Effects of Enteromorpha prolifera polysaccharides on growth performance,intestinal barrier function and cecal microbiota in yellow-feathered broilers under heat stress

Background Global warming leading to heat stress(HS)is becoming a major challenge for broiler production.This study aimed to explore the protective effects of seaweed(Enteromorpha prolifera)polysaccharides(EPS)on the intestinal barrier function,microbial ecology,and performance of broilers under HS.A total of 144 yellow-feathered broilers(male,56 days old)with 682.59±7.38 g were randomly assigned to 3 groups:1)TN(thermal neutral zone,23.6±1.8℃),2)HS(heat stress,33.2±1.5℃ for 10 h/d),and 3)HSE(HS+0.1%EPS).Each group contained 6 replicates with 8 broilers per replicate.The study was conducted for 4 weeks;feed intake and body weights were measured at the end of weeks 2 and 4.At the end of the feeding trial,small intestine samples were collected for histomorphology,antioxidant,secretory immunoglobulin A(s Ig A)content,apoptosis,gene and protein expression analysis;cecal contents were also collected for microbiota analysis based on 16S r DNA sequencing.Results Dietary EPS promoted the average daily gain(ADG)of broilers during 3–4 weeks of HS(P<0.05).At the end of HS on broilers,the activity of total superoxide dismutase(T-SOD),glutathione S-transferase(GST),and the content of s Ig A in jejunum were improved by EPS supplementation(P<0.05).Besides,dietary EPS reduced the epithelial cell apoptosis of jejunum and ileum in heat-stressed broilers(P<0.05).Addition of EPS in HS group broilers'diet upregulated the relative m RNA expression of Occludin,ZO-1,γ-GCLc and IL-10 of the jejunum(P<0.05),whereas downregulated the relative m RNA expression of NF-κB p65,TNF-αand IL-1βof the jejunum(P<0.05).Dietary EPS increased the protein expression of Occludin and ZO-1,whereas it reduced the protein expression of NF-κB p65 and MLCK(P<0.01)and tended to decrease the protein expression of TNF-α(P=0.094)in heat-stressed broilers.Furthermore,the proportions of Bacteroides and Oscillospira among the three groups were positively associated with jejunal apoptosis and pro-inflammatory cytokine expression(P<0.05)and negatively correlated with jejunal Occludin level(P<0.05).However,the proportions of Lactobacillus,Barnesiella,Subdoligranulum,Megasphaera,Collinsella,and Blautia among the three groups were positively related to ADG(P<0.05).Conclusions EPS can be used as a feed additive in yellow-feathered broilers.It effectively improves growth performance and alleviates HS-induced intestinal injury by relieving inflammatory damage and improving the tight junction proteins expression.These beneficial effects may be related to inhibiting NF-κB/MLCK signaling pathway activation and regulation of cecal microbiota.

Dietary supplementation of bilberry anthocyanin on growth performance,intestinal mucosal barrier and cecal microbes of chickens challenged with Salmonella Typhimurium

Background Anthocyanins(AC)showed positive effects on improving the intestinal health and alleviating intestinal pathogen infections,therefore,an experiment was conducted to explore the protective effects of supplemented AC on Salmonella-infected chickens.Methods A total of 240 hatchling chickens were randomly allocated to 4 treatments,each with 6 replicates.Birds were fed a basal diet supplemented with 0(CON,and ST),100(ACL)and 400(ACH)mg/kg of AC for d 60,and orally challenged with PBS(CON)or 10^(9) CFU/bird(ST,ACL,ACH)Salmonella Typhimurium at d 14 and 16.Results(1)Compared with birds in ST,AC supplementation increased the body weight(BW)at d 18 and the average daily gain(ADG)from d 1 to 18 of the Salmonella-infected chickens(P<0.05);(2)AC decreased the number of Salmonella cells in the liver and spleen,the contents of NO in plasma and inflammatory cytokines in ileal mucosa of Salmonella-infected chickens(P<0.05);(3)Salmonella infection decreased the ileal villi height,villi height to crypt depth(V/C),and the expression of zonulaoccludins-1(ZO-1),claudin-1,occludin,and mucin 2(MUC2)in ileal mucosa.AC supplementation relieved these adverse effects,and decreased ileal crypt depth(P<0.05);(4)In cecal microbiota of Salmonella-infected chickens,AC increased(P<0.05)the alpha-diversity(Chao1,Pd,Shannon and Sobs indexes)and the relative abundance of Firmicutes,and decreased(P<0.05)the relative abundance of Proteobacteria and Bacteroidota and the enrichment of drug antimicrobial resistance,infectious bacterial disease,and immune disease pathways.Conclusions Dietary AC protected chicken against Salmonella infection via inhibiting the Salmonella colonization in liver and spleen,suppressing secretion of inflammatory cytokines,up-regulating the expression of ileal barrier-related genes,and ameliorating the composition and function of cecal microbes.Under conditions here used,100 mg/kg bilberry anthocyanin was recommended.

Effect of replacement of soybean oil by Hermetia illucens fat on performance,digestibility,cecal microbiome,liver transcriptome and liver and plasma lipidomes of broilers

Background In contrast to protein-rich insect meal,the feed potential of insect fat is generally less explored and knowledge about the suitability of insect fat as a fat source specifically in broiler diets is still limited.In view of this,the present study aimed to comprehensively investigate the effect of partial(50%) and complete replacement of soybean oil with insect fat from Hermetia illucens(HI) larvae in broiler diets on performance,fat digestibility,cecal microbiome,liver transcriptome and liver and plasma lipidomes.Thus,100 male,1-day-old Cobb 500 broilers were randomly assigned to three groups and fed three different diets with either 0(group HI-0,n cens(HI) larvae fat for 35 d.= 30),2.5%(group HI-2.5,n %(HI-5.0,n = 35) or 5.0= 35) Hermetia illuResults Body weight gain,final body weight,feed intake,and feed:gain ratio during the whole period and apparent ileal digestibility coefficient for ether extract were not different between groups.Cecal microbial diversity did not differ between groups and taxonomic analysis revealed differences in the abundance of only four low-abundance bacterial taxa among groups;the abundances of phylum Actinobacteriota,class Coriobacteriia,order Coriobacteriales and family Eggerthellaceae were lower in group HI-5.0 compared to group HI-2.5(P < 0.05).Concentrations of total and individual short-chain fatty acids in the cecal digesta were not different between the three groups.Liver transcriptomics revealed a total of 55 and 25 transcripts to be differentially expressed between groups HI-5.0 vs.HI-0 and groups HI-2.5 vs.HI-0,respectively(P < 0.05).The concentrations of most lipid classes,with the exception of phosphatidylethanolamine,phosphatidylglycerol and lysophosphatidylcholine in the liver and cholesterylester and ceramide in plasma(P < 0.05),and of the sum of all lipid classes were not different between groups.Conclusions Partial and complete replacement of soybean oil with HI larvae fat in broiler diets had no effect on growth performance and only modest,but no adverse effects on the cecal microbiome and the metabolic health of broilers.This suggests that HI larvae fat can be used as an alternative fat source in broiler diets,thereby,making broiler production more sustainable.

Cecal microbiota transplantation:unique influence of cecal microbiota from divergently selected inbred donor lines on cecal microbial profile,serotonergic activity,and aggressive behavior of recipient chickens

Background Accumulating evidence from human trials and rodent studies has indicated that modulation of gut microbiota affects host physiological homeostasis and behavioral characteristics.Similarly,alterations in gut micro-biota could be a feasible strategy for reducing aggressive behavior and improving health in chickens.The study was conducted to determine the effects of early-life cecal microbiota transplantation(CMT)on cecal microbial composi-tion,brain serotonergic activity,and aggressive behavior of recipient chickens.Methods Chicken lines 63 and 72 with nonaggressive and aggressive behavior,respectively,were used as donors and a commercial strain Dekalb XL was used as recipients for CMT.Eighty-four 1-d-old male chicks were randomly assigned to 1 of 3 treatments with 7 cages per treatment and 4 chickens per cage(n=7):saline(control,CTRL),cecal solution of line 6_(3)(6_(3)-CMT),and cecal solution of line 7_(2)(7_(2)-CMT).Transplantation was conducted via oral gavage once daily from d 1 to 10,and then boosted once weekly from week 3 to 5.At weeks 5 and 16,home-cage behavior was recorded,and chickens with similar body weights were assigned to paired aggression tests between the treat-ments.Samples of blood,brain,and cecal content were collected from the post-tested chickens to detect CMT-induced biological and microbiota changes.Results 63-CMT chickens displayed less aggressive behavior with a higher hypothalamic serotonergic activity at week 5.Correspondingly,two amplicon sequence variants(ASVs)belonging to Lachnospiraceae and one Ruminococ-caceae UCG-005 ASV were positively correlated with the levels of brain tryptophan and serotonin,respectively.7_(2)-CMT chickens had lower levels of brain norepinephrine and dopamine at week 5 with higher levels of plasma serotonin and tryptophan at week 16.ASVs belonging to Mollicutes RF39 and GCA-900066225 in 7_(2)-CMT chickens were nega-tively correlated with the brain 5-hydroxyindoleacetic acid(5-HIAA)at week 5,and one Bacteroides ASV was negatively correlated with plasma serotonin at week 16.Conclusion Results indicate that CMT at an early age could regulate aggressive behavior via modulating the cecal microbial composition,together with central serotonergic and catecholaminergic systems in recipient chickens.The selected CMT could be a novel strategy for reducing aggressive behavior through regulating signaling along the microbiota-gut-brain axis.

Acute appendicitis following endoscopic mucosal resection of cecal adenoma

Endoscopic mucosal resection(EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right-lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm3, a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/d L, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

Suspected uncomplicated cecal diverticulitis diagnosed by imaging:Initial antibiotics vs laparoscopic treatment

AIM:To compare the recurrence rate following initial antibiotic management to that following laparoscopic treatment for suspected uncomplicated cecal diverticulitis. METHODS: We examined the records of 132 patients who were diagnosed with uncomplicated cecal diverticulitis and a first attack during an 8-year period. The diagnosis of uncomplicated diverticulitis was made based on imaging findings, such as inflamed diverticulum or a phlegmon with cecal wall thickening. Concurrent appendiceal dilatation from 8 to 12 mm was observed in 36 patients (27%). One hundred and two patients were treated initially with antibiotics only, whereas 30 underwent laparoscopic treatment, including partial cecectomy (n=8) or appendectomy with diverticulectomy (n=9) or appendectomy alone (n =13). We compared clinical outcomes in both groups over a median follow-up period of 46 mo. RESULTS: All patients were successfully treated with initial therapy. Of the 102 patients who initially received only antibiotic treatment, 6 (6%) had a recurrence (3 in the cecum and 3 in the ascending colon or transverse colon) during the follow-up period. Five of these pa-tients were managed with repeated antibiotic treatmentand 1 underwent ileocolic resection for perforation. Of the 30 patients treated by the laparoscopic approach, 2 (7%) had a recurrence (ascending colon) which was treated with antibiotics. CONCLUSION: Initial antibiotic management for suspected uncomplicated cecal diverticulitis showed comparable effi cacy to laparoscopic treatment in the prevention of recurrence.

Predictors for difficult cecal insertion in colonoscopy: The impact of obesity indices

AIM To identify the factors influencing cecal insertion time(CIT) and to evaluate the effect of obesity indices on CIT. METHODS We retrospectively reviewed the data for participants who received both colonoscopy and abdominal computed tomography(CT) from February 2008 to May 2008 as part of a comprehensive health screening program. Age, gender, obesity indices [body mass index(BMI), waist-to-hip circumference ratio(WHR), waist circumference(WC), visceral adipose tissue(VAT)volume and subcutaneous adipose tissue(SAT) volume on abdominal CT], history of prior abdominal surgery, constipation, experience of the colonoscopist, quality of bowel preparation, diverticulosis and time required to reach the cecum were analyzed. CIT was categorized as longer than 10 min(prolonged CIT) and shorter than or equal to 10 min, and then the factors that required a CIT longer than 10 min were examined.RESULTS A total of 1678 participants were enrolled. The mean age was 50.42 ± 9.931 years and 60.3% were men. The mean BMI, WHR, WC, VAT volume and SAT volume were 23.92 ± 2.964 kg/m2, 0.90 ± 0.076, 86.95 ± 8.030 cm, 905.29 ± 475.220 cm3 and 1707.72 ± 576.550 cm3, respectively. The number of patients who underwent abdominal surgery was 268(16.0%). Colonoscopy was performed by an attending physician alone in 61.9% of cases and with the involvement of a fellow in 38.1% of cases. The median CIT was 7 min(range 2-56 min, IQR 5-10 min), and mean CIT was 8.58 ± 5.291 min. Being female, BMI, VAT volume and involvement of fellow were significantly associated with a prolonged CIT in univariable analysis. In multivariable analysis, being female(OR = 1.29, P = 0.047), lower BMI(< 23 kg/m2)(OR = 1.62, P = 0.004) or higher BMI(≥ 25 kg/m2)(OR = 1.80, P < 0.001), low VAT volume(< 500 cm3)(OR = 1.50, P = 0.013) and fellow involvement(OR = 1.73, P < 0.001) were significant predictors of prolonged CIT. In subgroup analyses for gender, lower BMI or higher BMI and fellow involvement were predictors for prolonged CIT in both genders. However, low VAT volume was associated with prolonged CIT in only women(OR = 1.54, P = 0.034).CONCLUSION Being female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases

AIM:To investigate the efficacy of cap-fitted colonoscopy(CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010.Colonoscopies were conducted by a single endoscopist.Patient characteristics including age,sex,body mass index,history of abdominal surgery,quality of preparation,and the presence of diverticulosis were recorded.RESULTS:One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC(NCF) group.Cecal intubations were achieved in all patients.Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions:age ≥ 60 years,prior abdominal surgery,and poor bowel preparation.The number of detected adenomas was higher in the CFC group than in the NCF group(P = 0.040).CONCLUSION:CFC facilitated shortening of the cecal intubation time in difficult cases,and was more sensitive for detecting adenomas than was NCF.

Effects of soybean meal replacement with fermented alfalfa meal on the growth performance,serum antioxidant functions,digestive enzyme activities,and cecal microflora of geese

Fermented forages are important feedstuffs. Bacillus subtilis inoculants are often used to improve the value of forage legume fermentation. The present work was conducted to study the effects of replacing soybean meal with solid-state fermented alfalfa meal（FAM） with B. subtilis ACCC 01746 on growth performance, serum antioxidant and digestive enzyme activities, and cecal microflora in goose. 300 healthy geese with similar body weights were randomly assigned to six treatment groups with five replicates of 10 geese（five males and five females） each. Geese were fed ad libitum for 35 days. Results showed that the geese fed with 4 and 8% FAM exhibited no significant effects on their final body weights（FBW） and average day gain（ADG）（P〉0.05）, whereas 12% or higher FAM caused poor growth of the geese compared with control diet（linear（L）： P〈0.05）. The average daily feed intake（ADFI）（quadratic（Q）： P〈0.05） and feed conversion ratio（FCR）（L： P〈0.05） with 8% or higher supplementation level were higher than those of the control group. The activities of antioxidant enzyme in serum increased, and the level of malondialdehyde（MDA） significantly decreased with increasing dietary FAM level（L： P〈0.05）. However, no significant differences were observed at 8% or lower supplementation level for glutathione peroxidase（GSH-Px） and superoxide dismutase（SOD）（P〉0.05） and at 4% for catalase（CAT） supplementation level compared with the control group. All diets containing FAM increased digestive enzyme activities in geese. However, geese fed diets with 12% FAM supplementation showed the highest trypsin activities in pancreas（Q： P〈0.05）. Supplementation with 12% or higher FAM significantly increased amylase activities in pancreas（L： P〈0.05） and duodenum（L： P〈0.05） compared with the control group. Significant differences were not observed in total anaerobic bacteria between geese fed with FAM and control diets on day 35（P〉0.05）. The numbers of Bifidobacterium and Lactobacillus in the cecum of geese fed with FAM significantly increased（L： P〈0.05）, but no significant effects were found with 4 and 8% FAM supplementation levels compared with the control（P〉0.05）. By contrast, the coliform counts of cecum decreased with increasing inclusion of FAM, but these counts were significantly reduced in geese fed diets with 12% or higher FAM supplementation level（L： P〈0.05）. Collectively, our results indicated that supplementation of the basal geese diet with 8% FAM had no apparent adverse effects on growth performance, serum antioxidant enzyme activities, and digestive parameters and beneficial microbiota.

Oral administration of Moringa oleifera leaf powder relieves oxidative stress,modulates mucosal immune response and cecal microbiota after exposure to heat stress in New Zealand White rabbits

Background:Heat stress(HS)disrupts the gut barrier allowing the uptake of lipopolysaccharide(LPS)and leads to an inflammatory response and changes in gut microbiota composition.Moringa oleifera leaf powder(MOLP)has been proposed to combat HS,yet its alleviate role is currently under investigation.The current study investigated the effects of chronic HS and MOLP supplementation on changes in redox status and immune response of cecal mucosa along with alteration in cecal microbiota.Methods:A total of 21 young New Zealand White(NZW)rabbits(male)about 32 weeks old(mean body weight of 3318±171 g)reared on a commercial pelleted diet were employed;divided into three groups(n=7):control(CON,25°C),heat stress(HS,35°C for 7 h daily),and HS supplemented orally with MOLP(HSM,35°C)at 200 mg/kg body weight per day for 4 weeks.Results:The results demonstrated that MOLP supplementation increased organ index of cecal tissue compared with the HS group(P>0.05).Levels of malonaldehyde(MDA)and activity of superoxide dismutase(SOD)as well as lactate dehydrogenase(LDH)were reduced in the cecal mucosa of the HSM group compared with the HS group.MOLP downregulated the contents of cecal mucosa LPS,several inflammatory markers(TNF-α/IL-1α/IL-1β),and myeloperoxidase(MPO)in the HSM group(P<0.05).Secretory immunoglobulin A(SIgA)was increased in the HSM group compared with the HS group(P<0.05).The transcriptome of cecal mucosa showed that MOLP reduced gene expression relative to several immune factors,including IL-10,IFNG,and RLA,whereas both HS and MOLP increased the gene expression of fat digestion and absorption pathway,including APOA1,FABP1,FABP2,MTTP,andLOC100344166,compared to the CON group(P<0.001).At the phylum level,the relative abundance of Proteobacteria was increased by HS,while Actinobacteria was significantly increased by HSM compared to other groups(P<0.05).At genus level,Papillibacter was higher in abundance in HSM groups compared to CON and HS groups(P<0.05).Higher butyrate concentrations were observed in the HSM group than HS and CON groups(P<0.05).Conclusion:In conclusion,HS in growing rabbits resulted in alteration of cecal microbiota at phyla level as well as increased oxidative stress and expression of mucosal inflammatory genes.Whereas,oral MOLP supplementation elevated the relative weight of cecum,affected their immunological and cecal micro-ecosystem function by improving antioxidant status and down-regulating mucosal tissue inflammatory response.

Cecal bascule herniation into the lesser sac

Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis,and surgical management of this uncommon condition.A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow.Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection.Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.

Ganjiang granule regulates cecal microflora and serum biochemical components in a rat model of constipation-predominant irritable bowel syndrome

Objective:To investigate the effects of Ganjiang granule(GG)on cecal microflora and serum biochemical components in rats with constipation-predominant irritable bowel syndrome(IBSeC).Methods:Twenty-four SpragueeDawley rats were randomly divided into four groups:control,model,GG,and probiotics.Rats in the model,GG,and probiotics groups received 3℃ tap water intragastrically;rats in the GG group were treated with GG;rats in the probiotics group were treated with probiotics.For all rats,enzyme-linked immunosorbent assay and colorimetry were used to assess serum biochemical components related to gastrointestinal function;16S rRNA high-throughput sequencing was used to analyze the cecal microflora.Results:The serum level of 5-hydroxytryptamine(HT)was higher in the model group than in the control group(Z=-2.082,P=.037).The model group exhibited changes in cecal microflora:the relative abundances of Lactobacillus decreased(Z=-2.882,P=.004)and Dorea increased(t=-3.030,P=.023),compared with the control group.The GG and probiotics groups exhibited normal serum levels of 5-HT.The GG and probiotics groups exhibited improved serum levels of gastrin;the probiotics group exhibited an improved serum level of vasoactive intestinal peptide.Compared with the model group,The GG group exhibited greater relative abundance of Ruminococcus(Z=-2.402,P=.016);the probiotics group exhibited greater relative abundance of SMB53(Z=-2.823,P=.005)and lower relative abundances of Desulfovibrio(Z=-2.823,P=.005)and Facklamia(Z=-2.608,P=.009).Conclusion:The effects of GG on IBS-C may be related to regulation of the serum level of 5-HT,as well as elevated relative abundance of beneficial bacteria in cecal microflora.

“Passive-bending colonoscope”significantly improves cecal intubation in difficult cases

Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and shortens.While non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of pain.Most of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the colon.The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope.The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain.The "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort.Therefore,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.

Novel isolated cecal pouch model for endoscopic observation in rats

AIM:To create a new rat model for drug administration,cell transplantation,and endoscopic examination for the treatment of intestinal diseases.METHODS:F344/NJc l-rnu/rnu rats(10-wk-old males,350-400 g) were used in this study.The rats were anesthetized via 2% isoflurane inhalation.The rat's cecum was isolated from the intestines,and a pouch was created.The remainder of the intestines was rejoined to create an anastomosis.The "side-to-side" anastomosis(SSA) technique initially involves the creation of a 2-cm longitudinal incision into each intestinal wall.To create an anastomosis along the ileal and colonic walls,both intestines were cut,and a continuous suture procedure was performed that included all layers of both intestines.The serous membrane was sutured along the edge and on the anterior wall of the anastomosis.The "end-toend" anastomosis(EEA) technique was compared with the SSA technique.In the EEA technique,the frontal surfaces of both cut intestinal lumens were joined together by continuous sutures.Additional sutures were made at the serosa.After the anastomotic intestine was successfully constructed,the two intestinal lumens that were cut at the isolated cecum were managed.In addition,one luminal side of the pouch remained open to create an artificial anus on the dorsum as a passage for the residual substances in the pouch.Finally,small animal endoscopy was used to observe the inside of the pouch.RESULTS:In this animal model,mucus and feces are excreted through the reconstructed passage.Accordingly,the cecal pouch mucosa was not obstructed or contaminated by feces,thus facilitating observations of the luminal surface of the intestine.The endoscopic observation of the cecal pouch provided clear visualization given the absence of feces.The membrane surface of the cecum was clearly observed.Two methods of creating an anastomotic intestine,the "SSA" and "EEA" techniques,were compared with regard to animal survival rate,complication rate,and operation time.The SSA technique resulted in a significantly increased survival rate and a lower incidence of complications in rat models compared with the EEA technique.The complications of stenosis and leakage resulted in death in the EEA technique.Thus,the EEA technique exhibited a lower survival rate compared with the SSA technique.However,the SSA technique required a significantly longer operation time compared with the EEA technique.CONCLUSION:Our new rat model is potentially useful for the development of a novel treatment for intestinal diseases.

Contained colonic perforation due to cecal retroflexion

Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain.

Adult intussusception with cecal adenocarcinoma:Successful treatment by laparoscopy-assisted surgery following preoperative reduction

We report a case of adult intussusception caused by cecal adenocarcinoma that was treated by laparoscopyassisted ileocecal resection following reduction by contrast enema and preoperative colonoscopy.A 68-yearold male with cecal cancer was admitted to our hospital because of colicky abdominal pain after taking a laxative.His abdomen was distended,and a mass was palpable in the right upper quadrant,which appeared as a target-or sausage-shaped lesion by ultrasonograhpy and computed tomography.A contrast enema using water-soluble material showed a cup-shaped filling defect characterized by intussusception in the ascending colon.This round defect with a clear margin was pushed gradually back into the cecum by the enema pressure.Re-occurrence of the intussusception is easilyreleased by colonoscopy.We performed laparoscopyassisted ileocecal resection of a protruding tumor measuring 6.5 cm × 5.0 cm × 3.5 cm from the cecum,with D3 lymph node dissection.Histological examination revealed a well-differentiated adenocarcinoma that had invaded the serosa without permeating the lymphatic or venous capillaries,as well as lymph node metastasis.The postoperative course was uneventful,and the patient has been well without evidence of disease recurrence for 5 years following the operation.Preliminary reduction of adult colonic intussusception before surgical resection is therefore an option in cases of an early and correct diagnosis of intussusception.

Cecal lipoma with subclinical appendicitis: A case report

BACKGROUND Colonic lipomas are rare, slow-growing benign tumors. Colonic lipomas are generally asymptomatic and are found incidentally. Although cases of cecal lipoma have been sporadically reported in the literature, the disease has not been systematically reviewed.CASE SUMMARY We present a 44-year-old man who underwent a routine physical check-up during which colonoscopic examination revealed an asymptomatic 1.5-cm cecal mass at the appendiceal orifice. Laparoscopic exploration was performed that also demonstrated a congested and erythematous appendix. En bloc resection of both the cecum and vermiform appendix was performed because of the suspicion of malignancy. Histopathological examination revealed a cecal lipoma composed of mature adipose tissue, and the appendix showed subclinical inflammation.Our procedures and findings were discussed, along with relevant English literature that was retrieved from the PubMed database from 2000 to 2017.Twenty-six cases, including ours, were reported. Consistent with the findings of the literature, it is difficult to obtain a definitive diagnosis by colonoscopic biopsy.CONCLUSION Surgery remains the treatment of choice for this condition. Intraoperative frozen pathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis. The prognosis is generally good, with only one of the 26 reported patients complicated with acute appendicitis, who subsequently succumbed due to severe comorbidities and sepsis.

Effects of Fructooligosaccharides, compared with Direct-Fed Microbial Bacteria,and Zinc Bacitracin on Cecal Microbial Populations and Performance of Broilers

An experiment was conducted to determine the effects of dietary fructooligosaccharides(FOS),compared with direct-fed microbial bacteria(DFM),and zinc bacitracin,on cecal microbial populations and performance of broiler Chickens.One hundred and ninety-two broilers(Avian) were randomly assigned to four groups,with four replicates of 12 birds each.The control group was fed with the basal diet,without any drug additive.FOS,DFM and zine bacitracin was respectively added to the basal diet at the level of 1.5%,800 mg·kg -1 and 300 mg·kg -1 to form the experimental diets.Body weight,feed intake and feed efficiency were measured weekly.The feeding trial started at 1 d and ended at 21 d.At day 14 and day 21,four broilers per group were killed and cecum was taken to determined microflors and pH.The results showed that dietary FOS increased bifidobactrial concentration by 1.75-fold(P<0.05) at 14 d of age and 1.45-fold(P<0.05) at 21 d of age compared with control.FOS had no effect on concnetrations of E.coli and pH.There were no dietary effects of FOS,DFM,and zinc bacitracin on weight gain,feed intake,feed conversion(P>0.05).

Cecal volvulus:Report of a case and review of Japanese literature

A 78-year-old woman presented with fever, severe abdominal pain, and distension.She had been institutionalized for depression and senile dementia.Laboratory examinations disclosed a leucocytosis(WBC:12 500/μL) and elevated levels of serum C-reactive protein(2.8 mEq/L).Diagnosis of acute cecal volvulus was made from a"coffee bean sign"on an abdominal computed tomography and a"beak sign"on a gastrographin enema.An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out.The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution.A review of Japanese literature disclosed that:(1) a marked increase of aged patients with mental disability presenting with cecal volvulus,(2) adoption of ileo-colectomy as the standard surgical procedure, and(3) improved survival of the patients, were observed in the last decade.

Cecal volvulus associated with mobile cecum in Cornelia de Lange syndrome: Report of a case

We report a case of cecal volvulus in an 11-year-old girl who had been diagnosed with Cornelia de Lange syndrome. She had undergone operative fundoplication several years earlier and was referred to our institute for treatment of intestinal obstruction. A severely dilated colon was detected on abdominal roentgenogram, and abdominal CT and colonic enema strongly suggested cecal volvulus. Emergency operation was performed and cecal volvulus with mobile cecum was ascertained;the volvulus was corrected and the mobile cecum was fixed to the peritoneum on the right side. Neurologically handicapped patients sometimes suffer from cecal volvulus, and patients with Cornelia de Lange syndrome are at especially high risk. Moreover, operative fundoplication promotes intestinal dilatation and it may be another risk factor for cecal volvulus.