Do bipolar scissors increase postoperative adhesions? An experimental double-blind randomized trial

AIM: The use of bipolar scissors (PowerStar) which has been suggested to reduce bleeding during surgical dissection, involves the theoretical risk for increasing intraperitoneal adhesions because of burn damages to the peritoneum secondary to bipolar electrocautery. MATERIAL AND METHOD: Thirty-six white new-Zealand rabbits have been included in a double-blind randomised trial to undergo a laparotomy using either a sharp scissors with on-demand monopolar coagulation or a bipolar scissors. Operatives procedures were standardised: midline laparotomy (5 cm), mobilisation of the right colon, incision of the colonic serosa without suture, incision of the colonic serosa with running sutures, incision of the mesentery. All these steps were performed by the same device according to the randomisation. Ten days later, the rabbits were killed. Adhesions were measured and scored according to the Zühlke classification by a surgeon who was not aware of the type of scissors used. Finally a pathological examination of adhesion was randomly performed. RESULTS: The two groups were similar for weight and sex-ratio. Two rabbits died before the tenth postoperative day (1 unknown aetiology and 1 evisceration). 34 rabbits were available for the study (18 in the "PowerStar" group and 16 in the control group). The results showed no significant difference between the groups for all measured endpoints (length and score of intraperitoneal and parietal adhesions). Nevertheless, pathological examination showed the burn damages to be less pronounced after using PowerStar. CONCLUSION: Bipolar scissors do not increase postoperative adhesions in the rabbit and probably induce less burn damages than monopolar cautery. The additional advantage i.e. the decrease adhesions formation, because of a less intraperitoneal bleeding, has not been observed in this randomised trial.     

The role of glutamine in intensive care unit patients: mechanisms of action and clinical outcome

Patients in the intensive care unit are at high risk of glutamine depletion and subsequent complications. Several controlled studies and a meta-analysis have concluded that glutamine supplementation has beneficial effects on the clinical outcome of critically ill and surgical patients. These results may be explained by glutamine's influences on the inflammatory response, oxidative stress, cell protection, and the gut barrier. In addition, glutamine may also improve glucose metabolism by reducing insulin resistance.     

Cachexie cancéreuse : bases physiopathologiquesCancer cachexia: physiopathology

Cachexia is a complex syndrome characterized by a decrease in nutritional intake and specific metabolic abnormalities in the host. Anorexia is a multifactorial phenomenon mainly of unknown origin which is not related to an increase in leptin level. Metabolic alterations in the host include an inconstant and weak hypermetabolism and specific perturbations in carbohydrate and lipid metabolism. Skeletal muscle wasting is the main feature of cachexia. There is a consensus on the view that muscle wasting is related not only to muscle catabolism but also to a decrease in the synthesis of new myofibrils and muscle proteins. Muscle protein catabolism is mainly related to an increase in ubiquitin-proteasom pathway by the cachectic factor PIF (Proteolysis inducing factor). Better understanding of the mechanisms of cachexia offers new targets for the development of specific therapeutic approach of cachexia.     

Low levels of gastric mucosal glutathione during upper gastric bleeding associated with the use of nonsteroidal anti-inflammatory drugs.

OBJECTIVES: To investigate the glutathione concentrations in gastric mucosa from patients with acute gastric bleeding related to nonsteroidal anti-inflammatory drugs (NSAIDs), and to test the influence of nutritional status on mucosal glutathione. Glutathione protects the gastrointestinal mucosa against reactive oxygen species, and glutathione content in various tissues may be depleted during malnutrition. METHODS: Endoscopic biopsies were obtained from 39 patients. Eighteen of these (9 well-nourished, 9 malnourished) presented with gastric bleeding ulcers related to NSAIDs. Twenty-one other patients (12 well-nourished, 9 malnourished) underwent normal routine diagnostic endoscopy and served as controls. Malnutrition was defined as a loss of over 10% of normal body weight and/or plasma albumin levels below 30 g/l. Gastric biopsies were taken from the fundus and antrum (controls) and from the region of the ulcer (patients with acute bleeding) and frozen quickly until glutathione analysis by high-performance liquid chromatography (HPLC) coulometric detection. Results were expressed as nmol/mg wet tissue. RESULTS: Gastric mucosal glutathione levels were significantly (P < 0.05) lower in both the antrum (0.81 +/- 0.34 v. 1.41 +/- 0.88 nmol/mg tissue) and the fundus (1.04 +/- 0.54 v. 1.43 +/- 0.92 nmol/mg tissue, P < 0.05) in malnourished than in well-nourished control patients. Glutathione mucosal concentrations were decreased significantly in patients with NSAID-induced gastric bleeding compared with control patients (0.38 +/- 0.36 v. 1.12 +/- 0.56 nmol/mg tissue, P < 0.001), and the lowest glutathione levels were observed in malnourished patients (0.28 +/- 0.20 v. 0.48 +/- 0.15 nmol/mg tissue in well-nourished patients, not significant). CONCLUSION: Malnutrition is associated with low levels of gastric glutathione. This may contribute to the severity and the onset of haemorrhage in NSAID-induced gastric ulcers.     

Colon cancer-associated B2 Escherichia coli colonize gut mucosa and promote cell proliferation

AIM:To provide further insight into the characterization of mucosa-associated Escherichia coli(E.coli)isolated from the colonic mucosa of cancer patients.METHODS:Phylogroups and the presence of cyclomodulin-encoding genes of mucosa-associated E.coli from colon cancer and diverticulosis specimens weredetermined by PCR.Adhesion and invasion experiments were performed with I-407 intestinal epithelial cells using gentamicin protection assay.Carcinoembryonic antigen-related cell adhesion molecule 6(CEACAM6)expression in T84 intestinal epithelial cells was measured by enzyme-linked immunosorbent assay and by Western Blot.Gut colonization,inflammation and procarcinogenic potential were assessed in a chronic infection model using CEABAC10 transgenic mice.Cell proliferation was analyzed by real-time mRNA quantification of PCNA and immunohistochemistry staining of Ki67.RESULTS:Analysis of mucosa-associated E.coli from colon cancer and diverticulosis specimens showed that whatever the origin of the E.coli strains,86%of cyclomodulin-positive E.coli belonged to B2 phylogroup and most harbored polyketide synthase(pks)island,which encodes colibactin,and/or cytotoxic necrotizing factor(cnf)genes.In vitro assays using I-407 intestinal epithelial cells revealed that mucosa-associated B2 E.coli strains were poorly adherent and invasive.However,mucosa-associated B2 E.coli similarly to Crohn’s disease-associated E.coli are able to induce CEACAM6expression in T84 intestinal epithelial cells.In addition,in vivo experiments using a chronic infection model of CEACAM6 expressing mice showed that B2 E.coli strain11G5 isolated from colon cancer is able to highly persist in the gut,and to induce colon inflammation,epithelial damages and cell proliferation.CONCLUSION:In conclusion,these data bring new insights into the ability of E.coli isolated from patients with colon cancer to establish persistent colonization,exacerbate inflammation and trigger carcinogenesis.     

Regulation of feeding and anxiety by alpha-MSH reactive autoantibodies

alpha-Melanocyte-stimulating hormone (alpha-MSH) is a stress-related neuropeptide involved in the regulation of motivated behavior, appetite and emotion including stimulation of satiety and anxiety. Although autoantibodies (autoAbs) reactive with alpha-MSH have been identified in human subjects and in rats, it remained unknown if these autoAbs are involved in the regulation of feeding and anxiety and if their production is related to stress. Here we show that repeated exposure of rats to anxiolytic mild stress by handling increases the levels and affinity of alpha-MSH reactive IgG autoAbs and that these changes are associated with adaptive feeding and anxiety responses during exposure of rats to a strong stress by food restriction. Importantly, an increase in affinity of alpha-MSH reactive autoAbs was associated with changes of their functional roles from stimulation to inhibition of alpha-MSH-mediated behavioural responses, suggesting that these autoAbs can be a carrier or a neutralizing molecule of alpha-MSH peptide, respectively. Using a model of passive transfer into the brain, we show that alpha-MSH autoAbs affinity purified from blood of rats exposed to repeated mild stress, but not from control rats, are able to increase acutely food intake, suppress anxiety and modify gene expression of hypothalamic neuropeptides in na?ve rats. These data provide the first evidence that autoAbs reactive with alpha-MSH are involved in the physiological regulation of feeding and mood, supporting a further role of the immune system in the control of motivated behavior and adaptation to stress.