Herbal extracts modulate the amplitude and frequency of slow waves in circular smooth muscle of mouse small intestine

Background: Herbal preparations like STW 5 (Iberogast(R)) are widely used drugs in the treatment of dyspepsia and motility-related disorders of the gastrointestinal tract. STW 5 is a phytotherapeutic agent consisting of a fixed mixture of 9 individual plant extracts. The electrophysiological mechanisms of action of STW 5 remain obscure. Aim: The aim of the present study was to investigate whether herbal extracts influence electrophysiological parameters of the small intestine. For this purpose, the resting membrane potential (RMP) and the slow wave rhythmicity of smooth muscle cells of mouse small intestine were observed. Methods: Intracellular recordings of smooth muscle cells of the circular muscle layer of mouse small intestine were performed using standard microelectrode techniques. After dissection of the mucosa, the small intestine was placed in an organ bath and a microelectrode was applied on a circular smooth muscle cell. The RMP and the amplitude of slow waves were measured in millivolts. Results: The RMP of smooth muscle cells was - 59 +/- 1.3 mV. This RMP was significantly depolarized by STW 5 ( 9.6 +/- 1.6 mV); the depolarizing effects can be mainly attributed to the constituents of matricariae flos, angelicae radix and chelidonii herba. The basal frequency of small intestinal slow waves was 39.5 +/- 1.4 min(-1) and the amplitude was 23.1 +/- 0.9 mV. STW 5 significantly reduced the amplitude and frequency of the slow waves ( 11.7 +/- 0.8 mV; 33.5 +/- 3.4 min(-1)). This effect on slow waves represents the sum of the effects of the 9 phytoextracts. Whereas angelicae radix and matricariae flos completely blocked slow wave activity, Iberis amara increased the frequency and amplitude, chelidonii herba reduced the frequency and amplitude of the slow waves, mentae piperitae folium reduced the frequency and left amplitude unchanged and liquiritae radix, carvi fructus and melissae folium had no effects. Conclusion: Herbal extracts cause changes in smooth muscle RMP and slow wave rhythmicity, up to reversible abolition, by blockade of large conductance Ca2+ channels and other not yet identified mechanisms. In herbal preparations like STW 5 these effects add up to a total effect and this study indicates that herbal preparations which are widely used in dyspepsia and motility-related disorders have characteristic, reproducible, reversible effects on small intestinal electrophysiology. Copyright (C) 2005 S. Karger AG, Basel

Topical and Systemic Cannabidiol Improves Trinitrobenzene Sulfonic Acid Colitis in Mice

Background/Aims: Compounds of Cannabis sativa are known to exert anti-inflammatory properties, some of them without inducing psychotropic side effects. Cannabidiol (CBD) is such a side effect-free phytocannabinoid that improves chemically induced colitis in rodents when given intraperitoneally. Here, we tested the possibility whether rectal and oral application of CBD would also ameliorate colonic inflammation, as these routes of application may represent a more appropriate way for delivering drugs in human colitis. Methods: Colitis was induced in CD1 mice by trinitrobenzene sulfonic acid. Individual groups were either treated with CBD intraperitoneally (10 mg/kg), orally (20 mg/kg) or intrarectally (20 mg/kg). Colitis was evaluated by macroscopic scoring, histopathology and the myeloperoxidase (MPO) assay. Results: Intraperitoneal treatment of mice with CBD led to improvement of colonic inflammation. Intrarectal treatment with CBD also led to a significant improvement of disease parameters and to a decrease in MPO activity while oral treatment, using the same dose as per rectum, had no ameliorating effect on colitis. Conclusion: The data of this study indicate that in addition to intraperitoneal application, intrarectal delivery of cannabinoids may represent a useful therapeutic administration route for the treatment of colonic inflammation. Copyright (C) 2012 S. Karger AG, Base

Acute Adhesive Small Bowel Obstruction: a Comparative Analysis of Open and Laparoscopic Surgery

Background. Acute adhesive small bowel obstruction (AASBO) is a common surgical emergency requiring immediate interventions. AASBO is a usual indication for both small bowel resection and adhesiolysis. Postoperative adhesions cause 60% of small bowel obstructions.Materials and methods. An analysis of treatment outcomes is presented for 197 acute adhesive small bowel obstruction patients; 63 patients had urgent laparotomy, and 134 were scheduled for laparoscopy. The examination included physical, laboratory, radiological methods (abdominal radiography, ultrasound, CT scan), laparoscopy and intra-abdominal pressure monitoring.Results and discussion. Of 134 patients scheduled for laparoscopic adhesiolysis, only 46.2% had laparoscopy completed, and 53.8% required conversion to laparotomy. The main rationale for conversion were massive adhesions, intraoperative haemodynamic instability, a need for intestinal decompression, as well as rare complications. Laparoscopic operations were reported with the lower vs. laparotomy rates of surgical complications (6.4  vs. 12.69%), mortality (6  vs. 6.3%), shorter hospital stays (6.5 vs. 12 days) and operation times (75 vs. 118 min, respectively).Conclusion. Laparoscopic surgery in acute adhesive small bowel obstruction was feasible in 31.47% patients and in 46.2% — after a diagnostic laparoscopy; however, a thorough patients selection for laparoscopic adhesiolysis is necessary. The first estimated should be the patient’s haemodynamic stability, the severities of condition, adhesions and comorbid cardiorespiratory pathology. Grade I—II adhesions are an indication for laparoscopic surgery

The Molpro quantum chemistry package

Molpro is a general purpose quantum chemistry software package with a long development history. It was originally focused on accurate wavefunction calculations for small molecules but now has many additional distinctive capabilities that include, inter alia, local correlation approximations combined with explicit correlation, highly efficient implementations of single-reference correlation methods, robust and efficient multireference methods for large molecules, projection embedding, and anharmonic vibrational spectra. In addition to conventional input-file specification of calculations, Molpro calculations can now be specified and analyzed via a new graphical user interface and through a Python framework

Острый аппендицит: как часто выполняется «напрасная» аппендэктомия?

   Introduction. At present, medical practice lacks a unifi ed approach to the choice of therapeutic tactics for acute catarrhal appendicitis and therefore lacks understanding of negative appendectomy.   Aim. To study the incidence of negative appendectomy in acute appendicitis. Materials and methods. The methodology involved a retrospective analysis of the results of 1590 appendectomies performed from 2003 to 2005 and a prospective non-randomized study of 1112 patientsfor the period from 2018 to 2019. During the first observation period, the examination included physical and laboratory examinations, and in the second period, Alvaro scoring, ultrasound scan, and videolaparoscopy.   Results and discussion. In the first period, catarrhal forms of appendicitis were reported in 7.82 % of cases, while in the second period — in 3.04 %. The diagnoses were confi rmed pathohistologically in all cases.   Conclusion. No cases of performing negative appendectomy were reported, based on the results of clinical, endoscopic and pathomorphological examinations. However, the ambiguous interpretation of acute catarrhal appendicitis in the national clinical practice guidelines for acute appendicitis does not allow for unambiguous conclusions from the study.   Введение. На сегодня не существует общепринятого подхода в выборе лечебной тактики при остром катаральном аппендиците и, соответственно, понимания так называемой «напрасной» аппендэктомии.   Цель работы. Изучить частоту выполнения т. н. «напрасных» аппендэктомий при остром аппендиците.   Материалы и методы. Проведен ретроспективный анализ результатов 1590 аппендэктомий за 2003–2005 гг. и проспективное нерандомизированное исследование 1112 пациентов за 2018–2019 гг. За первый период наблюдения обследование включало физикальное, лабораторное исследования, во II период обследование по шкале Alvarado, УЗИ, видеолапароскопию.   Результаты и обсуждение. В первый период катаральные формы аппендицита были в 7,82 %, во II — 3,04 %, патогистологически во всех случаях диагнозы были подтверждены.   Заключение. Случаев выполнения «напрасных» аппендэктомий по результатам клинического, эндоскопического и патоморфологического исследований не выявлено, однако неоднозначная трактовка острого катарального аппендицита в национальных клинических рекомендациях по острому аппендициту не позволяет делать однозначные выводы из исследования

Острая спаечная кишечная непроходимость: сравнительный анализ открытых и лапароскопических операций

Background. Acute adhesive small bowel obstruction (AASBO) is a common surgical emergency requiring immediate interventions. AASBO is a usual indication for both small bowel resection and adhesiolysis. Postoperative adhesions cause 60% of small bowel obstructions.Materials and methods. An analysis of treatment outcomes is presented for 197 acute adhesive small bowel obstruction patients; 63 patients had urgent laparotomy, and 134 were scheduled for laparoscopy. The examination included physical, laboratory, radiological methods (abdominal radiography, ultrasound, CT scan), laparoscopy and intra-abdominal pressure monitoring.Results and discussion. Of 134 patients scheduled for laparoscopic adhesiolysis, only 46.2% had laparoscopy completed, and 53.8% required conversion to laparotomy. The main rationale for conversion were massive adhesions, intraoperative haemodynamic instability, a need for intestinal decompression, as well as rare complications. Laparoscopic operations were reported with the lower vs. laparotomy rates of surgical complications (6.4  vs. 12.69%), mortality (6  vs. 6.3%), shorter hospital stays (6.5 vs. 12 days) and operation times (75 vs. 118 min, respectively).Conclusion. Laparoscopic surgery in acute adhesive small bowel obstruction was feasible in 31.47% patients and in 46.2% — after a diagnostic laparoscopy; however, a thorough patients selection for laparoscopic adhesiolysis is necessary. The first estimated should be the patient’s haemodynamic stability, the severities of condition, adhesions and comorbid cardiorespiratory pathology. Grade I—II adhesions are an indication for laparoscopic surgery. Введение. Острая спаечная кишечная непроходимость (ОСКН) является одной из частых причин в экстренной хирургии, требующих выполнения неотложных оперативных вмешательств. ОСКН — наиболее частое показание как для резекции тонкой кишки, так и для адгезиолизиса. В 60 % причиной обструкции тонкой кишки являются послеоперационные спайки.Материалы и методы. Представлен анализ результатов лечения 197 больных с острой спаечной кишечной непроходимостью, из которых 63 пациентам была выполнена экстренная лапаротомия, 134 — планировали лапароскопические операции. В обследовании применяли физикальные, лабораторные, лучевые методы исследования (обзорная рентгенография живота, УЗИ, КТ), лапароскопию, мониторинг внутрибрюшного давления.Результаты и  обсуждение. Из 134  пациентов, запланированных на лапароскопический адгезиолизис, только у 46,2 % операция завершена лапароскопически, в 53,8 % потребовалась конверсия на лапаротомию. Основными причинами конверсии были массивный спаечный процесс, интраоперационная нестабильность гемодинамики, потребность в декомпрессии кишечника, редко — осложнения. При лапароскопических операциях отметили снижение частоты хирургических осложнений по сравнению с лапаротомией (6,4 и 12,69 %), летальности (6 и 6,3 %), сроков госпитализации (6,5 и 12 дней), сокращение продолжительности операций (75 и 118 минут соответственно).Заключение. Хирургическое лечение лапароскопическим методом больных с острой спаечной кишечной непроходимостью возможно у 31,47 % к их общему числу, в 46,2 % — после диагностической лапароскопии, но требуется тщательный отбор больных на лапароскопический адгезиолизис. Прежде всего необходимо оценить тяжесть состояния больных, стабильность гемодинамики, выраженность спаечного процесса и коморбидной кардиореспираторной патологии. Показанием к лапароскопическим операциям является спаечный процесс I– II степени.

TWO-STAGE REOSTEOSYNTHESIS OF TIBIA IN THE PATIENT WITH FRACTURE NON-UNION COMPLICATED BY POSTOPERATIVE OSTEOMYELITIS

The authors present a case report of a patient with pseudarthrosis of the right tibia complicated by chronic postoperative osteomyelitis. The development of the osteomyelitis process is caused by locked intramedullary fixation of the right tibia by a retrograde nail. Unstable fixation led to the development of acute periimplant infection and osteomyelitis.A radical surgical debridement of the focus site of chronic infection was performed by removing locking screws and nail, removal of necrotic bone tissues by handling the tibial medullary cavity by special reamers. The authors used the pulse lavage with active removal of the solution for an additional sterilization of the surgical wound and medullary cavity. A reinforced spacer impregnated with vancomycin and polyvalent bacteriophage was placed in the medullary cavity to ensure local prolonged antimicrobial therapy. Instead of the removed monomer the polyvalent bacteriophage was introduced into the polymer composition including phages against the main infectious agents in patients of traumatology and orthopedics clinic.Three months after the first stage of treatment and stabilization of laboratory parameters the patient was readmitted to the clinic. The second stage of procedure included removal of spacer, closed antegrade locked internal fixation of the right tibia and talus by a nail with an antimicrobial coating of bone cement impregnated with vancomycin and a polyvalent bacteriophage. Antimicrobial coating of the nail was made intraoperatively using an original mold.Two stage procedure allowed to achieve a stable remission of chronic osteomyelitis and stable internal fixation of tibia pseudarthrosis with preservation of the supporting function of the lower limb