Ameliorative Effects of Larazotide Acetate on Intestinal Permeability and Bacterial Translocation in Acute Pancreatitis Model in Rats.

BACKGROUND: Intestinal barrier dysfunction in acute pancreatitis (AP) may progress to systemic inflammatory response syndrome (SIRS) and multi-organ failures by causing bacterial translocation. Larazotide acetate (LA) is a molecule that acts as a tight junction (TJ) regulator by blocking zonulin (Zo) receptors in the intestine. AIMS: In our study, we aimed to investigate the effects of LA on intestinal barrier dysfunction and bacterial translocation in the AP model in rats. METHODS: Thirty-two male Sprague-Dawley rats were divided into 4 groups; control, larazotide (LAR), AP, and AP + LAR. The AP model was created by administering 250 mg/100 g bm L-Arginine intraperitoneally 2 times with an hour interval. AP + LAR group received prophylactic 0.01 mg/mL LA orally for 7 days before the first dose of L-Arginine. For intestinal permeability analysis, fluorescein isothiocyanate-dextran (FITC-Dextran) was applied to rats by gavage. The positivity of any of the liver, small intestine mesentery, and spleen cultures were defined as bacterial translocation. Histopathologically damage and zonulin immunoreactivity in the intestine were investigated. RESULTS: Compared to the control group, the intestinal damage scores, anti-Zo-1 immunoreactivity H-Score, serum FITC-Dextran levels and bacterial translocation frequency (100% versus 0%) in the AP group were significantly higher (all p < 0.01). Intestinal damage scores, anti-Zo-1 immunoreactivity H-score, serum FITC-Dextran levels, and bacterial translocation frequency (50% versus 100%) were significantly lower in the AP + LAR group compared to the AP group (all p < 0.01). CONCLUSIONS: Our findings show that LA reduces the increased intestinal permeability and intestinal damage by its effect on Zo in the AP model in rats, and decreases the frequency of bacterial translocation as a result of these positive effects.

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Objectives: Despite being routinely used before elective colorectal surgery in most surgical clinics, mechanical bowel preparation (MBP) remains controversial. This study aimed to investigate postoperative complications and outcomes of right, left, or rectosigmoid resection without MBP. Material and Methods: Patients who underwent elective colorectal surgery without mechanical bowel preparation and oral antibiotics between January 2011 and December 2021 were included in the study. Patients were categorized according to the side of resection, and these subgroups were compared for anastomotic leakage, surgical site infections (SSI), and overall morbidity measured using the Clavien-Dindo complication grade. Results: Data of 422 patients were analyzed. Overall anastomotic leakage was found in 14 patients (3.3%), SSI in 46 (10.9%), collection in 14 (3.3%), mortality in 18 (4.3%), and reoperation in 17 (%4) patients. Anastomotic leakage was observed in six (3.9%) in right colectomy, two (1.9%) in left colectomy, and in six (3.7%) patients in the rectosigmoid resection group when the groups were evaluated separately. There was no statistical difference between the groups (p= 0.630). Furthermore, there was no statistical difference between the groups regarding collection and reoperation (p values were p= 0.31, and p= 0.251, respectively). Conclusion: Study results showed that anastomotic leakage, surgical site infection, intra-abdominal collection, reoperation, and mortality rates were similar to the current literature obtained from the studies with mechanical bowel preparation. In addition, these results were found to be similar according to the resection site.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br> <br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br> <br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br> <br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br> <br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br>.

An Evaluation of the Factors Affecting Failure of the Procedure in Reoperated Thyroidectomies: A Retrospective Analysis.

BACKGROUND: The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. METHODS: A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. RESULTS: The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68±12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue ≤25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone ≥3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size ≤25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. CONCLUSION: The results of this study clearly showed that as residual tissue size ≤25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.

Effects of larazotide acetate, a tight junction regulator, on the liver and intestinal damage in acute liver failure in rats.

BACKGROUND AND AIM: The epithelial cells are the strongest determinants of the physical intestinal barrier. Tight junctions (TJs) hold the epithelial cells together and allow for selective paracellular permeability. Larazotide acetate (LA) is a synthetic octapeptide that reduces TJ permeability by blocking zonulin receptors. In this study, we aimed to investigate the effects of LA, a TJ regulator, on the liver and intestinal histology in the model of acute liver failure (ALF) in rats. MATERIALS AND METHODS: The thioacetamide (TAA) group received intraperitoneal (ip) injections of 300 mg/kg TAA for 3 days. The TAA+LA(dw) (drinking water) group received prophylactic 0.01 mg/mL LA orally for 7 days before the first dose of TAA. The LA(dw) group received 0.01 mg/mL LA orally. The TAA + LA(g) (gavage) group received prophylactic 0.01 mg/mL LA via oral gavage for 7 days before the first dose of TAA. The LA(g) group received 0.01 mg/mL LA via oral gavage. While liver tissue was evaluated only with light microscopy, intestinal samples were examined with light and electron microscopy. RESULTS: Serum ammonia, AST, and ALT levels in the TAA group were significantly higher than in control groups (all p < 0.01). Serum ALT levels in the TAA + LA(dw) group were significantly lower than in the TAA group (p < 0.05). However, serum ammonia and ALT levels did not differ between the TAA and other groups. Serious liver damage in the TAA group was accompanied by marked intestinal damage. There was no significant difference between the TAA and TAA + LA(dw) groups and TAA and TAA + LA(g) groups for liver damage scores. However, intestinal damage scores significantly decreased in the TAA + LA(dw) group compared to the TAA group. In the TAA + LA(dw) group, fusion occurred between the surface epithelial cells of neighboring villi and connecting regions formed as epithelial bridges between the villi. CONCLUSION: Our findings suggest that LA reduced intestinal damage by acting on TJs in the TAA-induced ALF model in rats.

A novel simplified scoring system for predicting mortality in emergency colorectal surgery: prediction model development.

BACKGROUND: Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. OBJECTIVE: We aimed to create a simple and distinctive scoring system, for predicting mortality among patients undergoing emergency colorectal surgery. DESIGN AND SETTING: Prediction model development study based on retrospective data-gathering. METHODS: Patients who underwent emergency colorectal surgery between March 2014 and December 2016 at a single tertiary-level referral center were included in our study. Patient demographics, comorbidities, type of surgery, etiology and laboratory and radiological findings were collected retrospectively and analyzed. A new clinical score (named the Numune emergency colorectal resection score) was constructed from the last logistic regression model, in which one point was assigned for the presence of each predictive factor. RESULTS: 138 patients underwent emergency colorectal surgery. These comprised 64 males (46.4%) and 74 females (53.6%), with a mean age of 64 years. Multivariate analysis revealed that blood urea nitrogen level > 65 mg/dl (odds ratio, OR: 8.03; 95% confidence interval, CI: 2.16-15.77), albumin level < 0.7 -mg/-dl (OR: 4.43; 95% CI: 1.96-14.39) and American Society of Anesthesiologists score ≥ 3 (OR: 3.47; 95% CI: 0.81-9.18) were associated with postoperative complications. The Numune score was graded from I to III. The risk of mortality was found to be 63.2% in the group with grade III, which accounted for 35.2% of the subjects. There were 37 postoperative deaths. CONCLUSIONS: Surgeons need scoring systems, especially to predict postoperative mortality. We propose the Numune emergency colorectal resection score for emergency surgical procedures as a practical, usable and effective system for predicting postoperative morbidity.

A novel simplified scoring system for predicting mortality in emergency colorectal surgery: prediction model development

ABSTRACT BACKGROUND: Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. OBJECTIVE: We aimed to create a simple and distinctive scoring system, for predicting mortality among patients undergoing emergency colorectal surgery. DESIGN AND SETTING: Prediction model development study based on retrospective data-gathering. METHODS: Patients who underwent emergency colorectal surgery between March 2014 and December 2016 at a single tertiary-level referral center were included in our study. Patient demographics, comorbidities, type of surgery, etiology and laboratory and radiological findings were collected retrospectively and analyzed. A new clinical score (named the Numune emergency colorectal resection score) was constructed from the last logistic regression model, in which one point was assigned for the presence of each predictive factor. RESULTS: 138 patients underwent emergency colorectal surgery. These comprised 64 males (46.4%) and 74 females (53.6%), with a mean age of 64 years. Multivariate analysis revealed that blood urea nitrogen level > 65 mg/dl (odds ratio, OR: 8.03; 95% confidence interval, CI: 2.16-15.77), albumin level < 0.7 ­mg/­dl (OR: 4.43; 95% CI: 1.96-14.39) and American Society of Anesthesiologists score ≥ 3 (OR: 3.47; 95% CI: 0.81-9.18) were associated with postoperative complications. The Numune score was graded from I to III. The risk of mortality was found to be 63.2% in the group with grade III, which accounted for 35.2% of the subjects. There were 37 postoperative deaths. CONCLUSIONS: Surgeons need scoring systems, especially to predict postoperative mortality. We propose the Numune emergency colorectal resection score for emergency surgical procedures as a practical, usable and effective system for predicting postoperative morbidity.

Clinical infection in burn patients and its consequences.

BACKGROUND: Burn injuries facilitate invasive infections and sepsis not only by destroying the continuity of the protective skin barrier but also through systemic effects. The burn wound, blood, and urine samples are frequently cultured to determine the pathogen agent. The aim of this study was to analyze pathogen growth in patients' cultures confirmed as "infection positive" by the hospital Infection Control Committee and to assess the clinical implications of these growths. METHODS: Hospitalized patients included in the study were those with a total burned body surface area of >10% and "presence of infection" confirmed by the Infection Control Committee. The patients were evaluated with respect to age, gender, burn etiology, the total body surface area burned (TBSA), the presence of inhalation injury, sepsis, positive cultures, the microorganisms cultured in wound-blood-urine samples, and septic focus. RESULTS: Of the total 36 (10.3%) "infection-positive" patients, 26 (72.2%) were male; the mean age of patients was 44±21 years. The mean burned TBSA of the whole group was 45.58%±23.1%. Acinetobacter baumannii was the most isolated organism in the wound cultures. In patients with confirmed infection, there was a correlation between the pathogen isolated in urine cultures and mortality rates (p=0.023). Sepsis was diagnosed in 23 (63.9%) patients, of whom 21 had inhalation injuries. There was a significant correlation between inhalation injury and sepsis (p=0.015), and both the presence of sepsis or inhalation injury increased mortality (p=0.027 and p=0.009, respectively). CONCLUSION: According to the study data, the TBSA burned demonstrated a greater significance for mortality, although the presence of sepsis and/or urinary tract infection should also be noted as a cause of mortality in burned patients.