Natural history of spontaneous isolated celiac artery dissection after conservative treatment.

OBJECTIVE: Optimal treatment of spontaneous isolated celiac artery dissection (SICAD) is not well established because the natural history of this rare disease is poorly understood. We analyzed the natural history of patients who underwent conservative treatment. METHODS: The study included 28 patients with SICAD from December 2008 to January 2017. Our institutional policy of first-line treatment for SICAD patients was conservative, and invasive procedures were reserved for unstable complications such as severe persistent pain, significant organ malperfusion, rapid aneurysmal change, and rupture or concealed rupture. Demographics, clinical features, morphologic characteristics on computed tomography, treatment modalities, and follow-up results of these patients were retrospectively reviewed. RESULTS: Mean age was 52 years, and 89% of patients were male; 86% presented with pain, mostly abdominal, and 14% of cases were detected incidentally on abdominal imaging. None of these patients had unstable complications on admission, and all underwent initial conservative treatment. During the follow-up period (22 ± 20 months), aneurysmal change and propagation of thrombosis were noted in one patient and two patients, respectively, all of whom were managed conservatively without adverse clinical events. No difference in clinical and morphologic outcomes was noted between patients who were treated with antihypertensive therapy and those who were not. Patients with intramural hematoma on initial images showed dynamic vascular remodeling (partial to complete resorption) during the follow-up period compared with patients who had dominant intimal flap on initial images. CONCLUSIONS: The clinical course of patients with SICAD was benign. Even progressive vascular changes during follow-up did not require invasive treatment. Antihypertensive therapy might not modify the clinical course. The short-term results of conservative management are encouraging, but further evaluation with long-term follow-up in a large population is needed.

A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.

Postoperative ileus (POI) is an important factor prolonging the length of hospital stay following colorectal surgery. We retrospectively explored whether there is a clinically relevant association between intraoperative hypothermia and POI in patients who underwent laparoscopic colorectal surgery for malignancy within the setting of an enhanced recovery after surgery (ERAS) program between April 2016 and January 2017 at our institution. In total, 637 patients were analyzed, of whom 122 (19.2%) developed clinically and radiologically diagnosed POI. Overall, 530 (83.2%) patients experienced intraoperative hypothermia. Although the mean lowest core temperature was lower in patients with POI than those without POI (35.3 ± 0.5°C vs. 35.5 ± 0.5°C, P = 0.004), the independence of intraoperative hypothermia was not confirmed based on multivariate logistic regression analysis. In addition to three variables (high age-adjusted Charlson comorbidity index score, long duration of surgery, high maximum pain score during the first 3 days postoperatively), cumulative dose of rescue opioids used during the first 3 days postoperatively was identified as an independent risk factor of POI (odds ratio = 1.027 for each 1-morphine equivalent [mg] increase, 95% confidence interval = 1.014-1.040, P <0.001). Patients with hypothermia showed significant delays in both progression to a soft diet and discharge from hospital. In conclusion, intraoperative hypothermia was not independently associated with POI within an ERAS pathway, in which items other than thermal measures might offset its negative impact on POI. However, as it was associated with delayed discharge from the hospital, intraoperative maintenance of normothermia is still needed.

Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study.

Objective To compare the effects of saddle, lumbar epidural and caudal blocks on anal sphincter tone using anorectal manometry. Methods Patients undergoing elective anorectal surgery with regional anaesthesia were divided randomly into three groups and received a saddle (SD), lumbar epidural (LE), or caudal (CD) block. Anorectal manometry was performed before and 30 min after each regional block. The degree of motor blockade of the anal sphincter was compared using the maximal resting pressure (MRP) and the maximal squeezing pressure (MSP). Results The study analysis population consisted of 49 patients (SD group, n = 18; LE group, n = 16; CD group, n = 15). No significant differences were observed in the percentage inhibition of the MRP among the three regional anaesthetic groups. However, percentage inhibition of the MSP was significantly greater in the SD group (83.6 ± 13.7%) compared with the LE group (58.4 ± 19.8%) and the CD group (47.8 ± 16.9%). In all groups, MSP was reduced significantly more than MRP after each regional block. Conclusions Saddle block was more effective than lumbar epidural or caudal block for depressing anal sphincter tone. No differences were detected between lumbar epidural and caudal blocks.

Immune and anti-oxidant effects of in ovo selenium proteinate on post-hatch experimental avian necrotic enteritis.

This study was conducted to investigate the effects of in ovo administration of selenium (Se) incorporated into hydrolyzed soybean protein (B-Taxim [BT]) on protection against experimental avian necrotic enteritis (NE). Broiler eggs were injected with either 100 µl of PBS alone (BT0), or 20 or 40 µg/egg of BT in PBS (BT20, BT40) at 18 days of embryogenesis. On day 14 post-hatch, the chickens were uninfected or orally infected with 1.0 × 10(4) oocysts of Eimeria maxima (E. maxima). On day 18 post-hatch, E. maxima-infected chickens were orally infected with 1.0 × 10(9) CFU of Clostridium perfringens (C. perfringens). Compared with untreated and infected BT0 controls, BT20 and/or BT40 birds showed increased body weights, decreased fecal shedding of E. maxima oocysts, lower serum α-toxin and NetB levels, increased levels of serum antibodies against C. perfringens α-toxin and NetB toxin, decreased levels of serum malondialdehyde, reduced serum catalase and superoxide dismutase catalytic activities, and increased intestinal levels of gene transcripts encoding interleukin (IL)-1ß, IL-6, IL-8, and peroxiredoxin-6, but decreased levels of transcripts for catalase and glutathione peroxidase. Interestingly, transcript levels for inducible nitric oxide synthase and paraoxonase/arylesterase 2 were decreased in the BT20 group and increased in the BT40 group, compared with BT0 controls. These results indicate that in ovo administration of broiler chickens with a Se-containing protein hydrolysate enhanced protection against experimental NE possibly by altering the expression of proinflammatory and anti-oxidant genes and their downstream pathways.

Immune effects of dietary anethole on Eimeria acervulina infection.

The effects of anethole on in vitro and in vivo parameters of chicken immunity during experimental avian coccidiosis were evaluated. Anethole reduced the viability of invasive Eimeria acervulina sporozoites after 2 or 4 h of treatment in vitro by 45 and 42%, respectively, and stimulated 6.0-fold greater chicken spleen cell proliferation compared with controls. Broiler chickens continuously fed from hatch with an anethole-supplemented diet and orally challenged with live E. acervulina oocysts showed enhanced BW gain, decreased fecal oocyst excretion, and greater E. acervulina profilin antibody responses compared with infected chickens given an unsupplemented standard diet. The levels of transcripts encoding the immune mediators IL6, IL8, IL10, and tumor necrosis factor ligand superfamily member 15 (TNFSF15) in intestinal lymphocytes were increased in E. acervulina-infected chickens fed the anethole-containing diet compared with untreated controls. Global gene expression analysis by microarray hybridization identified 1,810 transcripts (677 upregulated, 1,133 downregulated) whose levels were significantly altered in intestinal lymphocytes of anethole-fed birds compared with unsupplemented controls. From this transcriptome, 576 corresponding genes were identified. The most significant biological function associated with these genes was "Inflammatory Response" in the "Disease and Disorders" category. This new information documents the immunologic and genomic changes that occur in chickens following anethole dietary supplementation that may be relevant to host protective immune response to avian coccidiosis.

Dietary Curcuma longa enhances resistance against Eimeria maxima and Eimeria tenella infections in chickens.

The effects of dietary supplementation with an organic extract of Curcuma longa on systemic and local immune responses to experimental Eimeria maxima and Eimeria tenella infections were evaluated in commercial broiler chickens. Dietary supplementation with C. longa enhanced coccidiosis resistance as demonstrated by increased BW gains, reduced fecal oocyst shedding, and decreased gut lesions compared with infected birds fed a nonsupplemented control diet. The chickens fed C. longa-supplemented diet showed enhanced systemic humoral immunity, as assessed by greater levels of serum antibodies to an Eimeria microneme protein, MIC2, and enhanced cellular immunity, as measured by concanavalin A-induced spleen cell proliferation, compared with controls. At the intestinal level, genome-wide gene expression profiling by microarray hybridization identified 601 differentially expressed transcripts (287 upregulated, 314 downregulated) in gut lymphocytes of C. longa-fed chickens compared with nonsupplemented controls. Based on the known functions of the corresponding mammalian genes, the C. longa-induced intestinal transcriptome was mostly associated with genes mediating anti-inflammatory effects. Taken together, these results suggest that dietary C. longa could be used to attenuate Eimeria-induced, inflammation-mediated gut damage in commercial poultry production.

Improved resistance to Eimeria acervulina infection in chickens due to dietary supplementation with garlic metabolites.

The effects of a compound including the secondary metabolites of garlic, propyl thiosulphinate (PTS) and propyl thiosulphinate oxide (PTSO), on the in vitro and in vivo parameters of chicken gut immunity during experimental Eimeria acervulina infection were evaluated. In in vitro assays, the compound comprised of PTSO (67 %) and PTS (33 %) dose-dependently killed invasive E. acervulina sporozoites and stimulated higher spleen cell proliferation. Broiler chickens continuously fed from hatch with PTSO/PTS compound-supplemented diet and orally challenged with live E. acervulina oocysts had increased body weight gain, decreased faecal oocyst excretion and greater E. acervulina profilin antibody responses, compared with chickens fed a non-supplemented diet. Differential gene expression by microarray hybridisation identified 1227 transcripts whose levels were significantly altered in the intestinal lymphocytes of PTSO/PTS-fed birds compared with non-supplemented controls (552 up-regulated, 675 down-regulated). Biological pathway analysis identified the altered transcripts as belonging to the categories 'Disease and Disorder' and 'Physiological System Development and Function'. In the former category, the most significant function identified was 'Inflammatory Response', while the most significant function in the latter category was 'Cardiovascular System Development and Function'. This new information documents the immunologic and genomic changes that occur in chickens following PTSO/PTS dietary supplementation, which are relevant to protective immunity during avian coccidiosis.

Extracts from Schizandra chinensis fruit activate estrogen receptors: a possible clue to its effects on nitric oxide-mediated vasorelaxation.

Schizandra chinensis fruit has long been used for the treatment of cardiovascular symptoms associated especially with menopausal symptoms in Korea. To provide a scientific rationale for such uses, we have investigated the vasorelaxant effects of Schizandra chinensis fruit on the vasomotor tone of the rat thoracic aorta in an organ bath. The crude extracts of Schizandra chinensis fruit (SC-Ex) elicited a transient relaxing response in the endothelium-intact rat aorta contracted with norepinephrine. This relaxant effect was abolished by removal of the endothelium, and also by pretreatment with nitric oxide synthase inhibitor. We then examined whether this vasodilatory effect occurs through estrogen receptor by reporter assays. SC-Ex activated the estrogen-responsive luciferase gene in COS cells transiently transfected with estrogen receptor and reporter plasmids. The activation was maintained in the butanol-soluble fraction and further increased in the successively fractionated C(18) cartridge-adsorbed fraction (SC-ADF). Reporter gene activation by SC-ADF was inhibited by the specific estrogen receptor antagonist ICI 182,780, indicating that the effect is estrogen receptor dependent. However, SC-ADF failed to activate the androgen receptor in COS cells transfected with the corresponding receptor and reporter plasmids. These data show that extracts of Schizandra chinensis fruit act as a weak phytoestrogen.

Pseudoaneurysm of the abdominal aorta caused by acupuncture therapy.

Acupuncture is a major treatment modality used in Oriental medicine to control chronic pain. However, several complications have been reported, including spinal cord injury, pneumothorax, and subcutaneous pseudoaneurysm, according to the puncture sites. We report the case of a pseudoaneurysm of the abdominal aorta caused by acupuncture.