Looking for the Ideal Probiotic Healing Regime.

Wound healing is a multi-factorial response to tissue injury, aiming to restore tissue continuity. Numerous recent experimental and clinical studies clearly indicate that probiotics are applied topically to promote the wound-healing process. However, the precise mechanism by which they contribute to healing is not yet clear. Each strain appears to exert a distinctive, even multi-factorial action on different phases of the healing process. Given that a multi-probiotic formula exerts better results than a single strain, the pharmaceutical industry has embarked on a race for the production of a formulation containing a combination of probiotics capable of playing a role in all the phases of the healing process. Hence, the object of this review is to describe what is known to date of the distinctive mechanisms of each of the most studied probiotic strains in order to further facilitate research toward the development of combinations of strains and doses, covering the whole spectrum of healing. Eleven probiotic species have been analyzed, the only criterion of inclusion being a minimum of two published research articles.

How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases. AIM: To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance. METHODS: After a thorough research of the international literature of a period of more than 30 years of published "case reports" concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist. RESULTS: Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas. CONCLUSION: For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.

Role of Lactiplantibacillus plantarum UBLP-40, Lactobacillus rhamnosus UBLR-58 and Bifidobacterium longum UBBL-64 in the Wound Healing Process of the Excisional Skin.

The probiotics Lactiplantibacillus plantarum UBLP-40, Lactobacillus rhamnosus UBLR-58 and Bifidobacterium longum UBBL-64 seem to promote wound healing when applied topically. Our aim was to investigate their effect on the mRNA expression of pro-inflammatory, healing and angiogenetic factors during the healing process of a standardized excisional wound model in rats. Rats subjected to six dorsal skin wounds were allocated to Control; L. plantarum; combined formula of L. rhamnosus plus B. longum; L. rhamnosus; and B. longum treatments, applied every two days, along with tissue collection. The pro-inflammatory, wound-healing, and angiogenetic factors of mRNA expression were assessed by qRT-PCR. We found that L. plantarum exerts a strong anti-inflammatory effect in relation to L. rhamnosus-B. longum, given alone or in combination; the combined regime of L. rhamnosus-B. longum, works better, greatly promoting the expression of healing and angiogenic factors than L. plantarum. When separately tested, L. rhamnosus was found to work better than B. longum in promoting the expression of healing factors, while B. longum seems stronger than L. rhamnosus in the expression of angiogenic factors. We, therefore, suggest that an ideal probiotic treatment should definitively contain more than one probiotic strain to speed up all three healing phases.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Predictive Factors for Mortality and Length of Hospital Stay after Cardiac Surgery.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are widely accepted indices positively correlated with disease severity, progression, and mortality. In this study, we tested whether NLR and PLR could predict mortality and length of hospital stay (LOS) after cardiac surgery. METHODS: NLR and PLR were calculated on days 0, 3, 5, and 7 postoperatively. A ROC curve was generated to assess their prognostic value; multivariate logistic analysis identified independent risk factors for 90-day mortality. RESULTS: Analysis was performed on 179 patients' data, 11 of whom (6.15%) died within 90 days. The discriminatory performance for predicting 90-day mortality was better for NLR7 (AUC = 0.925, 95% CI:0.865-0.984) with the optimal cut-off point being 7.10. NLR5 and PLR3 also exhibited a significant strong discriminative performance. Similarly, a significant discriminative performance was prominent for PLR3, NLR5, and NLR7 with respect to LOS. Moreover, NLR7 (OR: 2.143, 95% CI: 1.076-4.267, p = 0.030) and ICU LOS (OR:1.361, 95% CI: 1.045-1.774, p = 0.022) were significant independent risk factors for 90-day mortality. CONCLUSIONS: NLR and PLR are efficient predictive factors for 90-day mortality and LOS in cardiac surgery patients. Owing to the simplicity of determining NLR and PLR, their postoperative monitoring may offer a reliable predictor of patients' outcomes in terms of LOS and mortality.

Buried bumper syndrome: A critical analysis of endoscopic release techniques.

Buried bumper syndrome (BBS) is the situation in which the internal bumper of the gastrostomy tube, due to prolonged compression of the tissues between the external and the internal bumper, migrates from the gastric lumen into the gastric wall or further, into the tract outside the gastric lumen, ending up anywhere between the stomach mucosa and the surface of the skin. This restricts liquid food from entering the stomach, since the internal opening is obstructed by gastric mucosal overgrowth. We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management, after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube. From the "push" and the "push and pull T" techniques to the most sophisticated-using high tech instruments, all 10 published techniques have been critically analysed and the pros and cons presented, in an effort to optimize the criteria of choice based on maximum efficacy and safety.

Endothelial Damage and Muscle Wasting in Cardiac Surgery Patients.

This is a post-hoc analysis to assess the effect of anesthesia, surgical trauma, and extracorporeal circuit on endothelial integrity, microvascular permeability, and extracellular fluid balance, as well as on skeletal muscle catabolism, in patients undergoing elective cardiac surgery. We included 127 well-nourished patients undergoing "on-pump" elective cardiac surgery. One day prior to surgery (D0) and again on postoperative day 7 (POD7), body mass index, body composition assessment, hand-grip strength (HGS), and mid-upper arm muscle circumference (MAMC) were measured. Patients were assigned to early recovery (ER) and late recovery (LR) groups, depending on the duration of ICU stay (cut-off 48 hours). The magnitude of change (Δ) in all parameters studied was assessed in ER versus LR groups, regarding (i) epithelial tissue dysfunction (Δ-Extra-Cellular Water percentage (Δ-ECW%), Δ-Phase Angle (Δ-PhA)), (ii) skeletal muscle mass catabolism (Δ-Skeletal muscle mass reduction%, Δ-Hand Grip Strength (Δ-HGS) and Δ-Mid Upper-Arm Muscle Circumference (Δ-MAMC)). Baseline measurements were similar in both groups. A significant difference was observed in all Δ-parameters studied (Δ-ECW%, Δ-PhA and muscle catabolism, Δ-HGS, Δ-MAMC), the worse results being correlated to the LR group. The results raise the issue that patients with early recovery may silently have pathological conditions, continuing even on the day of discharge - further research should be planned.

Nutritional Status in a Sample of Patients With ß-Thalassemia Major.

BACKGROUND: Patients suffering from thalassemia have decreased levels of lean body mass and an increased nutritional risk. To assess the body composition and vitamin D levels of thalassemic patients in relation to nutritional risk. METHODS: A total of 67 consecutive adult patients who were diagnosed with thalassemia major and followed a regular blood transfusion scheme were included in this study. Demographic and clinical data were collected for each participant. Blood samples were collected to assess 25-hydroxy-vitamin D (25-OH-D) levels. The assessment of patients' nutritional risk was based on the Malnutrition Universal Screening Tool. Body composition assessment was based on bioelectrical impedance analysis (BIA). RESULTS: Eleven patients (16.4%) and five patients (7.5%) were at moderate and high risk for malnutrition, respectively. Moreover, 86.6% of patients had a low fat-free mass index (FFMI) and 74.6% of patients had a high-fat mass (FM) index. The prevalence of sarcopenic obesity and 25-OH-D deficiency was 64.2% and 92.2%, respectively. Medium and high-risk patients had significantly lower BMI (18.81 ± 1.29 vs 23.90 ± 2.65 kg/m2, p<0.001), lower FFM index (12.80 ± 1.38 vs 14.19 ± 1.89 kg/m2, p=0.009) and lower FM index (5.97 ± 1.86 vs 9.70 ± 2.70 kg/m2, p<0.001) than their low-risk counterparts. CONCLUSIONS: Adult patients with ß-thalassemia major had low levels of vitamin D and altered body composition, presenting with increased adiposity, low levels of lean body mass, and high rates of sarcopenic obesity. Timely detection of patients at risk could lead to the prioritization of patients who could benefit from nutritional interventions.

Rubber band ligation of hemorrhoids: is the procedure effective for the immunocompromised, hemophiliacs and pregnant women?

Background: Rubber band ligation (RBL) is an effective, well-established, non-surgical option for symptomatic grade II-III hemorrhoid treatment. However, few reports exist about the benefit and risks of RBL in high-risk patients. We herein evaluated the effectiveness and safety of RBL in hemophiliac, human immunodeficiency virus (HIV)-positive and pregnant patients vs. other patients. Methods: We retrospectively evaluated the effectiveness of RBL, during the period 2001-2021, in 3 distinct patient categories deemed high-risk and thus not suitable for anesthesia and/or surgical management of their hemorrhoids: hemophiliacs, HIV-positive patients, and pregnant women. These were compared to matched controls, selected from our outpatient pool, who had no major comorbidities and who had opted for RBL as the primary method of treatment. Results: There were 3 study groups (44 with hemophilia, 29 HIV-positive patients, and 45 pregnant women) and controls respectively matched for grade, sex and age (2 for each one in the study groups). Hemophilia patients needed up to 6 RBL sessions for relief of symptoms (3.22 sessions/patient) compared to controls, who needed up to 4 sessions (1.88 sessions/patient, P<0.001); in the other 2 groups there was no difference. There were 3 minor complications: one minor bleeding in a hemophilia patient, a thrombosis in an HIV-positive patient, and severe rectal pain in a control patient. Patients were followed-up for at least 1 year. Conclusion: RBL is a safe and effective procedure in hemophiliacs, HIV-positive patients and pregnant women, with low complication rates for grade I-III hemorrhoids, similar to those in healthy matched controls.

Emergencies in the COVID-19 Era: Less Attendances, More Admissions.

Introduction Healthcare systems suffered a significant hit by the COVID-19 pandemic since the spring of 2020, and a need for major reorganization emerged. Along with the constant increase in COVID-19 cases, a significant drop in emergency attendances for non-COVID-19-related conditions was noted worldwide. We decided to document attendances in our hospital's emergency department during the first lockdown period in order to monitor this trend, compare it to data from other countries, and start monitoring the effects of this reduction in the years to come. Materials and methods Emergency department attendances at AHEPA University Hospital, Thessaloniki, Greece, from March 10, 2020, to May 31, 2020, were documented and compared to the corresponding period in 2019. The data collected included the number of patients per specialty, severity upon admission, as well as the need for admission. Results We found a 58% reduction in emergency department attendance during the studied period compared to the corresponding period in 2019 (p<0.0001). The reduction was more noticeable in ears, nose, throat (ENT), and ophthalmology attendances (75.7% and 78.1% reductions, respectively, p<0.001), but other specialties, such as cardiology and general surgery, were also significantly affected (60% and 63% reductions, respectively, p<0.001). However, the percentage of attendances that required admission increased significantly by 25-33% (p<0.001) during the lockdown, reflecting the higher severity of cases reaching the hospital. Conclusion Despite the obvious reduction in attendances during the COVID-19 pandemic, patients still suffer from serious conditions that require hospital admission. Therefore, hospitals need to be supported to also care for these patients. The long-term effects of avoiding hospital attendance need to be closely monitored.

A Four-Probiotic Regime to Reduce Surgical Site Infections in Multi-Trauma Patients.

Investigations that focused on the protective role of probiotics against Surgical Site Infections (SSI) in multiple-trauma (MT) patients are generally few, probably due to the complexity of the concept of trauma. We aimed to assess the efficacy of a four-probiotic regime to reduce the incidence of SSI in MT patients, with a brain injury included. MT patients, being intubated and expected to require mechanical ventilation for >10 days, were randomly allocated into placebo (n = 50) or probiotic treatment (n = 53) comprising Lactobacillus acidophilus LA-5 (1.75 × 109 cfu), Lactiplantibacillus plantarum UBLP-40 (0.5 × 109 cfu), Bifidobacterium animalis subsp. lactis BB-12 (1.75 × 109 cfu), and Saccharomycesboulardii Unique-28 (1.5 × 109 cfu) in sachets. All patients received two sachets of placebo or probiotics twice/day for 15 days and were followed-up for 30 days. The operations were classified as neurosurgical, thoracostomies, laparotomies, orthopedics, and others; then, the SSI and the isolated pathogen were registered. A total of 23 (46.0%) and 13 (24.5%) infectious insults in 89 (50 placebo patients) and 88 (53 probiotics-treated) operations (p = 0.022) were recorded, the majority of them relating to osteosynthesis­17 and 8, respectively. The most commonly identified pathogens were Staphylococcus aureus and Acinetobacter baumannii. Our results support published evidence that the prophylactic administration of probiotics in MT patients exerts a positive effect on the incidence of SSI.

Mapping of Intragastric Balloon Use: a Guide to the Activity of Institutions Through Bibliometry.

BACKGROUND: Bibliometric analysis is an effective method for measuring scientific contributions in a variety of fields. It enables the numerical analysis of publications in a specific field and period of time, as well as the relationships between these publications. The present bibliometric analysis of publications relating to obesity treatment by means of intragastric balloons aimed to identify the bariatric centers using intragastric balloons, through the publications relating to their productivity; and furthermore, to reveal collaborations, types of balloons used, number of patients involved, and authors' productivity and favored journals. METHOD: The PubMed and Scopus databases were used to retrieve only original articles presenting the results in body weight reduction. RESULTS: Bibliographic research identified 164 publications for the period 2000-2021. Italy was ranked first with 37 publications; USA participated as collaborator with 9 different countries; the fluid-filled Orbera balloon is featured in 126 publications; the journal Obesity Surgery hosted 86 publications; Brazil reported the greatest number of patients with 5874 cases; Lorenzo M and Genco A, co-authors from Italy, authored 14 and 12 publications, respectively, and the most cited article was that of Genco et al. [2007] with 441 citations. CONCLUSIONS: Bibliometric analysis gave us the opportunity to identify the centers through their scientific publications and to classify them in relation to their productivity in articles, in collaborations, in number of cases reported, and in the number of citations gained.

The 3-D configuration of excisional skin wound healing after topical probiotic application.

Nowadays, there is an increasing knowledge that probiotic bacteria, topically applied, affects skin pathology. The objective of this study is to evaluate the effect on wound healing of locally applied probiotics by calculating the 3-D configuration of a standardized excisional wound. Fifty-two male Wistar rats were randomly allocated into groups: control, PRO1 [L. plantarum] and PRO2 [L. rhamnosus, B. longum]. Six excisional full-thickness wounds were created on each dorsum by an 8-mm circular biopsy punch; probiotics or saline were applied on days 0, 2, 4, 8, 16, photos of the wounds taken and specimens excised for histology [4 rats/group/time-point]. Both probiotic-groups exhibited accelerated healing significantly faster than the control, throughout, PRO2 exhibiting finally the best results [day 16]. However, only on day 2, did PRO1 exhibit the best results [wounded area, borders distance and epitheliazation line]. The results clearly demonstrate that the topical application of probiotics significantly improves the healing process, each strain working differently and more effectively in different healing phases. Thus, a combined formula containing different probiotics to modulate various healing phases is desirable. To this end our research continous.

A four-probiotic preparation for ventilator-associated pneumonia in multi-trauma patients: results of a randomized clinical trial.

The role of probiotics in the prevention of ventilator-associated pneumonia (VAP) remains inconclusive. The aim of this study was to assess the efficacy of a probiotic regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, patients expected to require mechanical ventilation for >10 days were assigned at random to receive prophylaxis with a probiotic formula (n=59) or placebo (n=53). The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 [1.75 × 109 colony-forming units (cfu)], Lactobacillus plantarum (0.5 × 109 cfu), Bifidobacterium lactis BB-12 (1.75 × 109 cfu) and Saccharomyces boulardii (1.5 × 109 cfu) in sachets. Each patient received two sachets twice daily for 15 days: one through the nasogastric tube and one spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis, and the duration of hospital stay were the secondary endpoints. Administration of probiotics reduced the incidence of VAP [11.9% vs 28.3%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.13-0.92; P=0.034] and sepsis [6.8% vs 24.5%, odds ratio 0.22, 95% CI 0.07-0.74: P=0.016]. Furthermore, probiotic prophylaxis reduced the time of stay in the intensive care unit (ICU) and the length of hospital stay. The prophylactic use of probiotics with a combination of enteral and topical application to the oropharynx had a positive effect on the incidence of VAP and sepsis, as well as on ICU and total hospital stay in patients receiving protracted mechanical ventilation.

Post-Cardiac Arrest Syndrome Is Not Associated With an Early Bacterial Translocation.

BACKGROUND: The aim of this study was to investigate bacterial translocation and its possible role in the development of post-resuscitation inflammatory response following Cardio-Pulmonary Resuscitation (CPR) after cardiac arrest. METHODS: Munich female swine were employed for a model of cardiac arrest via application of electrical current. After 7 min, CPR was initiated, and animals were either successfully return to spontaneous circulation (ROSC) within 40 min or not (no-ROSC). At the end of experimental period and prior to sacrifice, samples from the intestine, mesenteric lymph nodes (MLN), liver and portal vein blood were obtained. Evaluation of inflammation and gut permeability was performed; MLN, liver and portal vein samples were analyzed for 16 s rRNA detection and cytokine mRNA expression. RESULTS: A decreased expression of the tight junction protein Occludin, with higher levels of inflammation, greater epithelial disintegration, ulceration, loss of crypts and villi height were found in the intestines of the ROSC swine in comparison to no-ROSC. The macrophage surface antigen CD-14 staining was relatively more intense in the ROSC than in no-ROSC. Higher levels of TNF-α mRNA expression were present in the liver of the ROSC group. Finally, despite the inflammatory response and the gut mucosal alterations in ROSC group, no bacterial translocation was detected in liver, MLN and portal vein. CONCLUSIONS: We show that resuscitation from cardiac arrest induces inflammatory response and intestinal permeability in swine 4h after resuscitation, but not a bacterial translocation. Bacterial translocation is not an early phase phenomenon but probably part of the pathophysiologic sequelae.

Six intragastric balloons: Which to choose?

Endoscopically placed intragastric balloons (IGBs) have played a significant role in obesity treatment over the last 30 years, successfully bridging the gap between lifestyle modification/pharmacotherapy and bariatric surgery. Since they provide a continuous sensation of satiety that helps the ingestion of smaller portions of food, facilitating maintenance of a low-calorie diet, they have generally been considered an effective and reversible, less invasive, non-surgical procedure for weight loss. However, some studies indicate that balloons have limited sustainable effectiveness for the vast majority attempting such therapy, resulting in a return to the previous weight after balloon removal. In this review we try to summarize the pros and cons of various balloon types, to guide decision making for both the physician and the obese individual looking for effective treatment. We analyzed the six most commonly used IGBs, namely the liquid-filled balloons Orbera, Spatz3, ReShape Duo and Elipse, and the gas-filled Heliosphere and Obalon - also including comments on the adjustable Spatz3, and the swallowable Obalon and Elipse - to optimize the choice for maximum efficacy and safety.

Benchmarking the Discriminatory Performance of Body Mass Index and Body Fat for Obesity Detection in Patients Treated by Intragastric Balloon.

INTRODUCTION/PURPOSE: The accuracy of body mass index (BMI) in detecting obesity in patients treated by intragastric balloon (IGB) remains still speculative. We aimed to determine the discriminatory performance of BMI as an estimate of excess body fat (%BF) in an IGB-treated population. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data of 476 patients who completed the 6-month IGB treatment period and were subjected to body composition analysis. We evaluated the relationship between BMI and %BF or lean mass and the diagnostic performance of BMI ≥ 30 kg/m2 for adipose tissue detection, stratified by age (< 40 and ≥ 40 years) and gender. Moreover, we identified anthropometric and body composition parameters serving as predictors of obesity according to %BF-based criteria (> 25% in men or > 35% in women). RESULTS: Gender emerged as an effect modifier in the quadratic polynomial relationship between BMI and %BF (R2 = 0.849 for men, R2 = 0.715 for women), while BMI was linearly associated with %BF in both age groups (R2 = 0.435 for men, R2 = 0.474 for women). BMI was strongly correlated with both %BF (r = 0.67) and lean mass (r = - 0.65). The overall area under the ROC curve for BMI ≥ 30 kg/m2 to detect %BF was 0.87 (95%CI 0.85-0.90). A regression model including lean mass, total body water, age, BMI, and female gender explained 0.970 of the variance in %BF. CONCLUSION: The discriminatory performance of BMI as an estimate of excess body fat is enhanced by the implementation of gender- and age-specific BMI thresholds for defining obesity, in IGB-treated patients.

Phase Angle and Handgrip Strength as Complements to Body Composition Analysis for Refining Prognostic Accuracy in Cardiac Surgical Patients.

OBJECTIVE: This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population. DESIGN: Prospective, cohort study. SETTING: Tertiary university hospital. PARTICIPANTS: Patients undergoing cardiac surgery procedures. INTERVENTIONS: Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality. RESULTS: Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II. CONCLUSIONS: Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality.

The adaptive immune response in cardiac arrest resuscitation induced ischemia reperfusion renal injury.

BACKGROUND: The present study aims to investigate, immunohistochemically, the role of the adaptive immune response in cardiac arrest/resuscitation-induced ischemia-reperfusion renal injury (IRI), namely to assess the presence of lymphocytes in renal tissue samples and the connection between the extent of the damage and the concentration of the lymphocytes by comparing the kidneys of non resuscitated swine with the kidneys of resuscitated swine. METHODS: Twenty four swine underwent cardiac arrest (CA) via a pacemaker wire. After 7 min, without any intervention, Cardiopulmonary Resuscitation, CPR, was commenced. Five min after CPR was commenced advanced life-support, ALS. Animals were divided into resuscitated animals and non resuscitated animals. Tissue samples obtained from the two groups for immunohistological study aiming to detect T-cells, B-cells and plasma cells using CD3 + , CD20 + , and CD138 + antibodies. RESULTS: There seems to be a strong concentration of T lymphocytes in the kidney tissues after ischemia of both non-resuscitated and resuscitated swine. B lymphocytes, also, appear to have infiltrated the ischemic kidneys of both animal groups; nevertheless, the contribution of T lymphocytes to the induction of injury remains greater. There is no strong evidence of correlation between the plasma cells and the damage. CONCLUSION: The adaptive immune response seems to have a strong association with kidney injury and acute tubular necrosis after cardiac arrest/ resuscitation-induced ischemia-reperfusion. However, the extent to which the adaptive immune cells are involved in the induction of renal injury remains uncertain and there are many questions about the mechanism of function of these cells, the answers of which require further studies.

Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety.

PURPOSE: Percutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards. METHODS: We describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this "stoma" as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth. RESULTS: The performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident. CONCLUSION: The use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.