Gallbladder perforation with fistulous communication

BACKGROUND The management of gallbladder perforation(GBP)with fistulous communication(Neimeier type I)is controversial.AIM To recommend management options for GBP with fistulous communication.METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines.The search strategy was conducted in Scopus,Web of Science,MEDLINE,and EMBASE(May 2022).Data extraction was obtained for patient characteristics,type of intervention,days of hospitalization(DoH),complications,and site of fistulous communication.RESULTS A total of 54 patients(61%female)from case reports,series,and cohorts were included.The most frequent fistulous communication occurred in the abdominal wall.Patients from case reports/series had a similar proportion of complications between open cholecystectomy(OC)and laparoscopic cholecystectomy(LC)(28.6 vs 12.5;P=0.569).Mortality was higher in OC(14.3 vs 0.0;P=0.467)but this proportion was given by only one patient.DoH were higher in OC(mean 26.3 d vs 6.6 d).There was no clear association between higher rates of complications of a given intervention in cohorts,and no mortality was observed.CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options.OC and LC are adequate options for the surgical management of GBP,with no significant differences.

Effects of Rice Straw Silicification and Characters of Extraction Biogenic Silicon on the Degradation of Fibrous Components in Rice Straw

Straw of seven rice varieties with early-, middle- and late maturity was collected from Huazhong Agricultural University in Hubei. A study was carried out for rice straw in the aspects of the characters of straw silicification and extraction biogenic silica (EBSi), the relationship between characters of EBSi and kinetic characteristics of degradation of fibrous components in fistulated cows, as well as the effect of urea treatment on rice straw desilicification. Although total silica content (ADISi) in rice straw was similar, the efficiency of extraction biogenic silica (EEBSi) and cellulose in early varieties were significantly higher than those in middle (18.9% and 9.1 %) and late ones (26.1% and 11.2%). The degradability of EBSi and cellulose of early varieties were higher than those of middle by 70.0% and 17.5%, and of late varieties by 47.8% and 23.7% , respectively. The in sacco degradability and in vitro VFA production of early varieties were also higher than those of middle by 14.5% and 19.0%, and late by 12.9% and 14.8%. Comparing the morphological fractions of the rice straws, EEBSi, cellulose content, and in vitro VFA production were different with the order of blade < sheath < stem. A significant correlation was found between the contents of EBSi and cellulose (r= 0.86), and the two contents were remarkably correlated with the potential straw degradability (a + b) by r = 0.90 and 0.84 respectively. Therefore, EBSi in rice straw was a main factor affecting the potential degradability of rice straw, rather than the ADISi of straw. Urea treatment improved rice straw degradability, degradation rate and potential degradability by 10.8% , 27.9% , and 10.1% respectively, compared to untreated straws.

One more chance of fistula healing in inflammatory bowel disease:Stem cell therapy

Patients with fistulizing inflammatory bowel disease are traditionally difficult to treat. This patient population often experiences delayed or insufficient healing of fistulas using current standard regimens including anti-biotics, immunomodulators, anti-tumor necrosis factor--α drug, placement of setons, and surgical repair. Several studies over the last ten to fifteen years have been conducted using stem cell therapies with promising results in this patient population. These studies show stem cell therapy in fistulizing disease to be successful in healing between 60%--88% compared to currently 50% with infliximab. Moreover, remission was seen 24 wk to 52 wk in these studies. Further research with a multi--approach treatment using medications, stem cell therapy, and surgical interventions will likely be the future of this innovative treatment approach.

An unusual presentation of fistulating Crohn's disease:Ascites

Whilst ascites is a common presenting complaint in patients with decompensated chronic liver disease and disseminated malignancy,in Crohn's disease however,it is exceptionally rare.We describe a patient with no prior history of inflammatory bowel or liver disease,presenting with rapid onset gross ascites and scrotal swelling.Further investigations revealed severe hypoalbuminemia and transudative ascitic fluid with normal other liver function tests and a negative liver screen.Computed tomography revealed widespread ascites and pleural effusions with no features of malignancy or portal hypertension,and a small bowel barium series showed features of fistulating small bowel Crohn's disease.An ileo-colonoscopy confirmed the presence of terminal ileal inflammatory stricture.The patient's clinical condition and serum albumin improved with a combination of diuretics,elemental diet,antibiotics and oral 5-aminosalicylic acid therapy.

Mineral Concentrations and Rumen Degradability of Biodegraded <i>Enterolobium cyclocarpum</i>(Jacq) and <i>Pterocarpus santalinoides</i>(L’Her) with <i>Aspergillus niger</i>

The effects of solid state fermentation on the mineral concentrations and in sacco degradation characteristics of dry matter in two multipurpose tree leaves was investigated. Biodegraded Enterolobium cyclocarpum (EC) and Pterocarpus santalinoides (PS) leaves were previously inoculated with Aspergillus niger and incubated at 30&degC for five incubation periods (0, 7, 14, 21 and 28 days). After each incubation period, samples were oven dried at 60&degC, allowed to cool and ground for mineral analysis and in sacco dry matter degradability. Three fistulated West African Dwarf (WAD) rams (Ovis aries) were then used for the dry matter degradability. Five grams of each sample was emptied into nylon bag (Polymon, Switzeland) with pore size of 4 μ and effective size of 5 cm × 18 cm and incubated in the rumen of the fistulated animals for 6, 12, 24, 48, 72, and 96 h. The results showed that the mineral contents of biodegraded EC samples were affected by incubation period. Mean values of Ca, Cu, K, Na, and Zn were significantly increased (0.05), while mean values of Fe, Mg, and Mn were first reduced before significantly increasing (0.05). However, the composition of P showed significant reduction (0.05) up to day 28 where no change was observed. Mineral concentrations in biodegraded PS were also affected by incubation periods. Values of Ca, Fe, K, Mg, Mn, Na, and Zn were significantly increased (0.05). However values of Cu, and Fe only increased after day 14, while the value of P was reduced significantly over the different incubation periods. Potential degradability (PD) for biodegraded EC was highest at day 0 (50.79%) but not significantly different from potential degradability of longer incubation periods to day 28 (48.68%). PS had higher PD than EC. In spite of high PD values, PS comparatively degraded faster than EC. Effective degradability (ED) for EC was highest for day28 (36.71%) and not significantly different from days 21 (34.83%) and 7 (35.29%) but significantly different from days 0 (31.32%) and 14 (31.75%) respectively. However, the ED for PS was highest for day 0 (31.39) samples and significantly differed from other incubation periods, further increase in period only showed lower but similar ED values for days 7 (27.52%), 14 (26.76%), 21 (27.42%) and 28 (26.86%) respectively. In this study, the continued reduction in P concentrations in both biodegraded EC and PS suggest that Aspergillus niger has preferential demand for P and in sacco degradation showed increase in PD and ED values for fungal biodegraded EC and reduction in PS, suggesting improved quality of EC.