Jithinraj Edakkanambeth Varayil

Preclinical electrogastrography in experimental pigs

Preclinical electrogastrography in experimental pigs Surface electrogastrography (EGG) is a non-invasive means of recording gastric myoelectric activity or slow waves from cutaneous leads placed over the stomach. This paper provides a comprehensive review of preclinical EGG. Our group recently set up and worked out the methods for EGG in experimental pigs. We gained our initial experience in the use of EGG in assessment of porcine gastric myoelectric activity after volume challenge and after intragastric administration of itopride and erythromycin. The mean dominant frequency in pigs is comparable with that found in humans. EGG in experimental pigs is feasible. Experimental EGG is an important basis for further preclinical projects in pharmacology and toxicology.

Catheter Salvage After Catheter-Related Bloodstream Infection During Home Parenteral Nutrition.

Background: Catheter-related bloodstream infection (CRBSI) is a common complication in patients receiving home parenteral nutrition (HPN). Data regarding catheter salvage after a CRBSI episode are limited. We aimed to determine the incidence of CRBSI and rates of catheter salvage in adult patients receiving HPN. Materials and Methods: We retrospectively searched our prospectively maintained HPN database for the records of all adult patients receiving HPN from January 1, 1990, to December 31, 2013, at our tertiary referral center. Data abstracted from the medical records included demographics, diseases, treatments, and outcomes. The incidence of CRBSI and rates of catheter salvage were determined. Results: Of 1040 patients identified, 620 (59.6%) were men. The median total duration on HPN was 124.5 days (interquartile range, 49.0–345.5 days). Mean (SD) age at HPN initiation was 53.3 (15.3) years. During the study period, 465 CRBSIs developed in 187 patients (18%). The rate of CRBSI was 0.64/1000 catheter days. Overall, 70% of catheters were salvaged (retained despite CRBSI) during the study period: 78% of infections with coagulase-negative staphylococci, 87% with methicillin-sensitive Staphylococcus aureus, and 27% with methicillin-resistant S aureus. The percentage of catheters salvaged was 63% from 1990 to 1994, 63% from 1995 to 1999, 61% from 2000 to 2004, 72% from 2005 to 2009, and 76% from 2010 to 2013. Conclusion: Catheter salvage is possible after a CRBSI episode. Since most episodes of CRBSI are caused by skin commensals, effective treatment without removal of the central venous catheter is possible in most cases.

The effect of general anaesthesia on gastric myoelectric activity in experimental pigs

BackgroundSurface electrogastrography (EGG) is a non-invasive method for clinical assessment of gastric myoelectrical activity. Different forms of general anaesthesia might have various effects on porcine EGG. The aim of this study was to evaluate the impact of different anaesthetic agents on EGG in experimental pigs.MethodsFour 15-minute EGG intervals were recorded and analysed. A baseline EGG recording was started 20u2009minutes after intramuscular injection of ketamine and azaperone (periods A and B). Four different regimens of general anaesthesia followed immediately after the baseline EGG (5 pigs in each experimental group): thiopental, isoflurane, nitrous oxide and isoflurane plus nitrous oxide. EGG recordings followed for the next 30u2009minutes under general anaesthesia (periods C and D). The dominant frequencies of slow waves were compared between the baseline intervals A and B and periods C and D under general anaesthesia.ResultsThe mean dominant frequency was within the normal range (2.3 – 3.5u2009cycles per minute) in all animals in all regimens. Thiopental general anaesthesia did not influence any change of the dominant frequency of slow waves. Nitrous oxide general anaesthesia increased the dominant frequency of slow waves in a statistically significant manner (baseline: 2.93u2009±u20090.53 and 3.01u2009±u20090.53; under general anaesthesia: 3.25u2009±u20090.34 and 3.29u2009±u20090.38u2009cycles per minute; pu2009<u20090.001, pu2009=u20090.003, pu2009<u20090.001, pu2009<u20090.001). Nitrous oxide together with isoflurane induced a statistically significant decrease of dominant frequency in the last 15-minute interval (2.66u2009±u20090.55u2009cycles per minute) compared to the baseline recording (2.81u2009±u20090.49; pu2009=u20090.030).ConclusionsAll changes of porcine gastric myoelectric activity assessed by the dominant frequency of slow waves during EGG remained within the normal range although some of them achieved statistical significance. Thus all tested agents used for general anaesthesia can be recommended in preclinical studies with porcine models focused on gastric myoelectric activity without any risk of compromising the results. Thiopental seems to be the most suitable as it did not cause any changes at all.

Advanced Studies in Clinical and Experimental Research in Gastroenterology.

Current research in gastroenterology and hepatology (both clinical and experimental) made great and rapid progress in new methods, in biomedical technology, and last but not least in practical application of basic scientific achievements during the last decade. n nOriginal research articles focusing on new, advanced studies in clinical and experimental research in gastroenterology and hepatology that have a potential to influence our daily practice and further clinical and experimental research were sent to this journal to be published by many leading gastroenterology specialists. n nWe bring ten articles in this special issue focused on the most interesting topics in gastroenterology and hepatology research. One of the leading areas of advanced studies in gastroenterology is cancer research. Colorectal cancer is one of the most common malignancies worldwide in terms of incidence and mortality. Although clear progress in both diagnosis and treatment has been achieved, efficacy of surgery and chemotherapy remains unsatisfactory due to late diagnosis. A possible new prognostic marker and therapeutic target in this disease is discussed in the article “ATAD2 Overexpression Identifies Colorectal Cancer Patients with Poor Prognosis and Drives Proliferation of Cancer Cells.” The aim of another article dealing with the colorectal cancer “Molecular Features and Methylation Status in Early Onset (≤40 Years) Colorectal Cancer: A Population Based, Case-Control Study” was to define the frequency of known hereditary colorectal syndromes and to characterise genetic and epigenetic features of early nonhereditary tumours in order to elucidate possible pathogenetic mechanisms. Colonoscopy plays an important role in colorectal cancer screening in many countries worldwide. Quality of colonic cleansing achieved is crucial for good quality of colonoscopy screening. Possible improvements in the field of low volume colonoscopy cleansing were described in the article “A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.” Second malignancy, which is discussed in a special issue in more detail, is the third most common cause of cancer-related death in the world: the gastric cancer. In the article “The Prevalence of Gastric Intestinal Metaplasia and Distribution of Helicobacter pylori Infection, Atrophy, Dysplasia, and Cancer in Its Subtypes,” the prevalence of the precancerous gastric lesions (intestinal metaplasia especially) in a large cohort of patients within the region with a high risk of gastric cancer was described. The metastatic involvement of the posterior lymph nodes along the common hepatic artery (the extra-regional lymph nodes called No.8p) was identified as a prognostic factor in the retrospective study: “Prognostic Value of Metastatic No.8p LNs in Patients with Gastric Cancer.” n nThe research based on the use of experimental animals still plays an important role in gastroenterology and the rat is one of the most extensively used experimental animal models. n nThe study “Surgical Anatomy of the Gastrointestinal Tract and Its Vasculature in the Laboratory Rat” investigated the functional anatomy and vasculature of the stomach, liver, and intestine in the laboratory rat and compared it with human morphology. n nNonsteroidal anti-inflammatory drug-induced gastropathy and ulcers represent an important complication related to one of the most commonly used drugs worldwide. Possible mucosal protective effect of Syzygium cumini (L.) Skeels aqueous extract in experimental mice model of indomethacin-induced gastric damage was proven in article “Anti-Inflammation Property of Syzygium cumini (L.) Skeels on Indomethacin-Induced Acute Gastric Ulceration.” n nResearch in hepatology is represented in three articles: “Assessing the Effect of Leptin on Liver Damage in Case of Hepatic Injury Associated with Paracetamol Poisoning,” “Lower Viral Response to Pegylated Interferon Alpha 2a Treatment of Chronic Hepatitis B in Roma People in Eastern Slovakia,” and “Serum Liver Fibrosis Markers for Predicting the Presence of Gastroesophageal Varices in Liver Cirrhosis: A Retrospective Cross-Sectional Study.” n nThe special issue cannot be a complete overview of research in the field of gastroenterology and hepatology. However, we believe that it is an interesting look at this area and provides a preview with an important impact on clinical medicine. n n nIlja Tacheci n nJithinraj Edakkanambeth Varayil n nZuzana Zelinkova n nMarcela Kopacova n nMiroslav Zavoral

Effects of enteral nutrition on clinical outcomes among mechanically ventilated and sedated patients in the pediatric intensive care unit

Objective. To analyze the effects of enteral nutrition on outcomes and complications of critically ill children in the pediatric in-tensive care unit (PICU).Design. Retrospective cohort study. Setting. PICU in a tertiary care academic medical center.Patients. Patients up to age 17 years who were admitted to the PICU between Janu-ary 1, 2011, and December 31, 2013. Interventions. Intubation for more than 48 hours and requiring any sedative medica-tions. Patients with surgical contraindica-tions to feeding were excluded. Measures and Main Results. A total of 165 patients met inclusion criteria. Both manual review of the electronic health re-cord and automated data capture (when-ever technically feasible) were conducted. Data were collected in REDCap software and analyzed using a statistical discovery program. The mean (SD) calorie intake within the first 10 days of PICU admission was 40% (31.9%) of the prescribed calo-ries. Only 67% of the patients had feeding initiated within 48 hours of admission. No significant difference in hospital or PICU length of stay or ventilator-free days was observed in patients who met one-third of their nutritional goals (50.3%) compared with patients who did not (49.7%). Mor-tality was nonsignificantly higher among patients who did not meet nutritional goals (P=.07). No association was found between higher doses of opioids or benzo-diazepines and nutrition tolerance or gas-trointestinal complications. Conclusions. Early adequate enteral nutri-tion had no statistically significant impact on the short-term clinical outcomes of PICU patients.