Taiwan Society of Colon and Rectum Surgeons (TSCRS) Consensus for Anti-Inflammatory Nutritional Intervention in Colorectal Cancer

Malnutrition and systemic inflammatory response (SIR) frequently occur in patients with colorectal cancer (CRC) and are associated with poor prognosis. Anti-inflammatory nutritional intervention is not only a way to restore the malnourished status but also modulate SIR. Nine experts, including colorectal surgeons, physicians and dieticians from 5 hospitals geographically distributed in Taiwan, attended the consensus meeting in Taiwan Society of Colon and Rectum Surgeons for a 3-round discussion and achieved the consensus based on a systematic literature review of clinical studies and published guidelines. The consensus recommends that assessment of nutritional risk and SIR should be performed before and after CRC treatment and appropriate nutritional and/or anti-inflammatory intervention should be adapted and provided accordingly.

Sequentially calibrating a Bayesian microsimulation model to incorporate new information and assumptions

Background Microsimulation models are mathematical models that simulate event histories for individual members of a population. They are useful for policy decisions because they simulate a large number of individuals from an idealized population, with features that change over time, and the resulting event histories can be summarized to describe key population-level outcomes. Model calibration is the process of incorporating evidence into the model. Calibrated models can be used to make predictions about population trends in disease outcomes and effectiveness of interventions, but calibration can be challenging and computationally expensive. Methods This paper develops a technique for sequentially updating models to take full advantage of earlier calibration results, to ultimately speed up the calibration process. A Bayesian approach to calibration is used because it combines different sources of evidence and enables uncertainty quantification which is appealing for decision-making. We develop this method in order to re-calibrate a microsimulation model for the natural history of colorectal cancer to include new targets that better inform the time from initiation of preclinical cancer to presentation with clinical cancer (sojourn time), because model exploration and validation revealed that more information was needed on sojourn time, and that the predicted percentage of patients with cancers detected via colonoscopy screening was too low. Results The sequential approach to calibration was more efficient than recalibrating the model from scratch. Incorporating new information on the percentage of patients with cancers detected upon screening changed the estimated sojourn time parameters significantly, increasing the estimated mean sojourn time for cancers in the colon and rectum, providing results with more validity. Conclusions A sequential approach to recalibration can be used to efficiently recalibrate a microsimulation model when new information becomes available that requires the original targets to be supplemented with additional targets.

Cherry Polyphenol Extract Ameliorated Dextran Sodium Sulfate-Induced Ulcerative Colitis in Mice by Suppressing Wnt/β-Catenin Signaling Pathway

Ulcerative colitis (UC) is a chronic and nonspecific inflammatory disease of the colon and rectum, and its etiology remains obscure. Cherry polyphenols showed potential health-promoting effects. However, both the protective effect and mechanism of cherry polyphenols on UC are still unclear. This study aimed to investigate the potential role of the free polyphenol extract of cherry in alleviating UC and its possible mechanism of action. Our study revealed that the free polyphenol extract of cherry management significantly alleviated UC symptoms, such as weight loss, colon shortening, the thickening of colonic mucous layer, etc. The free polyphenol extract of cherry treatment also introduced a significant reduction in levels of malondialdehyde (MDA), myeloperoxidase (MPO) and nitric oxide (NO), while causing a significant elevation in levels of catalase (CAT), glutathione (GSH-Px), superoxide dismutase (SOD), as well as the downregulation of pro-inflammatory cytokines. This indicated that such positive effects were performed through reducing oxidative damage or in a cytokine-specific manner. The immunofluorescence analysis of ZO-1 and occludin proteins declared that the free polyphenol extract of cherry had the potential to prompt intestinal barrier function. The reduced expression levels of β-catenin, c-myc, cyclin D1 and GSK-3β suggested that the cherry extract performed its positive effect on UC by suppressing the Wnt/β-ctenin pathway. This finding may pave the way into further understanding the mechanism of cherry polyphenols ameliorating ulcerative colitis.

Gut Microbiota Reveals the Environmental Adaption in Gastro-intestinal Tract of Wild Boar in Karst Region of Southwest China

BackgroundGut microbes, has become one of the research hotspots in animal ecology, playing an important role in monitoring dietary adaptation and health status of host. However, there are few studies on the gut microbiota in the stomach, small intestine (ileum) and large intestine (cecum, colon and rectum) of wild boar. ResultsAlpha diversity and Beta diversity showed there were significant differences in the abundance and distribution of microbes in gastrointestinal tract of wild boar. Firmicutes and Bacteroidetes were the most dominant phyla in stomach, cecum, colon and rectum of wild boar, while Proteobacteria and Firmicutes were the most dominant in ileum. At genus level, there were different leading genera in stomach (Prevotella and Lactobacillus), small intestine (Escherichia-Shigella and Lactobacillus) and large intestine (Ruminococcaceae_UCG-005, Christensenellaceae_R-7_group and Escherichia-Shigella). PICRUSt function predictive analysis suggested that there were significant differences in microbial metabolic pathways among five locations of wild boar. ConclusionsThis study comprehensively revealed the differences in composition of microbial community in gastrointestinal trac of wild boar. Future work links microbes with the metabolites to accurately reveal the health of wild boar.

Colonic Mucosa-associated Mycobiota in Individuals With Normal Colons

To characterize the spatial variation of the mucosa-associated adherent mycobiota along the large intestine in individuals with a normal-colon, we performed eukaryotic rRNA operon’s internal transcribed spacer-2 sequencing to profile fungal community composition and structure in 70 mucosal biopsies taken from the cecum, ascending, transverse, descending colon, and rectum of 14 polyp-free individuals. The bacteriome of these samples was previously characterized by sequencing the V4 region of the 16S rRNA gene. We identified 64 amplicon sequence variants (ASVs) with the relative abundance no less than 0.05% from these colonic mucosa samples. Each individual has a unique community composition of the gut mycobiome (P = 0.001 for beta diversity). Alpha-diversity and beta-diversity did not differ significantly across the colon segments. The most common phyla (relative abundance) were Ascomycota (45.4%) and Basidiomycota (45.3%). The most common genera were Malassezia (28.2%) and Candida (13.4%). Malassezia was found in 13 of 14 individuals. Other fungi genera were sporadically found in the large intestine. The most common species were Malassezia restricta (22.7%), Candida albicans (11.9%), Malasseziales sp. (8.80%), unclassified fungi (7.80%), and Penicillium paneum (5.70%). Malasseziaceae was co-abundant with Enterobacteriaceae and co-exclusive with Barnesiellaceae, Rikenellaceae, and Acidaminococcaceae. Malassezia was widely colonized whereas other fungal genera were sporadically colonized in the large intestine. The physiologic and pathogenic functions of fungi in human gastrointestinal tract including Malasseziaceae that may interact with several bacterial families remain to be fully elucidated.

Comprehensive Ultrasound Diagnosis of Sigmoid Diverticulitis

Aim. A definition and systematisation of sigmoid diverticulitis semiotics in a comprehensive ultrasonic check-up for early illness diagnosis.Materials and methods. Ultrasound examination data on 64 patients with sigmoid diverticulum have been analysed. The primary visit reason was recurrent varying-intensity pain in left abdominal quadrant, unstable stool and flatulence. The patients were 28 (43.75%) men and 36 (56.25%) women aged 38–85 years, mean age 55.6 years; 31 (48.44%) were diagnosed with diverticulitis. We used the HD15 (Philips, the Netherlands), HS 60 (Samsung, South Korea) and Hi Vision Preirus (Hitachi, Japan) ultrasound instruments equipped with convex and intracavitary microconvex 2–12 MHz linear transducers. Patients were examined on an empty stomach and unprepared intestine. Colon and rectum were explored at different approaches, transabdominally, transperineally, transrectally and transvaginallyResults. The findings laid out a more elaborated ultrasound semiotics of diverticulitis. Ultrasound check-up enables a reliable estimation of blood supply and peristalsis, colonic wall thickness and layers, presence of asymptomatic diverticula, signs of acute diverticulitis (pain on sensor touch, mesocolic tissue infiltration, presence of faecal calculi and gas in diverticulum, peridiverticulitis) and other complications of diverticular disease (fistulae, abscess or peritonitis), as well as a consistent differential instrumental diagnosis of other organ illnesses.Conclusion. Ultrasound is an indispensable supplement in clinical diagnosis of diverticula, diverticulitis and their complications in the cases when other methods like X-ray, CT or colonoscopy are contraindicated.

Nicotine Oral Administration Attenuates DSS-Induced Colitis Through Upregulation of Indole in the Distal Colon and Rectum in Mice

Nicotine affects the gastrointestinal environment and modulates ulcerative colitis (UC). However, the associations among nicotine, gut metabolites, and UC are still largely unknown. We investigated whether orally administered nicotine affected gut metabolites and dextran sodium sulfate (DSS)-induced colitis. C57BL/6 male mice were orally administered nicotine solution in drinking water prior to inducing DSS-induced colitis. Short-chain fatty acids (SCFAs) and indole in gut contents and fecal samples were measured by GC-MS and hydroxylamine-based indole assays, respectively. Oral administration of nicotine increased indole concentration in feces, but, in contrast, SCFA values did not differ with nicotine administration. Indole levels were increased in the distal colon and rectum but not in the cecum and proximal colon. DSS-induced colitis was less severe clinically and histological changes were minimal in the rectum of orally nicotine-administered mice compared to mice drinking only water. 16S rRNA microbiome on the feces revealed an increasing in Clostridium and Porphyromonas in nicotine-administered mice. In conclusion, nicotine administration was associated with increased indole levels in the distal colon and rectum and attenuated DSS-induced colitis. Oral administration of nicotine may play a potential role in indole upregulation and prevention of UC.

Multiple Colorectal Mucosa-Associated Lymphoid Tissue Lymphoma Successfully Treated with Chemotherapy

The standard treatment for colorectal mucosa-associated lymphoid tissue (MALT) lymphoma has not yet been established due to the rarity of the disease. Here, we report a case of long-term response to chemotherapy for colorectal MALT lymphoma (stage I). A 77-year-old frail female patient with diabetes mellitus and dementia developed melena of unknown etiology, and a colonoscopy was performed at a nearby hospital. A biopsy suggested malignant lymphoma, and she was referred to our department. As a result of re-examination of colonoscopy, a total of 3 submucosal tumor-like lesions were confirmed. Of these, a biopsy of the lesions in the ascending colon and rectum was performed, and MALT lymphoma was diagnosed on the basis of the histopathological findings. Following close examination, no other lymphoma lesions were found, and the patient was diagnosed with primary colorectal MALT lymphoma, stage I. After 1 course of R-THP-COP chemotherapy (rituximab + cyclophosphamide, pirarubicin, vincristine, and prednisone), the rectal lesion was confirmed to have almost disappeared endoscopically, and lymphoma cells were not found histopathologically. The patient was determined to be in complete remission (CR). However, due to hematological toxicity and a slight worsening of glucose control, the second chemotherapy course was changed to the BR regimen (rituximab + bendamustine), and 4 courses were performed (5 total courses of chemotherapy). Currently, >3 years have passed since reaching CR, and the patient is alive without recurrence.