Molecular identification, characterization, and antagonistic activity profiling of Bacillus cereus LOCK 1002 along with the in-silico analysis of its presumptive bacteriocins.

Objectives: This research aimed to isolate, identify, and characterize a new strain of Bacillus cereus through different molecular biology approaches so that it could be further studied for therapeutic purposes against selective enteric pathogens. Materials and Methods: Pure isolates of B. cereus were prepared from buffalo yogurt samples in REMBA medium. Initially, the morphological, physiological, and biochemical properties were studied accordingly. Following the tests, the molecular identification for the strain identification was conducted through plasmid DNA extraction, PCR, agarose gel electrophoresis, and 16S rRNA sequencing up to 1.37 kb. Afterward, the antibiotic sensitivity [Epsilometer test (E-Test)] and antifungal activity were tested considering different concentrations. Being classified from the aforementioned tests, a comprehensive antimicrobial activity test was conducted using the cell-free-supernatant (CFS) of the test strain against selective enteric pathogens in humans in vitro. Besides, the different clusters of genes were identified and characterized for understanding the presumptive bacteriocins present in the CFS of the strain in silico, where molecular string properties were calculated. Finally, the evolutionary relationship among diversified bacteriocins synthesized by different Bacillus strains was studied to predict the CFS-containing bacteriocins of the new strain. Results: Purified isolates of B. cereus were Gram-positive rods and showed significant tolerance (p < 0.0001) to different concentrations of pH, phenol, bile salt, and NaCl. 16S rRNA revealed the strain as LOCK 1002, which was strongly sensitive to all the antibiotics used and resistant to selective antifungal agents. The CFS of B. cereus LOCK 1002 was found to be a very promising antagonist to all the enteric pathogens used in the culture condition. Two gene clusters were predicted to be interconnected and responsible for different presumptive bacteriocins. Conclusion: The newly identified LOCK 1002 can be a very potent strain of B. cereus in use as an antimicrobial agent for having different bacteriocin coding gene clusters.

Magneto-structural coupling in [Formula: see text].

[Formula: see text] compound is well Known to show the frustration of the spin structure. At 12 K, [Formula: see text] distorts to break symmetry of the degenerated frustrated spin states by the spin-Peierls-like phase transition, accompanying with the antiferromagnetic ordering. On the other hand, [Formula: see text] undergoes a Jahn-Teller phase transition at a temperature of 310 K, differing from the low temperature ferrimagnetic transition temperature [Formula: see text] of about 60 K. It is also reported that [Formula: see text] shows another magnetic phase transition at about 30 K. These two phase transitions accompanying with the lattice change can be understood by the magneto-elastic interactions. Two interactions, the Jahn-Teller interaction and the spin-Peierls-like interaction are co-exist in [Formula: see text] system. In this report the [Formula: see text] compounds with x = 0.8, 0.6 and 1 are investigated by the X-ray diffraction measurements. From these measurements the crystal structures are determined. The full width at half maximum and integrated intensity give the fruitful information for magnetic elastic interactions.

Selective Inhibition of SIRT2 Improves Outcomes in a Lethal Septic Model.

BACKGROUND: Seven isoforms of histone deacetylase Class III have been reported - Sirtuin (SIRT) 1-7. We recently demonstrated that EX-527, an inhibitor of SIRT1, reduces mortality in a mouse model of lethal-cecal-ligationand- puncture (CLP)-induced septic shock. Our present study was aimed at determining whether selective inhibition of SIRT2, with AGK2, would decrease animal death and attenuate the inflammatory response in a septic model. METHODS: Experiment I: C57BL/6J mice were intraperitoneally given either AGK2 (82 mg/kg) in dimethyl sulfoxide (DMSO) or DMSO alone, and 2 h later subjected to CLP. Survival was monitored for 240 hours. Experiment II: mice treated the same way as Experiment I, were grouped into (i) DMSO vehicle, and (ii) AGK2, with sham mice (operating but without any treatment) serving as controls. Peritoneal fluid and peripheral blood were examined at 24 and 48 hours for cytokine production. Samples of blood at 48 h were also allocated to assess coagulability using Thrombelastography (TEG). Morphological changes of bone marrow were evaluated from long bones (femurs and tibias) with hematoxylin and eosin (H&E) staining. Bone marrow atrophy was quantified by a blinded pathologist. Experiment III: cytokines in supernatant of the cultured normal primary splenocytes were measured after the cells were stimulated by lipopolysaccharide and treated with or without AGK2 (10 µM) for 6 hours. RESULTS: AGK2 significantly reduced mortality and decreased levels of cytokines in blood (TNF-α: 298.3±24.6 vs 26.8±2.8 pg/ml, p=0.0034; IL-6: 633.4±82.8 vs 232.6±133.0 pg/ml, p=0.0344) and peritoneal fluid (IL-6: 704.8±67.7 vs 391.4±98.5 pg/ml, p=0.033) compared to vehicle control. Also, AGK2 suppressed the TNF-α and IL-6 production in the cultured splenocytes (TNF-α: 68.1±6.4 vs 23.9±2.8 pg/ml, p=0.0009; IL-6: 73.1±4.2 vs 49.6±3.0 pg/ml; p=0.0051). The TEG data showed that the mice subjected to CLP displayed prolonged fibrin formation and fibrin cross-linkage time, slower clot formation, decreased platelet function, and clot rigidity. AGK2 treatment was associated with dramatic improvements in fibrin cross-linkage and clot formation times, without a significant impact on the clot initiation parameters or platelet function. Additionally, AGK2 significantly attenuated the bone marrow atrophy (58.3±6.5 vs 30.0±8.2%, p=0.0262). CONCLUSION: Selective inhibition of SIRT2 significantly improves survival, and attenuates sepsis-associated "cytokine storm", coagulopathy, and bone marrow atrophy in a mouse model of lethal septic shock.

Histone cleavage as a mechanism for epigenetic regulation: current insights and perspectives.

Discovered over a century ago, histones constitute one of the oldest families of proteins and have been remarkably conserved throughout eukaryotic evolution. However, only for the past 30 years have histones demonstrated that their influence extends far beyond packaging DNA. To create the various chromatin structures that are necessary for DNA function in higher eukaryotes, histones undergo posttranslational modifications. While many such modifications are well documented, others, such as histone tail cleavage are less understood. Recent studies have discovered several proteases that cleave histones and have suggested roles for clipped histones in stem cell differentiation and aging in addition to infection and inflammation; the underlying mechanisms, however, are uncertain. One histone class in particular, histone H3, has received outstanding interest due to its numerous N-terminal modification sites and prevalence in regulating homeostatic processes. Here, with special consideration of H3, we will discuss the novel findings regarding histone proteolytic cleavage as well as their significance in the studies of immunology and epigenetics.

Clinical significance of aberrant vimentin expression in oral premalignant lesions and carcinomas.

OBJECTIVE: To investigate the clinical significance of vimentin expression at early and late events of tobacco/areca nut-associated oral tumorigenesis. MATERIALS AND METHODS: Immunohistochemistry (IHC) was carried out on paraffin-embedded tissues of oral mucosa normal (n = 10), inflammatory lesions (n = 19), leukoplakia (n = 52), submucous fibrosis (n = 71) and tumours/cut margins (n = 227 each), using anti-vimentin antibody, and the expression profile was correlated with patients' clinical parameters. Immunofluorescence, Western blot and RT-PCR analysis were also carried out wherever adequate and fresh tissues were available. RESULTS: Aberrant vimentin expression was seen in hyperplastic, dysplastic and fibrotic tissues, which showed statistically significant correlation with the histopathological grade of dysplasia (P = 0.001) and fibrosis (P = 0.009). Vimentin expression also showed statistically significant correlation with tumour size (P = 0.048), clinical stage (P = 0.013), regional lymph node metastases (P = 0.001), local recurrence (P = 0.001) and survival (P = 0.021) of patients with oral squamous cell carcinoma (OSCC). Its expression in invasive fronts statistically correlated with development of nodal metastasis and local recurrence. CONCLUSIONS: Our results suggest possible role of vimentin in early events of tobacco/areca nut-associated oral tumorigenesis, which may prove useful to predict the malignant potential of high-risk oral lesions. Further, association between vimentin expression in invasive fronts and aggressive phenotype of tumours may help clinicians to choose the appropriate treatment modality for OSCC management.

Translational barriers and opportunities for emergency preservation and resuscitation in severe injuries.

BACKGROUND: Hypothermia is commonly used for organ and tissue preservation in multiple clinical settings, but its role in the management of injured patients remains controversial. There is no doubt that temperature modulation is a powerful tool, and hypothermia has been shown to protect cells during ischaemia and reperfusion, decrease organ damage and improve survival. Yet hypothermia is a double-edged sword: unless carefully managed, its induction can be associated with a number of complications. METHODS: A literature review was performed to include important papers that address the impact of hypothermia on key biological processes, and explore the potential therapeutic role of hypothermia in trauma/haemorrhage models. RESULTS: No clinical studies have been conducted to test the therapeutic benefits of hypothermia in injured patients. However, numerous well designed animal studies support this concept. Despite excellent preclinical data, there are several potential barriers to translating hypothermia into clinical practice. CONCLUSION: Therapeutic hypothermia is a promising life-saving strategy. Appropriate patient selection requires a thorough understanding of how temperature modulation affects various biological mechanisms.

Fifty-four emergent cricothyroidotomies: are surgeons reluctant teachers?

BACKGROUND: Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that, although most cricothyroidotomies occur in the emergency department (ED), they are rarely performed by EM physicians. METHODS: We conducted a retrospective analysis of all emergent cricothyroidotomies performed at two large level one trauma centers over 10 years. Operators and assistants for all procedures were identified, as well as mechanism of injury and patient demographics were examined. RESULTS: Fifty-four cricothyroidotomies were performed. Patients were: mean age of 50, 80% male and 90% blunt trauma. The most common primary operator was a surgeon (n = 47, 87%), followed by an Emergency Medical Services (EMS) provider (n = 6, 11%) and a EM physician (n = 1, 2%). In all cases, except those performed by EMS, the operator or assistant was an attending surgeon. All EMS procedures resulted in serious complications compared to in-hospital procedures (p < 0.0001). CONCLUSIONS: 1. Pre-hospital cricothyroidotomy results in serious complications. 2. Despite the ubiquitous presence of emergency medicine physicians in the ED, all crico-thyroidotomies were performed by a surgeon, which may represent a serious emergency medicine training deficiency.

Status of HIV infection among the pregnant women attending in outpatient department.

Human immunodeficiency virus (HIV) infection has been spreading rapidly in the developing countries and vertical transmission also taking place. This study has been done to find out the prevalence of HIV infection among the pregnant women, so that necessity of routine screening test can be identified. It is a cross sectional study. Five hundred two pregnant women were included. Three ml venous blood was taken and then HIV screening test was done by ELISA method. All reactive tests were confirmed by Western blot antibody testing. The positive cases were followed up and necessary treatment was given. Delivery was conducted in this hospital. Baby's blood was tested to see vertical transmission after 18 months. Most of the subject were educated housewife, mean age was 25 years. Six (6%) husband was overseas service holder, 12% were smoker and 1.6% had drug addiction. Eight (8%) subject had previous history of blood transfusion and 49% subject or her husband had history of surgery or got parental therapy. 2% subject gave the history of familial disharmony and 2% had multiple sex partners. HIV infection was found in 2 patients (0.4%). Both of them got infection from their husband. One husband was over seas service holder and another one was injecting drug user. For the prevention of spread, reduction of vertical transmission and providing early management to the positive patient all pregnant women should be screened for HIV routinely.

Characteristics of infertile couples.

The objective of the study was to evaluate the sociodemographic characteristics and to find out the causes of infertility among the couple attending out patient department of infertility unit in Bangabandhu Sheikh Mujib Medical University (BSMMU) from January to December 2007. This is a descriptive observational study. Data were analyzed done manually and statistical analysis was calculated by Statistical package for social sciences (SPSS) program. During this period 3184 patients were attended out patient department (OPD) of infertility unit (IU-I & II). Among them primary infertility was present in 1971(61.90%) and secondary infertility in 1213(38%) cases. One thousand four hundred and two (1402) patient's complete data were reviewed from OPD register book of IU-I. The mean duration of the infertility was 4.7(4.52) years. The mean age of female patient was 26.5±5.35 years. The mean age of male patient was 34.56±6.33 years. A positive male factor problem alone was found in 13% couples, female factors in 71.46% couples and unexplained infertility in 15.47% couples. Among the male factor Oligozoospermia (33.33%) was the most common cause of male infertility. Anovulation (52.16%) was the most common cause of female infertility and major cause of anovulation was Polycystic ovary syndrome (PCOS) (29.90%). Fibroid uterus, Bilateral tubal block and Pelvic inflammatory disease (PID) were significantly (p<0.001) higher in secondary infertility. Endometriosis and unexplained infertility were significantly (p<0.001) higher in primary infertility. Distribution of other causes of infertility was same for both primary and secondary infertility.

Ethical awareness in surgical management.

Getting information about disease has been suffering, the management needed, procedure and complication of that management, is the right of the patients. Giving that information to the patients is the responsibility of the physician/surgeons. The objective of this study was to assess the existing awareness of the surgeons and female patients regarding ethical issues of medical practices. This observational study was undertaken in the gynecological department of two tertiary hospital of the capital city of Bangladesh. One hundred fifty five patients were interviewed who were underwent surgical management for different gynecological problems. Mean age of the studied population was 41 (SD+/-10) years. All of them were from lower and lower middle economical classes. Sixty three percents (63%) were illiterate. Consent for the surgery was given by the husband in 52% cases, by son in 22% cases, by herself in 1% case and remaining by other relatives. About 50% of the patients did not know the name of their disease, 75% of them never talked with the surgeon. Only in 31% cases surgeon spontaneously explained them about her disease. Most of them had no knowledge about anaesthesia, operating time, need of blood transfusion, operating complications and long-term effects of the surgery they had. The result of this study showed very poor awareness about medical ethics and patient's right.

[The war on (too many) fluids. New horizons in combat medicine]. / Krieg und Flüssigkeitsmanagement. Neue Horizonte.

In the coming years, our approach to the bleeding patient will have to change radically. The inevitable knowledge from the wars in Iraq and Afghanistan permits the prediction that conventional crystalloids will sooner or later disappear from volume replacement therapy. The dogma that fluids must always be given will be abandoned, to be replaced by the practice of careful and goal-directed resuscitation. In the near future, we would rely on designer fluids and sophisticated pharmacological agents to deliver personalized resuscitation based upon the specific needs of the individual patient.

An update on fluid resuscitation.

Hemorrhagic shock is the leading cause of death in civilian and military trauma. Effective hemorrhage control and better resuscitation strategies have the potential of saving lives. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. It is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. It is important to recognize that unlike numerous other variables, resuscitation is completely under our control. We decide who, when and how should get resuscitated. This paper summarizes data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids on cellular injury, and how these relate to clinical practice. In addition, some novel resuscitation strategies are described that may become clinically available in the near future.

Design of preservation solutions for universal tissue preservation in vivo: demonstration of efficacy in preclinical models of profound hypothermic cardiac arrest.

The design of new solutions for the universal preservation of tissues is a quest that would facilitate multiple-organ harvesting from organ donors since current preservation solutions do not provide optimum preservation for all organs. In contrast, a new approach to bloodless surgery using hypothermic blood substitution (HBS) to protect the whole body during profound hypothermic circulatory arrest (clinical suspended animation) has focused on the development of a hybrid solution design with the objective of providing universal tissue preservation. In this study, a porcine model of uncontrolled lethal hemorrhage was employed. A combination of two new solutions, maintenance and purge, was used in a cardiopulmonary bypass (CPB) technique to affect profound hypothermia and prolonged cardiac arrest (60 min), with resuscitation after surgical repair of the vascular deficit induced to affect exsanguination. After rewarming and recovery, pigs were monitored for 6 weeks for neurological deficits, cognitive function (learning new skills), and organ dysfunction. All the normothermic control animals died (n = 10), whereas 90% (9 of 10) in the HBS group survived (P < .05). Moreover, all of the survivors were neurologically intact, displayed normal learning and memory capability, and had no long-term organ dysfunction. Histology of brains after 6 weeks revealed no ischemic damage in marked contrast to control animals, which all showed diffuse ischemic damage. The demonstrated efficacy of these synthetic, acellular HBS solutions for protection of all the tissues in the body during clinical suspended animation justifies their consideration for multiple-organ harvesting from cadaveric and living donors.

Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial.

INTRODUCTION: Clinicians' judgment as to which burns require excision and grafting remains one aspect of burn care without objective measurements. This study presents a prospective, blinded trial to assess decision to operate by laser Doppler imaging (numerical criteria) versus the clinical judgment of an experienced burn surgeon. METHODS: A number of 23 patients were enrolled in this prospective trial and 41 representative wounds of indeterminate depth were selected for observation. Daily determination of need to operate (burn depth) was made by a single burn surgeon. Laser Doppler imager (LDI) scans of the same wounds were simultaneously obtained, and not revealed to the clinician. Data analysis compared quickness of decision to operate by LDI to the clinician's judgment. Concurrence of decisions by either method was compared. RESULTS: A total of 23 patients and 41 wounds were analyzed. LDI and the surgeon agreed in determination of wound depth 56% of the time (23/41, P=0.031). Biopsy confirmation was obtained for 21 wounds. The surgeon's determination of burn depth was accurate in 71.4% of wounds biopsied (15/21). When the LDI scan median flux indicated need for excision, it was 100% accurate (7/7). When both the surgeon and the LDI were correct in assessing wound depth, LDI would have saved median number of 2 days (minimum=0, maximum=4). CONCLUSION: LDI allowed for earlier, objective determination of need to operate. Concurrence with clinical judgment in this blinded study was excellent. LDI should be seen as an effective aid to clinical judgment when contemplating excision of burns with indeterminate depth.

Resuscitation-induced pulmonary apoptosis and intracellular adhesion molecule-1 expression in rats are attenuated by the use of Ketone Ringer's solution.

BACKGROUND: Resuscitation with Lactated Ringer's solution after hemorrhagic shock in rats has been shown to cause early cellular injury in the lung. We hypothesized that the use of energy substrates, such as ketone bodies, in the resuscitation fluids would protect against this injury. As markers of cellular injury we measured the induction of apoptotic cell death and the expression of Intracellular Adhesion Molecule-1 (ICAM-1). STUDY DESIGN: Male Sprague Dawley rats (n = 35) under inhaled isoflurane anesthesia had placement of femoral arterial and venous catheters. A three-stage hemorrhage model was used for this experiment. There was an initial hemorrhage of 27 mL/kg for 10 minutes. During the next 75 minutes another 8 mL/kg of blood was withdrawn at a steady rate. The resuscitation fluids were then infused for 45 minutes during which the third continuous hemorrhage of 8 mL/kg was performed. The animals were randomized to five groups: 1) sham hemorrhage (n = 6); 2) sham resuscitation (n = 7); 3) Lactated Ringer's resuscitation, three times the volume of shed blood (n = 8); 4) Ketone Ringer's (containing 28 mEq/L of beta-hydroxybutyrate) resuscitation, three times the volume of shed blood (n = 7); and 5) plasma resuscitation, volume equal to shed blood (n = 7). The animals were sacrificed 1 hour after resuscitation and lungs were harvested. Western blot technique was used for the determination of proapoptotic protein (bax), antiapoptotic protein (bcl-2), apoptotic fragments of poly ADP-ribose polymerase, and ICAM-1. Sections of lung were also subjected to immunostaining using antibodies to bax and ICAM-1 proteins (reported as number of positive cells/mm2). RESULTS: Lactated Ringer's resuscitation caused a significant increase in pulmonary apoptosis and ICAM-1 expression compared with the sham hemorrhage group. Animals resuscitated with Ketone Ringer's solution and plasma did not show this injury pattern. CONCLUSIONS: Substitution of lactate with ketone bodies in the resuscitation fluid attenuates the expression of cellular injury markers in the lung.

Subchronic toxicity of fish oil concentrates in male and female rats.

There are an overwhelming number of reports indicating the beneficial effects of fish oil supplements in human and animal nutrition. The purpose of this study, second in a series, was to evaluate the effects, particularly those that may be harmful, of high-dose, long-term consumption of fish oil concentrates (FOC) using male and female rats. One hundred and twenty male and 120 female rats were gavaged daily with oils and oil mixtures in a volume equal to 0.5% body weight (5 mL/kg/d) for 13 weeks. The administered oils were corn oil, pure menhaden oil (MO), pure MaxEPA fish oil or different mixtures of corn oil with MO. The stability and the homogeneity of the dosing solutions were tested under study conditions. The animals received isocaloric and isonitrogenous diets throughout. Food and pure water were supplied ad libitum. At the end of the in-life phase of the study, the animals were anaesthetized with CO2 and humanely killed by exsanguination. Blood and other tissues were prepared for various clinical, histopathological and laboratory tests. Some beneficial effects of FOC, such as reduction in total serum cholesterol, in rats were confirmed. However, we also observed a significant reduction in absolute amount of serum HDL and a significant increase in relative liver and spleen weights in both sexes with the high dose of FOC. High doses of FOC (5 mL/kg/d) reduced serum iron and vitamin E concentrations. A reduction in osmotic fragility of RBC as well as an increase in RBC deformity were also observed in rats treated with high doses of FOC. These rats showed a significant overall increase in WBC count. We conclude that in rats, subchronic consumption of high levels of FOC can be beneficial but may also be harmful because of induction of clinical abnormalities including increased red cell deformity, increased relative liver and spleen weights, and reduced serum HDL, iron and vitamin E concentrations.

E- and P-selectin expression depends on the resuscitation fluid used in hemorrhaged rats.

BACKGROUND: E- and P-selectins are adhesion molecules that effect neutrophil-mediated reperfusion injury. Our hypothesis was that the expression of E- and P-selectins is dependent on the type of fluid used for resuscitation and that lactated Ringer's (LR) solution would result in an early upregulation of these molecules. METHODS: Male Sprague-Dawley rats (n = 36) were subjected to a 27 ml/kg hemorrhage over 5 min followed by a 1-h shock period and 1-h of resuscitation. The animals were randomized into the following resuscitation groups: (1) sham; (2) hemorrhage, no resuscitation; (3) whole blood (27 ml/kg); (4) 3:1 lactated Ringer's (81 ml/kg); (5) sham hemorrhage, infusion of lactated Ringer's (81 ml/kg); (6) 7. 5% hypertonic saline (9.7 ml/kg). Immediately after resuscitation, the spleen and lung were harvested for measurement of E- and P-selectin mRNA expression with reverse transcriptase- polymerase chain reaction (RT-PCR), and protein expression with immunostaining. RESULTS: LR resuscitation and LR infusion without prior hemorrhage significantly increased the E- and P-selectin mRNA in the lung and spleen. Immunostaining demonstrated that the adhesion molecule expression was mainly located in perivascular/peribronchial areas in the lung, and the marginal and trabecular areas in the spleen. Pulmonary edema and inflammatory cell infiltration were observed only in the animals that were hemorrhaged and resuscitated with LR. No resuscitation and resuscitation with whole blood caused no significant increase in selectin expression. CONCLUSION: LR resuscitation and LR infusion without hemorrhage are associated with early increased expression of E- and P-selectin molecules in the lung and spleen.

Visceral ischemia after cardiopulmonary bypass.

The diagnosis and management of gastrointestinal complications associated with cardiopulmonary bypass is often hindered by a complicated clinical picture and equivocal examination. To better define the incidence, risk factors, and mortality, we reviewed the records of all patients undergoing cardiopulmonary bypass from 1988 through 1996. The database for this study comprised 14,521 patients who underwent cardiac surgery. The patients (543) with gastrointestinal complications were identified, and those with major complications (166) were individually reviewed. Major complications included pancreatitis, gastritis, laparotomy, gastric ulcer, cholecystitis, colonic perforation, gastrointestinal bleeding, diverticulitis, bowel obstruction, perforation, and visceral ischemia. Our results were the following. 1) Gastrointestinal complications were noted in 3.7 per cent (543) of patients with major complications occurring in 1.2 per cent. In 166 patients, 187 major complications were noted. 2) Visceral ischemia, an infrequent but usually fatal (71%) complication, occurred in 24 (0.17%). 3) Of the ischemic events, 83 per cent (20 of 24) affected the bowel; with the colon involved 80 per cent of the time (16 of 20). 4) Patients with visceral ischemia were more likely to be female (relative risk 2.1), have longer pump times (92.2 versus 74.2), have cardiac procedures other than coronary artery bypass graft (relative risk 2.6), and have end-stage renal disease (relative risk 16.7). We conclude that, given the incidence and mortality related to visceral ischemia, especially to the colon, patients with risk factors (end-stage renal disease, female sex, non-coronary artery bypass graft, and longer pump times) should undergo routine endoscopic examination of the colon early after bypass and when clinically indicated thereafter.

Xenogeneic patch closure of the small intestine: a novel approach to fistula management.

Previous work from our laboratory demonstrated the feasibility of utilizing placental-derived collagen tissue matrix (CTM) as a bowel wall substitute. We reasoned that this technique would also be suitable in managing intestinal fistulae. To test this hypothesis, we created a chronic cecal fistula in rats and randomly managed some with primary repair and others with CTM replacement. Leak rates, mortality, bursting pressures and histologic scores were similar, suggesting that a chronic fistula can be successfully managed with either a CTM or primary repair.