The Experts below are selected from a list of 18228 Experts worldwide ranked by ideXlab platform
Alexander H. Penn - One of the best experts on this subject based on the ideXlab platform.
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Transmural Intestinal Wall permeability in severe ischemia after enteral protease inhibition.
PloS one, 2014Co-Authors: Angelina E. Altshuler, Geert W. Schmid-schönbein, Itze Lamadrid, Stephanie R., Leena Kurre, Alexander H. PennAbstract:In Intestinal ischemia, inflammatory mediators in the small intestine's lumen such as food byproducts, bacteria, and digestive enzymes leak into the peritoneal space, lymph, and circulation, but the mechanisms by which the Intestinal Wall permeability initially increases are not well defined. We hypothesize that Wall protease activity (independent of luminal proteases) and apoptosis contribute to the increased transmural permeability of the intestine's Wall in an acutely ischemic small intestine. To model Intestinal ischemia, the proximal jejunum to the distal ileum in the rat was excised, the lumen was rapidly flushed with saline to remove luminal contents, sectioned into equal length segments, and filled with a tracer (fluorescein) in saline, glucose, or protease inhibitors. The transmural fluorescein transport was determined over 2 hours. Villi structure and epithelial junctional proteins were analyzed. After ischemia, there was increased transmural permeability, loss of villi structure, and destruction of epithelial proteins. Supplementation with luminal glucose preserved the epithelium and significantly attenuated permeability and villi damage. Matrix metalloproteinase (MMP) inhibitors (doxycycline, GM 6001), and serine protease inhibitor (tranexamic acid) in the lumen, significantly reduced the fluorescein transport compared to saline for 90 min of ischemia. Based on these results, we tested in an in-vivo model of hemorrhagic shock (90 min 30 mmHg, 3 hours observation) for Intestinal lesion formation. Single enteral interventions (saline, glucose, tranexamic acid) did not prevent Intestinal lesions, while the combination of enteral glucose and tranexamic acid prevented lesion formation after hemorrhagic shock. The results suggest that apoptotic and protease mediated breakdown cause increased permeability and damage to the Intestinal Wall. Metabolic support in the lumen of an ischemic intestine with glucose reduces the transport from the lumen across the Wall and enteral proteolytic inhibition attenuates tissue breakdown. These combined interventions ameliorate lesion formation in the small intestine after hemorrhagic shock.
Sandra Lindstedt - One of the best experts on this subject based on the ideXlab platform.
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microvascular blood flow changes in the small Intestinal Wall during conventional negative pressure wound therapy and negative pressure wound therapy using a protective disc over the intestines in laparostomy
Annals of Surgery, 2012Co-Authors: Sandra Lindstedt, Joanna Hlebowicz, Johan Hansson, Malin Malmsjo, Richard IngemanssonAbstract:OBJECTIVES:: Blood flow changes in the intestines during conventional negative pressure wound therapy (NPWT), and NPWT using a protective disc over the intestines in laparostomy. BACKGROUND:: Higher closure rates of the open abdomen have been reported with NPWT compared with other kinds of wound management. However, the method has been associated with increased development of fistulae. We have compared the changes in blood flow in the Intestinal Wall using conventional NPWT and NWPT with a protective disc between the intestines and the vacuum source. METHODS:: Midline incisions were made in 10 pigs and either conventional NPWT or NPWT with a disc over the intestines was applied. The microvascular blood flow was measured in the Intestinal Wall before and after the application of topical negative pressures of -50, -70, and -120 mmHg, using laser Doppler velocimetry. RESULTS:: The blood flow was significantly decreased (by 24%) after the application of conventional NPWT at -50 mmHg, compared with a slight decrease (2%) after the application of NWPT with a protective disc (P < 0.05). The blood flow was significantly decreased (by 54%) after the application of conventional NPWT at -120 mmHg, compared with a slight decrease (17%) after application of NPWT using a protective disc (P < 0.001). CONCLUSIONS:: Inserting a disc between the intestines and the vacuum source in NPWT protects the intestines from ischemia. The decreased blood flow in the Intestinal Wall may induce ischemia, which could promote the development of Intestinal fistulae. (Less)
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Microvascular blood flow response in the Intestinal Wall and the omentum during negative wound pressure therapy of the open abdomen
International journal of colorectal disease, 2011Co-Authors: Joanna Hlebowicz, Johan Hansson, Sandra LindstedtAbstract:Purpose Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of Intestinal fistulae. The present study measures microvascular blood flow in the Intestinal Wall and the omentum before and during NPWT.
Richard Ingemansson - One of the best experts on this subject based on the ideXlab platform.
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microvascular blood flow changes in the small Intestinal Wall during conventional negative pressure wound therapy and negative pressure wound therapy using a protective disc over the intestines in laparostomy
Annals of Surgery, 2012Co-Authors: Sandra Lindstedt, Joanna Hlebowicz, Johan Hansson, Malin Malmsjo, Richard IngemanssonAbstract:OBJECTIVES:: Blood flow changes in the intestines during conventional negative pressure wound therapy (NPWT), and NPWT using a protective disc over the intestines in laparostomy. BACKGROUND:: Higher closure rates of the open abdomen have been reported with NPWT compared with other kinds of wound management. However, the method has been associated with increased development of fistulae. We have compared the changes in blood flow in the Intestinal Wall using conventional NPWT and NWPT with a protective disc between the intestines and the vacuum source. METHODS:: Midline incisions were made in 10 pigs and either conventional NPWT or NPWT with a disc over the intestines was applied. The microvascular blood flow was measured in the Intestinal Wall before and after the application of topical negative pressures of -50, -70, and -120 mmHg, using laser Doppler velocimetry. RESULTS:: The blood flow was significantly decreased (by 24%) after the application of conventional NPWT at -50 mmHg, compared with a slight decrease (2%) after the application of NWPT with a protective disc (P < 0.05). The blood flow was significantly decreased (by 54%) after the application of conventional NPWT at -120 mmHg, compared with a slight decrease (17%) after application of NPWT using a protective disc (P < 0.001). CONCLUSIONS:: Inserting a disc between the intestines and the vacuum source in NPWT protects the intestines from ischemia. The decreased blood flow in the Intestinal Wall may induce ischemia, which could promote the development of Intestinal fistulae. (Less)
Angelina E. Altshuler - One of the best experts on this subject based on the ideXlab platform.
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Transmural Intestinal Wall permeability in severe ischemia after enteral protease inhibition.
PloS one, 2014Co-Authors: Angelina E. Altshuler, Geert W. Schmid-schönbein, Itze Lamadrid, Stephanie R., Leena Kurre, Alexander H. PennAbstract:In Intestinal ischemia, inflammatory mediators in the small intestine's lumen such as food byproducts, bacteria, and digestive enzymes leak into the peritoneal space, lymph, and circulation, but the mechanisms by which the Intestinal Wall permeability initially increases are not well defined. We hypothesize that Wall protease activity (independent of luminal proteases) and apoptosis contribute to the increased transmural permeability of the intestine's Wall in an acutely ischemic small intestine. To model Intestinal ischemia, the proximal jejunum to the distal ileum in the rat was excised, the lumen was rapidly flushed with saline to remove luminal contents, sectioned into equal length segments, and filled with a tracer (fluorescein) in saline, glucose, or protease inhibitors. The transmural fluorescein transport was determined over 2 hours. Villi structure and epithelial junctional proteins were analyzed. After ischemia, there was increased transmural permeability, loss of villi structure, and destruction of epithelial proteins. Supplementation with luminal glucose preserved the epithelium and significantly attenuated permeability and villi damage. Matrix metalloproteinase (MMP) inhibitors (doxycycline, GM 6001), and serine protease inhibitor (tranexamic acid) in the lumen, significantly reduced the fluorescein transport compared to saline for 90 min of ischemia. Based on these results, we tested in an in-vivo model of hemorrhagic shock (90 min 30 mmHg, 3 hours observation) for Intestinal lesion formation. Single enteral interventions (saline, glucose, tranexamic acid) did not prevent Intestinal lesions, while the combination of enteral glucose and tranexamic acid prevented lesion formation after hemorrhagic shock. The results suggest that apoptotic and protease mediated breakdown cause increased permeability and damage to the Intestinal Wall. Metabolic support in the lumen of an ischemic intestine with glucose reduces the transport from the lumen across the Wall and enteral proteolytic inhibition attenuates tissue breakdown. These combined interventions ameliorate lesion formation in the small intestine after hemorrhagic shock.
Joanna Hlebowicz - One of the best experts on this subject based on the ideXlab platform.
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microvascular blood flow changes in the small Intestinal Wall during conventional negative pressure wound therapy and negative pressure wound therapy using a protective disc over the intestines in laparostomy
Annals of Surgery, 2012Co-Authors: Sandra Lindstedt, Joanna Hlebowicz, Johan Hansson, Malin Malmsjo, Richard IngemanssonAbstract:OBJECTIVES:: Blood flow changes in the intestines during conventional negative pressure wound therapy (NPWT), and NPWT using a protective disc over the intestines in laparostomy. BACKGROUND:: Higher closure rates of the open abdomen have been reported with NPWT compared with other kinds of wound management. However, the method has been associated with increased development of fistulae. We have compared the changes in blood flow in the Intestinal Wall using conventional NPWT and NWPT with a protective disc between the intestines and the vacuum source. METHODS:: Midline incisions were made in 10 pigs and either conventional NPWT or NPWT with a disc over the intestines was applied. The microvascular blood flow was measured in the Intestinal Wall before and after the application of topical negative pressures of -50, -70, and -120 mmHg, using laser Doppler velocimetry. RESULTS:: The blood flow was significantly decreased (by 24%) after the application of conventional NPWT at -50 mmHg, compared with a slight decrease (2%) after the application of NWPT with a protective disc (P < 0.05). The blood flow was significantly decreased (by 54%) after the application of conventional NPWT at -120 mmHg, compared with a slight decrease (17%) after application of NPWT using a protective disc (P < 0.001). CONCLUSIONS:: Inserting a disc between the intestines and the vacuum source in NPWT protects the intestines from ischemia. The decreased blood flow in the Intestinal Wall may induce ischemia, which could promote the development of Intestinal fistulae. (Less)
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Microvascular blood flow response in the Intestinal Wall and the omentum during negative wound pressure therapy of the open abdomen
International journal of colorectal disease, 2011Co-Authors: Joanna Hlebowicz, Johan Hansson, Sandra LindstedtAbstract:Purpose Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of Intestinal fistulae. The present study measures microvascular blood flow in the Intestinal Wall and the omentum before and during NPWT.
