Long-Term Outcomes in Patients with Intestinal Failure Due to Short Bowel Syndrome and Intestinal Fistula

Short bowel syndrome (SBS) and enterocutaneous or enteroatmospheric fistulas are common indications for home parenteral nutrition (HPN). However, there are few data describing factors influencing surgical decision-making or outcomes particularly following fistula development. We aimed to compare outcomes between patients with SBS and fistulas and explore surgical decision-making. HPN-dependent adults from 2001–2018 at a national reference centre were included in this study. HPN cessation was analysed using death as competing risk. In total, 465 patients (SBS (62%), fistula (38%)) were included, with median HPN dependency of 2.6 years. In total, 203 patients underwent reconstructive surgery; while frailty was the commonest reason for not undergoing surgery (49.2%), 22.7% declined surgery. Overall, 170 ceased HPN, with a probability of 13.8%, 34.1% and 38.3% at 1, 5 and 10 years, respectively. Patients undergoing surgery had higher nutritional autonomy rates (109.8 incidences/1000 patient years) compared to those not undergoing surgery (18.1 incidences/1000 patient years; p < 0.001). A total of 295 patients (63.4%) were predicted to cease HPN based on gastrointestinal anatomy but only 162/295 (54.9%) achieved this; those unable to do so were older with a higher comorbidity index. There were no differences in long-term nutritional and survival outcomes or surgical decisions between patients with SBS and fistulas, or between enterocutaneous and enteroatmospheric fistulas. This study represents one of the largest datasets describing the ability of HPN-dependent patients with SBS or fistulas to achieve nutritional autonomy. While reconstructive surgery facilitates HPN cessation, approximately one-fifth of patients declined surgery despite HPN dependency. These data will better inform patient expectation and help plan alternative therapies.     

Thromboembolism in travelers]

The association between long haul travel and the risk of venous thromboembolism are suspected for long time. Mostly air travel related thrombosis series have been reported in the literature. Risk factors can be classified as: 1. travel related factors (coach position, immobilization, prolonged air travel, narrow seat and room, diuretic effect of alcohol, insufficient fluid intake, dehydration, direct pressure on leg veins, rare inspiration). 2. air plane related risk factors (low humidity, relative hypoxia, stress). 3. patient related factors (hereditary and acquired thrombophylia, previous deep venous thrombosis, age over 40, recent surgery or trauma, gravidity, puerperium, oestrogen containing pills, varicosity, chronic heart disease, obesity, fever, diarrhoea, vomiting, smoking). No patient related factors were found in some cases. To reduce the hazards air travellers are rightly concerned to know the level of the risk and the airlines should be responsible for this information. People should discuss with their physician what prophlylactic measures should be taken, such as compression stockings or low molecular weight heparin. Not only flight but car, bus and train travellers are also at risk of developing venous thromboembolism. Long haul travel alone is a separate risk factor for venous thromboembolism.     

Unique patterns of diffusion directionality in rat brain tumors revealed by high-resolution diffusion tensor MRI.

Diffusion tensor imaging (DTI) is a new technique that uses the microscopic motion of water molecules to probe tissue 3D microstructures. In this study, high-resolution DTI was performed on rats bearing intracranial 9L gliosarcoma, F98 glioma, and human glioblastoma. It was found that the tumors consisted of central zones with low diffusion anisotropy and peripheral structures (rim) with high diffusion anisotropy. In the rims, water diffusion directionality formed a circular pattern for the 9L and F98 tumors, and a radial pattern for the human glioblastoma xenografts. These well-organized diffusion patterns appeared at an early stage postimplantation and continued to exist with tumor growth in all three models. High-resolution ex vivo imaging and histology confirmed the in vivo findings. These distinct patterns, undetectable with conventional MRI, may reflect tumor organization and growth patterns at the cellular level.     

Plasmodium falciparum Genotypes, Low Complexity of Infection, and Resistance to Subsequent Malaria in Participants in the Asembo Bay Cohort Project

To assess the relationship between the within-host diversity of malaria infections and the susceptibility of the host to subsequent infection, we genotyped 60 children's successive infections from birth through 3 years of life. MSP-1 Block2 genotypes were used to estimate the complexity of infection (COI). Malaria transmission and age were positively associated with the number of K1 and Mad20 alleles detected (COI(KM)) (P < 0.003). Controlling for previous parasitemia, transmission, drug treatment, parasite density, sickle cell, and age, COI(KM) was negatively correlated with resistance to parasitemia of > 500/microl (P < 0.0001). Parasitemias with the RO-genotype were more resistant than those without this genotype (P < 0.0000). The resistance in low COI(KM) infections was not genotype specific. We discuss the impact of genotype-transcending immunity to conserved antigenic determinants. We also propose a diversity-driven immunomodulation hypothesis that may explain the delayed development of natural immunity in the first few years of life and suggest that interventions that decrease the COI(KM) could facilitate the development of protective immunity.     

Morphology of 3,4,5,3',4'-pentachlorinated biphenyl-induced change in canine lung

We investigated the light and electron microscopical changes of the lung in dogs treated with 3,4,5,3',4'-pentachlorinated biphenyl (PenCB). Beagle dogs were orally administered with 0.1 mg/kg of PenCB, and sacrificed 3, 5 and 7 weeks after the PenCB administration. Light microscopically, bronchiolar epithelial cells showed cytoplasmic vacuolization, which was most prominent 5 weeks after the PenCB administration. Electron microscopically, nonciliated bronchiolar epithelial cells (Clara cells) revealed degradation of glycogen particles, swollen, irregularly arranged smooth endoplasmic reticulum, and swollen mitochondria, while no significant change was found in other epithelial cells. The endothelial cells also showed no significant change except for increased number of cytoplasmic vesicles. This is a first report on halogenated hydrocarbon-induced degradation of glycogen particles in Clara cells.