[Total colonic exclusion plus side to side ileorectal antiperistaltic anastomosis in the treatment for elderly patients with slow transit constipation].

OBJECTIVE: To evaluate the feasibility and safety of total colonic exclusion plus side to side antiperistaltic ileorectal anastomosis in the treatment for elderly patients with slow transit constipation (STC). METHODS: Clinical data of 13 patients with severe idiopathic STC undergoing the above novel procedure in Zhongnan Hospital of Wuhan University between May 2009 and September 2012 were retrospectively analyzed. The Wexner constipation score and gastrointestinal quality of life index (GIQLI) before and 6 months after operation were compared. RESULTS: There were 8 female and 5 male patients, with a mean age of 74 years (range 63-82 years). No procedure-related deaths or any serious complication occurred. The length of follow-up ranged from 6 to 29 months (median,12 months). The duration of surgery was (55±4) min. Blood loss was (30±2) ml. The postoperative hospital stay ranged 10 to 16 days (mean 11.4 days). The first bowel movement occurred in the 4th day (range 2nd-8th day) after operation. There was no intestinal occlusion and anastomotic leakage that required surgery in all the patients. No fecal incontinence or constipation recurrence was found. One patient developed blind loop syndrome 14 months after operation. Postoperative complications included incision fat liquefaction in 2 cases, anorectal bearing-down while bowel movement in 2 cases, and minor defecate difficulty needed glycerin enema in 1 case. Wexner scores was significantly improved from 22.8±3.3 before operation to 5.4±2.1 six months after operation (P<0.05). GQLI was significantly increased from 93.6±20.5 before operation to 120.8±13.0 six months after operation (P<0.05). At 6 months after operation, the outcome was excellent in 11 patients and good in 2 patients. CONCLUSION: Total colonic exclusion plus side to side antiperistaltic ileorectal anastomosis is easy, safe and effective in the treatment for selected elderly patients with STC.

[Efficacy comparison of subtotal colectomy with antiperistaltic cecoproctostomy and total colectomy with ileorectal anastomosis for patients with slow transit constipation].

OBJECTIVE: To compare the efficacy between subtotal colectomy with antiperistaltic cecoproctostomy and total colectomy with ileorectal anastomosis (TAC-IRA) for patients with severe refractory slow transit constipation(STC). METHODS: During 1999 to 2002, TAC-IRA was the preferred procedure for 20 STC patients in our department. From 2003 to 2005, 17 STC patients underwent subtotal colectomy plus antiperistaltic cecoproctostomy. Clinical data of the two groups were collected and compared retrospectively. RESULTS: There were no significant differences in basic preoperative clinical data between the two groups. During the follow-up period, the time of daily defecation in the antiperistaltic cecoproctostomy group was less than that of TAC-IRA group (2.4+/-0.9 vs 3.4+/-0.8, P=0.0014), meanwhile the Wexner continence score was significantly lower in the antiperistaltic cecoproctostomy group (4.3+/-1.8 vs 5.8+/-1.9, P=0.0223). Barium enema after subtotal colectomy showed that residual ascending colon and cecum presented a sign of "reservoir". CONCLUSION: Subtotal colectomy with antiperistaltic cecoproctostomy is a better method for appropriately selected patients with STC than TAC-IRA.

Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report.

BACKGROUND AND AIMS: Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is recommended widely for the patients with severe, refractory slow transit constipation (STC). Subtotal colectomy with end-to-end antiperistaltic cecorectal anastomosis (Sarli procedure), an alternative for STC, has been paid particular attention. The purpose of this study was to retrospectively compare alterations of clinical functions and qualities of life between TAC-IRA and Sarli procedure. METHODS: Seventeen patients with STC who underwent Sarli procedure and 20 patients with STC who underwent TAC-IRA were chosen for this study. Patient characteristics, operative data, postoperative data, alterations of clinical function, and quality of life were compared. The gastrointestinal quality of life index (GIQLI) survey was used to evaluate postoperative qualities of life. RESULTS: At the mean 4-year follow-up (range 2-6 years), the frequency of daily bowel movement in the Sarli group was significantly less than that in the TAC-IRA group (2.4 +/- 0.9 vs. 3.4 +/- 0.8; P = 0.0014), and the Wexner continence scores were significantly lower in the Sarli group compared to the TAC-IRA group (4.3 +/- 1.8 vs. 5.8 +/- 1.9; P = 0.0223). However, the GIQLI score in Sarli group was higher than the TAC-IRA group (119.8 +/- 7.5 vs. 111.1 +/- 12.0, P = 0.0455). Post subtotal colectomy barium enema showed a sign of "reservoir" at the residual ascending colon and cecum. CONCLUSIONS: Compared to the TAC-IRA, subtotal colectomy with end-to-end antiperistaltic cecoproctostomy for appropriately selected patients with STC resulted in relief of constipation, satisfactory functional outcome, and improved qualities of life.

A novel selenium-containing glutathione transferase zeta1-1, the activity of which surpasses the level of some native glutathione peroxidases.

Glutathione peroxidase (GPX) is a critical antioxidant selenoenzyme in organisms that protects cells against oxidative damage by catalyzing the reduction of hydroperoxides by glutathione (GSH). Thus, some GPX mimics have been generated because of their potential therapeutic value. The generation of a semisynthetic selenoenzyme with peroxidase activity, which matches the catalytic efficiencies of naturally evolved GPX, has been a great challenge. Previously, we semisynthesized a GPX mimetic with high catalytic efficiency using a rat theta class glutathione transferase (rGST T2-2) as a scaffold, in which the highly specific GSH-binding site is adjacent to an active site serine residue that can be chemically modified to selenocysteine (Sec). In this study, we have taken advantage of a new scaffold, hGSTZ1-1, in which there are two serine residues in the active site, to achieve both high thiol selectivity and highly catalytic efficiency. The GPX activity of Se-hGSTZ1-1 is about 1.5 times that of rabbit liver GPX, indicating that the selenium content at the active site plays an important role in enhancement of catalytic performance. Kinetic studies revealed that the catalytic mechanism of Se-hGSTZ1-1 belong in a ping-pong mechanism similar to that of the natural GPX.

Selenium-containing 15-mer peptides with high glutathione peroxidase-like activity.

Glutathione peroxidase (GPX) is one of the most crucial antioxidant enzymes in a variety of organisms. Here we described a new strategy for generating a novel GPX mimic by combination of a phage-displayed random 15-mer peptide library followed by computer-aided rational design and chemical mutation. The novel GPX mimic is a homodimer consisting of a 15-mer selenopeptide with an appropriate catalytic center, a specific binding site for substrates, and high catalytic efficiency. Its steady state kinetics was also studied, and the values of k(cat)/K(m)(GSH) and k(cat)/ K(mH(2)O(2)) were found to be similar to that of native GPX and the highest among the existing GPX mimics. Moreover, the novel GPX mimic was confirmed to have a strong antioxidant ability to inhibit lipid peroxidation by measuring the content of malondialdehyde, cell viability, and lactate dehydrogenase activity. Importantly, the novel GPX mimic can penetrate into the cell membrane because of its small molecular size. These characteristics endue the novel mimic with potential perspective for pharmaceutical applications.

Protection of epidermal cells against UVB injury by the antioxidant selenium-containing single-chain Fv catalytic antibody.

The antioxidant effect of selenium-containing single-chain Fv catalytic antibody (Se-scFv2F3), a new mimic of glutathione peroxidase, was confirmed using a model system in which cultured rat skin epidermal cells were injured by ultraviolet B (UVB). The cell damage was characterized in terms of lipid peroxidation of the cells, cell viability, and cell membrane integrity. The injury effects of UVB and protection effects of Se-scFv2F3 on the cells were studied using the model system. UVB can damage the cells severely. Upon precultivation of the cells with 0.4U/ml Se-scFv2F3, however, the damage was significantly reduced as shown by the increase in cell viability, the decrease in the malondialdehyde and hydrogen peroxide levels, and the normalization of lactate dehydrogenase activity. In addition, a novel finding that Se-scFv2F3 can stimulate cultured epidermal cells to proliferate under certain conditions was observed.