Nanoparticle-Mediated Delivery of Emodin via Colonic Irrigation Attenuates Renal Injury in 5/6 Nephrectomized Rats

Our previous study showed that emodin enema modulates gut microbiota and delays CKD progression. However, the poor solubility, limited colonic irrigation retention time, and inadequate colon adhesion of emodin hinder its clinical application. Based on the deficiencies of emodin, we prepared monomethoxy-poly (ethylene glycol)-poly (lactic acid)-chitosan-2-mercaptobenzimidazole nanoparticles with incorporated emodin (emodin-NP) and studied their efficacy in delaying CKD progression. 5/6 nephrectomized Male Sprague Dawley rats were administered via colonic irrigation with emodin-NP every two days for eight weeks. We found that treatment with emodin-NP improved the kidney function of the rats and limited the expansion of tubulointerstitial fibrosis. Treatment with emodin-NP once every two days is comparable to emodin treatment once a day. Furthermore, emodin-NP via colonic irrigation remarkably reduced IL-1β, IL-6, and LPS levels in serum, improved intestinal barrier functions, and downregulated the key proteins (TLR4, MyD88, and NF-κB) expression in intestinal TLR4 signaling pathway. 16S rDNA analyses showed that emodin-NP can regulate microbiota disturbance in CKD. Taken together, these results suggest that emodin-NP alleviates kidney dysfunction and tubulointerstitial fibrosis by mediation through the modification of gut microbiota disorders. Emodin-NP may be a new method to treat CKD.

The Use оf Intraoperative Colonic Irrigation in Surgical Treatment of Obstructing Cancer of the Left Colon

Purpose. Study of technical options and immediate results of primary anastomoses using intraoperative colonic irrigation in the surgical treatment of left-sided colonic tumor obstruction.Material and methods. Of the 128 patients with left-sided colonic obstruction, 20 patients underwent surgery with intraoperative colonic lavage and the formation of a primary colonic anastomosis. The mean age was 61.7 1.4 years. In 5 patients, the compensated stage of colonic malignant obstruction was detected, in 8 patients - subcompensated, in 7 patients - decompensated. Colon icirrigation was carried out by means of antegrade jet injection of 8 -10 liters of isoosmolar solution of electrolytes and was terminated by the introduction of enterosorbent microsorb-P. In 11 cases left-sided hemicolectomy was performed in patients and in 9 cases - resection of the sigmoid colon with primary anastomosis.Results. After surgical interventions various complications were observed in 7 patients. In 2 patients afailure of anastomosis was revealed, the successful treatment of which did not require repeated surgical procedures. In the postoperative period 1 (5.0%) patient died on the 4th day after surgical intervention from cardiopulmonary insufficiency on the basis of concomitant pathology.Conclusion. In the conditions of specialized surgical hospitals after careful evaluation of operational risk with obstructing cancer of the left colon it is possible to use segmental resections of the colon with the imposition of a primary anastomosis with mandatory use of intraoperative colonic lavage . This tactic helps to increase the effectiveness of surgical interventions and provides early rehabilitation of operated patients.

Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction?

Historically, the use of colonic irrigation or transanal irrigation (TAI) has been viewed as an alternative therapy for the treatment of a wide variety of conditions not relating to bowel dysfunction, including nausea, fatigue, depression, headache, anxiety and rheumatism. However, these days it is viewed as an effective treatment in individuals who may present with bowel dysfunction and related symptoms of constipation and faecal incontinence. Such individuals would include people with neuropathic bowel disorders, conditions that affect sphincter control or bowel motility disorders. injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor, and chronic faecal incontinence. TAI may be performed by the person with bowel dysfunction, or by a carer or health professional. An individual's ability to use a device to undertake the procedure will be influenced by a range of factors, which are explored in this article.

Appendicostomy Antegrade Colonic Irrigation by Electromechanical Pump, a Novel Method for Managing Fecal Incontinence, Randomized Clinical Trial

Antegrade colonic irrigation enema (ACIE) is established as an old treatment for child fecal incontinence and recently is approved as a treatment for different causes of adult fecal incontinence (cancer surgery, neurogenic bowel, spinal cord injury, sphincter trauma, etc.). Despite the benefits of emptying the large bowel and prevention of fecal incontinence or constipation, this method is time-consuming and requires thorough instruction and training. The purpose of this study was to innovate and assess novel technique to decrease time-consuming and improve performance of irrigation. We designed and electromechanical pump for colon irrigation and assessed by a randomized crossover clinical trial study, involving two-four weeks treatment phases. 30 patients have included that suffered fecal incontinence and had been managed with appendicostomy antegrade colon irrigation. The results showed that the pump decrease time and volume of irrigation compare with the traditional method. All patients had a reduction in toileting times. Traditional mean toileting time was 67 minutes, versus pump-toileting time that was 24.6 minutes (P:0.00). The volume of water was reduced in 13 patients. Mean of the volume was 1712 ml in the traditional method and 1128 ml in pump method (P:0.279). Mean Cleveland Clinic Florida Fecal Incontinence score (CCF_FIS) for the pump was 5.84 compare 6.24 for traditional method (P:0.000). Our study provides evidence for the first time that our novel method can facilitate and speed-up colon irrigation without any adverse effect on the outcome. © 2018 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2018;57(4):216-223.