COMPARATION OF EFFICACY OF DIFFERENT PERIOPERATIVE MEDICAL PREPARATION SCHEMES FOR TRANSPAPILLAR ENDOSCOPIC INTERVENTIONS

The intensity of peristaltic activity has significant impact on the duration of transpapillar endoscopic interventions and in some cases (juxtapapillary diverticulum, stenotising papillitis or severe oedema of papilla) can impede operations. Therefore, proper inhibition of duodenal peristalsis is one of the important preconditions for successful fulfilment of such procedures. The aim of the study was to carry out comparative analysis of impact of antispasmodic medications used through the perioperative period on the quality of transpapillar endoscopic interventions. Case histories of patients, who were treated at the Surgical Department of Municipal Enterprise “Sklifosovskiy Poltava Regional Clinical Hospital” for 2017-2019, were investigated, and 75 cases were chosen for further analysis. We divided our cohort in two groups depending on medications used for duodenal peristalsis inhibition: I group – hyoscine butyl bromide (1 ml 2% solution intramuscular injection); II – hyoscine butyl bromide (1 ml 2% solution intramuscular injection), and atropine (1ml 0,1% solution intramuscular injection). Time needed for selective cannulation, total procedure length, number and type of adverse events during manipulation and in early postoperative period were compared between the groups. After statistical data processing the following conclusions were made: 1) proper medical preparation significantly facilitates the implementation of transpapillar endoscopic interventions; 2) combined scheme to reduce duodenal peristalsis, which includes hyoscine butyl bromide and atropine, is not superior to hyoscine butyl bromide alone.

An In Vivo Microfluidic Study of Bacterial Load Dynamics and Absorption in the C. elegans Intestine

Caenorhabditiselegans (C. elegans) has gained importance as a model for studying host-microbiota interactions and bacterial infections related to human pathogens. Assessing the fate of ingested bacteria in the worm’s intestine is therefore of great interest, in particular with respect to normal bacterial digestion or intestinal colonization by pathogens. Here, we report an in vivo study of bacteria in the gut of C. elegans. We take advantage of a polydimethylsiloxane (PDMS) microfluidic device enabling passive immobilization of adult worms under physiological conditions. Non-pathogenic Escherichia coli (E. coli) bacteria expressing either pH-sensitive or pH-insensitive fluorescence reporters as well as fluorescently marked indigestible microbeads were used for the different assays. Dynamic fluorescence patterns of the bacterial load in the worm gut were conveniently monitored by time-lapse imaging. Cyclic motion of the bacterial load due to peristaltic activity of the gut was observed and biochemical digestion of E. coli was characterized by high-resolution fluorescence imaging of the worm’s intestine. We could discriminate between individual intact bacteria and diffuse signals related to disrupted bacteria that can be digested. From the decay of the diffuse fluorescent signal, we determined a digestion time constant of 14 ± 4 s. In order to evaluate the possibility to perform infection assays with our platform, immobilized C. elegans worms were fed pathogenic Mycobacterium marinum (M. marinum) bacteria. We analyzed bacterial fate and accumulation in the gut of N2 worms and mitochondrial stress response in a hsp-6::gfp mutant.

MODULATION OF MELOXICAM-INDUCED CHANGES IN GASTROINTESTINAL AND MOTOR ACTIVITY OF THE STOMACH BY APPLYING PLACENTA CRYOEXTRACT

Introduction. Current approaches to reducing the ulcerogenicity of nonsteroidal anti-inflammatory drugs are aimed primarily at eliminating the damaging effect on the gastric mucosa, and according to the literature, the use of proton pump inhibitors can even worsen the course of enteropathy. Objectives. To characterize the influence of cryopreserved placenta extract on the state of secretory and motor-evacuation activity of the stomach under the conditions of experimental meloxicam-induced gastropathy and enteropathy. Methods. Serial randomized placebo-controlled studies were performed on nonlinear rats and mice using a model of small intestine-induced gastrointestinal lesions. Gastric secretion in rats, gastric evacuation function and intestinal motor function in mice were studied with the help of standard methods. Results. The administration of meloxicam leads to a statistically significant increase (p <0.05) in the volume of gastric secretion by 31.6±7.3%, an increase in total acidity (p=0.002) by 7.7 [7.7; 16.6]% and a statistically significant increase (p<0.05) in peristaltic activity by 18.9% relative to intact animals. The administration of cryopreserved placenta extract led to a statistically significant (p=0.002) decrease in the ratio of free and total acidity by 2.3 times, with a statistically significant decrease (p<0.05) by 14.5% in peristaltic activity relative to intact animals. The combined threaded administration of meloxicam and cryopreserved placenta extract was accompanied by a decrease in the ratio of free and total acidity by 43.0±3.0%. Conclusion. The combined application of placental cryoextract and meloxicam eliminates meloxicam-induced hypersecretion of gastric juice and gastric hypermobility. The cryoextract has also proved to reduce the aggressiveness of gastric juice by reducing its free and increasing combined acidity.

Slippage phenomenon in hydromagnetic peristaltic rheology with hall current and viscous dissipation

The current research explores the slippage phenomenon in hydromagnetic peristaltic activity of a non-Newtonian fluid with porous media in an asymmetric channel. The analysis is performed under the influence of thermal radiation, Hall current, Joule heating and viscous dissipation. The problem is formulated with the assumption of small Reynolds number and large wavelength. Analytical solutions are achieved through perturbation technique and the impacts of involved influential parameters are examined through graphs. It is observed that the pressure gradient rises with fourth grade fluid parameter and decreases with increasing phase difference. The pressure rise increases in pumping regime and decreases in co-pumping regime for increasing magnetic field parameter, whereas it has opposite effects for hall parameter. It is also noted that the velocity drops in the middle of the channel, while it increases near the boundaries for growing slip parameter and magnetic field parameters and it has the opposite behavior for hall and permeability parameters. The slip parameter increases the temperature of the fluid and decreases the concentration. Also, in trapping phenomena, the bolus size reduces by enlarging Deborah parameter. The present research has profound use in biomedical science, polymer technology and artificial heart polishing.

Nitric Oxide Is Essential for Generating the Minute Rhythm Contraction Pattern in the Small Intestine, Likely via ICC-DMP

Nitrergic nerves have been proposed to play a critical role in the orchestration of peristaltic activities throughout the gastrointestinal tract. In the present study, we investigated the role of nitric oxide, using spatiotemporal mapping, in peristaltic activity of the whole ex vivo mouse intestine. We identified a propulsive motor pattern in the form of propagating myogenic contractions, that are clustered by the enteric nervous system into a minute rhythm that is dependent on nitric oxide. The cluster formation was abolished by TTX, lidocaine and nitric oxide synthesis inhibition, whereas the myogenic contractions, occurring at the ICC-MP initiated slow wave frequency, remained undisturbed. Cluster formation, inhibited by block of nitric oxide synthesis, was fully restored in a highly regular rhythmic fashion by a constant level of nitric oxide generated by sodium nitroprusside; but the action of sodium nitroprusside was inhibited by lidocaine indicating that it was relying on neural activity, but not rhythmic nitrergic nerve activity. Hence, distention-induced activity of cholinergic nerves and/or a co-factor within nitrergic nerves such as ATP is also a requirement for the minute rhythm. Cluster formation was dependent on distention but was not evoked by a distention reflex. Block of gap junction conductance by carbenoxolone, dose dependently inhibited, and eventually abolished clusters and contraction waves, likely associated, not with inhibition of nitrergic innervation, but by abolishing ICC network synchronization. An intriguing feature of the clusters was the presence of bands of rhythmic inhibitions at 4–8 cycles/min; these inhibitory patches occurred in the presence of tetrodotoxin or lidocaine and hence were not dependent on nitrergic nerves. We propose that the minute rhythm is generated by nitric oxide-induced rhythmic depolarization of the musculature via ICC-DMP.

Advances and caveats in modern achalasia management

Achalasia is a rare esophageal motility disorder characterized by the incomplete relaxation of the lower esophageal sphincter (LES) and impaired peristaltic activity. The advent of high-resolution manometry (HRM) and the rapidly evolving role of therapeutic endoscopy have revolutionized the approach to the diagnosis and management of achalasia patients in the last decade. With advances in HRM technology and methodology, fluoroscopy and EndoFlip, achalasia can be differentiated into therapeutically meaningful phenotypes with a high degree of accuracy. Further, the newest treatment option, per-oral endoscopic myotomy (POEM), has become a staple therapy following the last 10 years of experience, and recent randomized trials appear to show no difference between POEM, graded pneumatic dilatation and surgical Heller myotomy in terms of short- and long-term efficacy or complication rate. On the other hand, how treatment outcomes are measured as well as the risk of reflux following therapy remain areas of contention. This review aims to summarize the recent advancements in achalasia testing and therapy, describes the recent randomized clinical trials as well as their potential setbacks, and touches on the future of personalizing achalasia treatment.

Sonographic Evaluation of Coprostatic Impaction with Sand and Ingesta in Draft Equids

Background: Impaction of colons is a major cause of deaths in equines; therefore the objective of the current study was to perform the detailed ultrasonographic examination of equids suffering from abdominal discomfort and to identify which measurable parameters were important in reaching a diagnosis of small intestinal abnormality and determining treatment options. Methods: In this study twenty five equids (age 10-13 years) with history of cessation of defecation ranging from 2-4 days were subjected to sonography. Result: The impaction of left ventral colon in all animals was imaged as hyperechoic intraluminal structure casting a strong acoustic shadow with loss of normal sacculations, edema, increase in wall thickness and absence of peristaltic activity. Findings giving an indication of sand colic were the flattening of left ventral colon wall against the ventral body wall with loss of normal sacculations, peristaltic activity, presence of small pinpoint hyperechoic structures on the mucosal surface seen casting small acoustic shadows and reverberation artifacts in different directions were highly suggestive of sand impaction. In all animals the loops of small intestine were observed in transverse as well as longitudinal sections as hypermotile distended with fluidy ingesta and hyperechoic feed particles swirling inside that fluidly ingesta. The presence of dilated multiple loops of intestine in a single scanning area was a consistent feature of left ventral colon impaction. Hence detailed ultrasonographic examination was useful to delineate normal and abnormal conditions and to distinguish between true and false colic which provided an important diagnostic lead in management of affections of left ventral colon.