The Impact of Restrictive Versus Conservative Intraoperative Fluid Strategies upon the Renal Outcome in Colorectal Surgeries. A Randomized Controlled Trial

Background: intraoperative fluid handling has a lot of concerns upon the postoperative organ function. One of the most sensitive organs which could be affected is the kidney. Objectives: We conducted this trial to address the impact of restrictive vs. conservative fluid approaches on postoperative renal complications, hemodynamics and hospital stay. Patients and methods: Prospective, randomized, double-blind placebo-controlled trial at Assiut University Hospitals. The study included 60 adult patients with American Society of Anesthesiologists (ASA) grade II-III undergoing elective colorectal surgery with an expected operative duration of at least two hours. Grouping was based upon the intraoperative fluid management Group (R): 6 mL/kg/h. of lactated ringer (LR), Group (C): 12 mL/kg/h. of LR. The preoperative serum Neutrophil gelatinase-associated lipocalin (NGAL) level (basal value) then by the 2nd and 24th postoperative hours, KDIGO (Kidney Disease: Improving Global Outcomes), serum urea and creatinine were documented by the end of 1st and 2nd postoperative days. Intraoperative hypovolemia events were noted as well. Results: serum NGAL has increased >149 ng/mlin three patients within group C, and two patients within group R; however, the difference was statistically insignificant p= 0.5. KDIGO showed significant difference between the two groups, with higher number of patients in the group R with p= 0.043. Serum urea and creatinine, intraoperative hypovolemic episodes showed insignificant differences between groups. Conclusion: no evident difference between restrictive and conservative intraoperative fluid strategies was noticed upon the early postoperative serum NGAL and other systems complications in patients undergoing major colorectal surgeries

Ozonated saline intradermal injection: promising therapy for accelerated cutaneous wound healing in diabetic rats

IntroductionThe use of ozonized water is gaining importance in medicine due to its effects on hyperglycemia and wound healing mechanisms.MethodsThis experiment was conducted to assess the impacts of intradermal administration of ozonated water on acute skin wound healing in a diabetic rat model. Sixty-four adult male Wistar rats were randomly divided into two groups: an ozonated water group (O3W) and a control group (CG). Experimental diabetes was chemically induced in the rats by the intraperitoneal administration of 60 mg/kg streptozotocin. One week later, full-thickness skin surgical wounds (1 cm2) were created between the two shoulders of the rats under general anesthesia. The wounds were then daily irrigated with normal saline (CG) or intradermally injected with 1 mL of ozonated water at 10 mg/L O3W. Wound healing was evaluated through macroscopic analysis, measuring wound size, diameter, and percentage of contraction rate before wounding and at 3, 7, 9, 12, 14, 18, 21, 24, and 28 days post-wounding. On days 7, 14, 21, and 28 after induction of the wounds, the body weights and blood glucose levels of rats (8 per group) were measured before the rats were euthanized. Moreover, the morphological structure of the tissue, vascular endothelial and transforming growth factor (VEGF and TGF) affinity and gene expression were examined.ResultsThe O3W group had significantly lower blood glucose levels and wound size and gained body weight. Additionally, epithelial vascularization, stromal edema, TGF, and VEGF gene expression significantly improved in the O3W group.DiscussionTherefore, ozonated water has the potential to enhance and promote cutaneous wound healing in diabetic rats

Innovative approach: utilizing silver nanoparticles sheet for improved rabbit cecal anastomosis healing

IntroductionAnastomotic leakage is a severe complication associated with gastrointestinal surgery. The process of intestinal wound healing is crucial for the successful outcome of digestive tract surgical repair procedures. This research aimed to determine the impact of silver nanoparticles sheet (Acticoat) on the anastomotic healing of the cecum in rabbits.MethodsA total of 48 New Zealand male rabbits in good health were used for cecum transection and anastomosis. The animals were randomized into the control group (C) and the silver nanoparticles group (AgNPs). In the C group, the transected cecum was end-to-end anastomosed with a single layer of simple continuous suture pattern using 3–0 polyglyconate. In contrast, a silver nanoparticle sheet (Acticoat) was covered around the sutured anastomotic line in the AgNPs group. Postoperatively, abdominal ultrasound imaging and the Bristol Rabbit Pain Score (BRPS) were measured on days 7, 15, and 30. Eight rabbits from each group were euthanized at each time point to assess macroscopic findings, bursting pressure tests, tensile strength tests, histopathological examinations, and immunohistochemical analyses.ResultsThe AgNPs group demonstrated a significant increase in the cecal lumen diameter wall (p ≤ 0.001), burst pressure measurement (p ≤ 0.02), and tensile strength (p ≤ 0.01). Conversely, the AgNPs group had significantly lower BRPS scores (p ≤ 0.01). In addition, histopathological examinations revealed that AgNPs significantly reduced inflammatory cell infiltration (neutrophils and macrophages) and enhanced collagen deposition. Immunohistochemical analyses revealed a significant increase (p ≤ 0.01) of α-SMA and a reduction of CD31 in the anastomotic tissue of the AgNPs group.DiscussionThe results of the present study indicate that the utilization of the AgNPs sheet (Acticoat®) effectively enhanced the strength of cecum anastomosis, resulting in a reduction in anastomosis leakages, pain scores, and abdominal adhesions. Additionally, the bursting pressure values in the rabbit model were significantly increased

Farm and animal-level risk factors associated with rectal prolapse in bovine and buffalo calves in Egypt with special reference to the optimal treatment strategy

Background: Rectal prolapse (RP) is a serious illness of the rectum and small intestine causing serious health problems in domestic animals. However, there is paucity in the estimation of the risk factors associated with this problem in calves.Aim: In the present study, we investigated the prevalence and risk factors associated with the rectal prolapse in both bovine and buffalo calves in Egypt, highlighting the most appropriate treatment strategy.Methods: Forty-two calves (23 bovine and 19 buffalo) suffering from varying degrees of rectal prolapse were used. From the owners’ anamnesis, the farm- and animal-level risk factors associated with each animal were collected. Fisher’s exact tests were used to determine the distribution of frequencies in the different rectal prolapse grades. Descriptive statistics were calculated in the form of mean ± standard deviation (SD) using one-way analysis of variance. Crosstabs were used to determine Spearman’s correlation between variables. According to the disease severity, the appropriate treatment strategy was accomplished either by medicinal or surgical interferences.Results: The final logistic regression form demonstrated that the statistical test, Hosmer and Lemeshow’s goodness of fit, indicates a significant result (χ2 = 8.91). Body score was the potential risk factor for the occurrence of RP in calves. Medicinal management along with dietary modification was sufficient to treat 70% of grade I in a successful manner, while 33.3% (grade I and grade II) were effectively treated surgically with reduction and application of purse-string sutures.Conclusion: The current study advocates the valid role of resection of rectal mucosa combined with manual reduction and retention in treating calves suffering from grade II rectal prolapse. The final multivariate logistic regression model indicates that the calf’s body score is a potential risk factor for the occurrence of RP