbor algorithm. The automated detection of intestinal abnormalities and ischemia was carried out using labeled data from the training process with various proportions of training and testing samples to validate the results. Results: Detection rates of intestinal ischemia and abnormalities are promising in terms of sensitivity and specificity, where the sensitivity is higher than the specificity in all test cases. The overall classification accuracy between the diseased and control subjects can be as high as 100% when all CT scans were included for measuring the difference between a cohort of three patients of ischemia and a single control subject. Conclusion: The proposed approach can be utilized as a computer-aided tool for decision making in the emergency department, where the availability of expert knowledge of the radiologist and surgeon about this complex bowel disease is limited.

This article is from BioMedical Engineering OnLine , volume 13 . Abstract Background: Evaluation of computed tomography (CT) for the diagnosis of intestinal wall abnormalities and ischemia is important for clinical decision making in patients with acute abdominal pain to which if surgery should be performed in the emergency department. Interpretation of such information on CT is usually based on visual assessment by medical professionals and still remains a challenge in a variety of settings of the medical emergency care. This paper reports a pilot study in the implementation of image processing methods for automated detection of intestinal wall abnormalities and bowel ischemia, which can be of a potential application for CT-based detection of the intestinal disease. Methods: CT scans of 3 patients of ischemia, one benign and one control subjects were used in this study. Statistical and geometrical features of the CT scans were extracted for pattern classification using two distance measures and the k-nearest neighbor algorithm. The automated detection of intestinal abnormalities and ischemia was carried out using labeled data from the training process with various proportions of training and testing samples to validate the results. Results: Detection rates of intestinal ischemia and abnormalities are promising in terms of sensitivity and specificity, where the sensitivity is higher than the specificity in all test cases. The overall classification accuracy between the diseased and control subjects can be as high as 100% when all CT scans were included for measuring the difference between a cohort of three patients of ischemia and a single control subject. Conclusion: The proposed approach can be utilized as a computer-aided tool for decision making in the emergency department, where the availability of expert knowledge of the radiologist and surgeon about this complex bowel disease is limited.

This article is from Journal of Cardiothoracic Surgery , volume 8 . Abstract Background: Intestinal ischemia after cardiac surgery is a rare but severe complication with a high mortality. Early surgery can be lifesaving. The aim was to analyze the incidence, outcome, and risk factors for these patients. Methods: A prospectively collected database with patients who underwent 18,879 cardiac surgical procedures between 1996 and 2011 was investigated. All patients with registered gastrointestinal complications were retrospectively reviewed. Univariate and multivariate analyses were performed to compare patients with and without intestinal ischemia. Results: Seventeen patients suffered from intestinal ischemia (0.09%), 10 of whom (59%) died. By investigating preoperative parameters independent risk factors were steroids, peripheral vascular disease, cardiogenic shock, and New York Heart Association class 4. When including pre-, per-, and postoperative parameters, only postoperative ones were significant, including elevated creatinine (> 200 μmol/L), prolonged ventilator time, need for intra-aortic balloon pump, and cerebrovascular insult (CVI). The gastrointestinal complications score (GICS) showed a ROC area of 0.87. This was superior compared with EuroSCORE (0.74), to predict intestinal ischemia. Conclusions: Intestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients.

Recent critical car literature by Piton et al has demonstrated that plasma citrulline may be a helpful adjunct in determining prognosis as well as determining intestinal dysfunction and failure. Citrulline is an amino acid produced by mitochondria within small bowel enterocytes. Citrulline is not incorporated into any protein, its plasma concentration is entirely derived from enterocyte production, and it is metabolized by the kidneys to arginine. Decreased plasma citrulline levels correlate with loss of enterocyte mass in short bowel syndrome and are associated with poor outcomes in radiation enteritis, sepsis, and critical illness. We compared their findings with our own recent observations of serial plasma citrulline levels in a severely burned adult who ultimately died from nonocclusive mescenteric ischemia leading to full-thickness small bowel necrosis.

ABSTRACT Aims: Sigmoid volvulus (SV), which causes closed-loop obstruction as a result of the rotation of the sigmoid colon around its mesentery, causes serious morbidity and mortality, especially in elderly patients, when necrosis develops in the intestine. In this study, it was investigated whether inflammatory markers, which guide the diagnosis and prognosis of many intra-abdominal pathologies, can predict the presence of ischemia in the intestine in patients with SV. Methods: In the study, patients who were operated on for SV in our clinic between January 2019 and March 2022 were retrospectively screened, and the demographic, clinicopathological, and laboratory parameters of the patients were examined. Data were analyzed with the Student’s T test and Mann-Whitney U-test. Results: Of the 47 patients included in the study, 28 (59.6%) were male and 19 (40.4%) were female. Intestinal necrosis was detected in 23 (48.9%) patients who underwent surgery. The mean age of the patient population was 70 (±19). There was no statistical difference between the two groups according to age (p=0.338). White blood cell count (WBC) (p=0.686); Neutrophil count (p=0.949); Lymphocyte count (p=0.790); Monocyte count (p=0.898); Neutrophil-lymphocyte ratio (NLR) (p=0.733); Platelet count (p=0.766); RDW value (p=0.725); There was no statistically significant difference between the two groups in lactate level (p=0.289), C-reactive protein (CRP) (p=0.212), Amylase (p=0.975) and Lactate dehydrogenase (LDH) (p=0.974) levels. Conclusion: Detection of intestinal necrosis is a vital condition for the patient. Inflammatory biomarkers obtained from preoperative routine blood parameters were not found to be significant in estimating the presence of intestinal necrosis in the SV clinic. It was concluded that large series are needed in this regard.

This article is from Critical Care , volume 17 . Abstract Introduction: Intestinal ischemia is a critical problem resulting in multiple organ failure and high mortality of 60 to 80%. Acute lung injury (ALI) is a common complication after intestinal ischemia/reperfusion (I/R) injuries and contributes to the high mortality rate. Moreover, activated neutrophil infiltration into the lungs is known to play a significant role in the progression of ALI. Integrin-mediated interaction is involved in neutrophil transmigration. Synthetic peptides containing an arginine-glycine-aspartate sequence compete with adhesive proteins and inhibit integrin-mediated interaction and signaling. Thus, we hypothesized that the administration of a cyclic arginine-glycine-aspartate peptide (cRGD) inhibited neutrophil infiltration and provided protection against ALI induced by intestinal I/R. Methods: Ischemia in adult male C57BL/6 mice was induced by fastening the superior mesenteric artery with 4-0 suture. Forty-five minutes later, the vascular suture was released to allow reperfusion. cRGD (5 mg/kg body weight) or normal saline (vehicle) was administered by intraperitoneal injection 1 hour prior to ischemia. Blood, gut, and lung tissues were collected 4 hours after reperfusion for various measurements. Results: Intestinal I/R caused severe widespread injury to the gut and lungs. Treatment with cRGD improved the integrity of microscopic structures in the gut and lungs, as judged by histological examination. Intestinal I/R induced the expression of β1, β2 and β3 integrins, intercellular adhesion molecule-1, and fibronectin. cRGD significantly inhibited myeloperoxidase activity in the gut and lungs, as well as neutrophils and macrophages infiltrating the lungs. cRGD reduced the levels of TNF-α and IL-6 in serum, in addition to IL-6 and macrophage inflammatory protein-2 in the gut and lungs. Furthermore, the number of TUNEL-staining cells and levels of cleaved caspase-3 in the lungs were significantly lowered in the cRGD-treated mice in comparison with the vehicle mice. Conclusions: Treatment with cRGD effectively protected ALI and gut injury, lowered neutrophil infiltration, suppressed inflammation, and inhibited lung apoptosis after intestinal I/R. Thus, there is potential for developing cRGD as a treatment for patients suffering from ALI caused by intestinal I/R.

I am visiting Gandhamardan Hills since year 1990 for Ethnobotanical surveys and collected information worth several TBs in these years. The present series is an effort to bring all aspects of Biodiversity rich Gandhamardan Hills among world community. For details please visit pankajoudhia.com Related References Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the breast . Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the cervix . Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the colon . Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the duodenum .Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the esophagus . Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com Oudhia, P. (2014). Medicinal Rice Laicha with Red, Brown and Black Rice based Traditional Herbal Formulations (Gandhamardan Hills Series) for Cancer of the ileum . Medicinal Rice Formulations (1990-2014) in Encyclopedia of Tribal Medicines by Pankaj Oudhia at pankajoudhia.com

This article is from Journal of Medical Case Reports , volume 7 . Abstract Introduction: Intestinal ischemia is a rare complication of laparoscopic surgery. Its prognosis depends on a high index of suspicion and effective early treatment. Case presentation: In the present report, we describe three cases where intestinal ischemia developed following laparoscopic surgery. Case 1 concerns a 52-year-old Caucasian man who developed large bowel ischemia following laparoscopic adjustable gastric band surgery. Case 2 concerns an 82-year-old Caucasian woman who developed fatal intestinal ischemia following laparoscopic cholecystectomy. Case 3 concerns a 58-year old Caucasian woman who developed right-sided lower intestinal ischemia following open cholecystectomy. Conclusions: Intestinal ischemia is a rare complication of laparoscopic surgery. The identification of high-risk patients is an essential primary preventive measure. A high index of suspicion is required to make an early diagnosis, which may help improve outcomes.

This article is from Arquivos Brasileiros de Cardiologia , volume 102 . Abstract Background: Intestinal ischemia-reperfusion is a frequent clinical event associated to injury in distant organs, especially the heart. Objective: To investigate the gene expression of oxidative stress and antioxidant defense in the heart of inbred mice subjected to intestinal ischemia and reperfusion (IR). Methods: Twelve mice (C57BL / 6) were assigned to: IR Group (GIR) with 60 minutes of superior mesenteric artery occlusion followed by 60 minutes of reperfusion; Control Group (CG) which underwent anesthesia and laparotomy without IR procedure and was observed for 120 minutes. Intestine and heart samples were processed using the RT-qPCR / Reverse transcriptase-quantitative Polymerase Chain Reaction method for the gene expression of 84 genes related to oxidative stress and oxidative defense (Student's "t" test, p < 0.05). Results: The intestinal tissue (GIR) was noted to have an up-regulation of 65 genes (74.71%) in comparison to normal tissue (CG), and 37 genes (44.04%) were hyper-expressed (greater than three times the threshold allowed by the algorithm). Regarding the remote effects of intestinal I/R in cardiac tissue an up-regulation of 28 genes (33.33%) was seen, but only eight genes (9.52%) were hyper-expressed three times above threshold. Four (7.14%) of these eight genes were expressed in both intestinal and cardiac tissues. Cardiomyocytes with smaller and pyknotic nuclei, rich in heterochromatin with rare nucleoli, indicating cardiac distress, were observed in the GIR. Conclusion: Intestinal I/R caused a statistically significant over expression of 8 genes associated with oxidative stress in remote myocardial tissue.

Complement activation occurs during tissue injury and inappropriate or excessive activation contributes to the expression of pathology becoming a double-edged sword. Understanding the role of complement and its natural regulatory molecules will enable the development of therapeutic interventions to prevent excessive damage during mesenteric ischemia/reperfusion (IR). In this chapter, we will briefly review the mechanism of complement activation during intestinal ischemia/reperfusion and discuss results and significance of mesenteric ischemia/reperfusion induced injury in animal models with altered complement activation. Finally, we will discuss development of current inhibitors of complement activation and those that may be used in the future.

Complement activation occurs during tissue injury and inappropriate or excessive activation contributes to the expression of pathology becoming a double-edged sword. Understanding the role of complement and its natural regulatory molecules will enable the development of therapeutic interventions to prevent excessive damage during mesenteric ischemia/reperfusion (IR). In this chapter, we will briefly review the mechanism of complement activation during intestinal ischemia/reperfusion and discuss results and significance of mesenteric ischemia/reperfusion induced injury in animal models with altered complement activation. Finally, we will discuss development of current inhibitors of complement activation and those that may be used in the future.

This article is from PLoS ONE , volume 9 . Abstract Background: Membrane bound guanylyl cyclase-G (mGC-G), a novel form of GC mediates ischemia and reperfusion (IR)-induced renal injury. We investigated the roles of mGC-G in intestinal IR-induced jejunal damage, inflammation, and apoptosis. Materials and methods: Male C57BL/6 wild-type (WT) and mGC-G gene knockout (KO) mice were treated with a sham operation or 45 min of superior mesenteric arterial obstruction followed by 3, 6, 12, or 24 h of reperfusion. Results: Sham-operated KO mice had significantly lower plasma nitrate and nitrite (NOx) levels and jejunal villus height, crypt depth, and protein expression of phosphorylated-nuclear factor-kappa-B (NF-κB), phosphorylated-c-Jun N-terminal kinases (JNK) 2/3, phosphorylated-p38, and B-cell lymphoma-2 (Bcl-2). They had significantly greater jejunal interleukin-6 mRNA, cytochrome c protein, and apoptotic index compared with sham-operated WT mice. Intestinal IR significantly decreased plasma NOx in WT mice and increased plasma NOx in KO mice. The jejunal apoptotic index and caspase 3 activities were significantly increased, and nuclear phosphorylated-NF-κB and phosphorylated-p38 protein were significantly decreased in WT, but not KO mice with intestinal IR. After reperfusion, KO mice had an earlier decrease in jejunal cyclic GMP, and WT mice had an earlier increase in jejunal proliferation and a later increase in cytosol inhibitor of kappa-B-alpha. Intestinal IR induced greater increases in plasma and jejunal interleukin-6 protein in WT mice and a greater increase in jejunal interleukin-6 mRNA in KO mice. Conclusions: mGC-G is involved in the maintenance of jejunal integrity and intestinal IR-induced inflammation and apoptosis. These results suggest that targeting cGMP pathway might be a potential strategy to alleviate IR-induced jejunal damages.

This article is from International Journal of Molecular Sciences , volume 15 . Abstract Notch signaling plays a critical role in the maintenance of intestinal homeostasis. The aim of the present study was to investigate the role of Notch signaling in the apoptosis of intestinal epithelial cells after intestinal ischemia reperfusion (I/R) injury. Male C57BL/6 mice were subjected to sham operation or I/R injury. Intestinal tissue samples were collected at 12 h after reperfusion. TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling) staining showed that intestinal I/R injury induced significantly increased apoptosis of intestinal epithelial cells. Meanwhile, the mRNA expression of Jagged1, DLL1, Notch2, and Hes5, and protein expression of NICD2 and Hes5 were increased significantly after I/R injury in intestinal epithelial cells. In an in vitro IEC-6 culture model, flow cytometry analyses showed that inhibition of Notch signaling by γ-secretase inhibitor DAPT and the suppression of Hes5 expression using siRNA both significantly increased the apoptosis of IEC-6 cells under the condition of hypoxia/reoxygenation (H/R). In conclusion, the Notch2/Hes5 signaling pathway was activated and involved in the regulation of intestinal epithelial cells apoptosis in intestinal I/R injury.

This article is from PLoS ONE , volume 9 . Abstract In intestinal ischemia, inflammatory mediators in the small intestine's lumen such as food byproducts, bacteria, and digestive enzymes leak into the peritoneal space, lymph, and circulation, but the mechanisms by which the intestinal wall permeability initially increases are not well defined. We hypothesize that wall protease activity (independent of luminal proteases) and apoptosis contribute to the increased transmural permeability of the intestine's wall in an acutely ischemic small intestine. To model intestinal ischemia, the proximal jejunum to the distal ileum in the rat was excised, the lumen was rapidly flushed with saline to remove luminal contents, sectioned into equal length segments, and filled with a tracer (fluorescein) in saline, glucose, or protease inhibitors. The transmural fluorescein transport was determined over 2 hours. Villi structure and epithelial junctional proteins were analyzed. After ischemia, there was increased transmural permeability, loss of villi structure, and destruction of epithelial proteins. Supplementation with luminal glucose preserved the epithelium and significantly attenuated permeability and villi damage. Matrix metalloproteinase (MMP) inhibitors (doxycycline, GM 6001), and serine protease inhibitor (tranexamic acid) in the lumen, significantly reduced the fluorescein transport compared to saline for 90 min of ischemia. Based on these results, we tested in an in-vivo model of hemorrhagic shock (90 min 30 mmHg, 3 hours observation) for intestinal lesion formation. Single enteral interventions (saline, glucose, tranexamic acid) did not prevent intestinal lesions, while the combination of enteral glucose and tranexamic acid prevented lesion formation after hemorrhagic shock. The results suggest that apoptotic and protease mediated breakdown cause increased permeability and damage to the intestinal wall. Metabolic support in the lumen of an ischemic intestine with glucose reduces the transport from the lumen across the wall and enteral proteolytic inhibition attenuates tissue breakdown. These combined interventions ameliorate lesion formation in the small intestine after hemorrhagic shock.

This article is from PLoS ONE , volume 8 . Abstract Ginsenoside Rb1 (RB1), the most clinically effective constituent of ginseng, possesses a variety of biological activities. The objectives of this study were to investigate the protective effects of RB1 and its underlying mechanism on renal injury induced by intestinal ischemia-reperfusion (IIR) in mice. RB1 was administered prior to inducing IIR achieved by occluding the superior mesenteric artery for 45 min followed by 120 min of reperfusion. All-trans-retinoic acid (ATRA) was used as an inhibitor of NF-E2-related factor-2 (Nrf2) signaling. Adult male C57BL/6J mice were randomly divided into six groups: (1) sham group, (2) IIR group, (3) RB1 group, (4) sham + ATRA group, (5) IIR + ATRA group, and (6) RB1 + ATRA group. Intestinal histology and pathological injury score were observed. Intestinal mucosal injury was also evaluated by measuring serum diamine oxidase (DAO). Renal injury induced by IIR was characterized by increased levels of histological severity score, blood urea nitrogen (BUN), serum creatinine (Scr) and neutrophil gelatinase-associated lipocalin (NGAL), which was accompanied with elevated renal TUNEL-positive cells and the Bcl-2/Bax expression ratio. RB1 significantly reduced renal injury and apoptosis as compared with IIR group, which was reversed by ATRA treatment. Immunohistochemistry and Western blot analysis demonstrated that RB1 significantly upregulated the protein expression of heme oxygenase-1 (HO-1) and Nrf2, which were attenuated by ATRA treatment. Taken together, these results suggest that the protective effects of RB1 pretreatment against renal injury induced by IIR are associated with activation of the Nrf2/ anti-oxidant response element (ARE) pathway.