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Yang C, Ge H, Xu Y. Incremental maintenance of three-way regions with variations of objects and values in hybrid incomplete decision systems. APPL INTELL 2022. [DOI: 10.1007/s10489-022-03736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Xiao J, Li QD. Multi-slice spiral CT evaluation of chronic radiation colitis and rectitis. Exp Ther Med 2020; 20:3033-3040. [PMID: 32855670 PMCID: PMC7444353 DOI: 10.3892/etm.2020.9069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to retrospectively analyse the multi-slice spiral CT (MSCT) findings of radiation colitis and rectitis (RC&R). A total of 23 cases of RC&R detected by helical CT were included. The CT findings and clinical and endoscopy data of the patients were reviewed. The primary tumours included cancers of the cervix (n=17), rectum (n=4), ovaries (n=1) and bladder (n=1). The total dose of radiation per patient was 46-60 Gy (mean, 49.7 Gy) delivered over 5 weeks. The CT manifestations included different degrees of increased thickness of the intestinal wall (n=20, 87.0%), with a maximum thickness of 16.6 mm. On enhanced CT, the target sign was observed (n=16, 69.9%), with an obviously enhanced mucosa and/or serosa and the following changes observed: Oedema and increased density of the mesentery (n=15, 65.2%); increased density of the subcutaneous fat, and blurred and oedematous pelvic wall muscles (n=4, 17.4%), with the obturator internus and levator ani muscles being most commonly affected; narrowed intestinal lumen (n=3, 13.0%); and a small amount of ascitic fluid (n=2, 8.7%) located in the paracolic sulci and bladder or Douglas pouch. The 23 patients underwent colonoscopy and were diagnosed with RC&R. The major manifestations included telangiectasia and mucosal hyperaemia (n=21, 91.3%). MSCT of chronic RC&R (CRC&R) was associated with certain characteristic findings, which, combined with a medical history of radiotherapy and the clinical manifestations, may prove to be of value in the diagnosis of CRC&R.
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Affiliation(s)
- Jing Xiao
- Key Laboratory for Biorheological Science and Technology of the Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing 400044, P.R. China
| | - Qing-Dong Li
- Key Laboratory for Biorheological Science and Technology of the Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing 400044, P.R. China
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Surgery for chronic radiation enteritis: outcome and risk factors. J Surg Res 2016; 204:335-343. [DOI: 10.1016/j.jss.2016.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/09/2016] [Accepted: 05/06/2016] [Indexed: 12/21/2022]
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Jacobs KM, Misri S, Meyer B, Raj S, Zobel CL, Sleckman BP, Hallahan DE, Sharma GG. Unique epigenetic influence of H2AX phosphorylation and H3K56 acetylation on normal stem cell radioresponses. Mol Biol Cell 2016; 27:1332-45. [PMID: 26941327 PMCID: PMC4831886 DOI: 10.1091/mbc.e16-01-0017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/22/2016] [Indexed: 01/08/2023] Open
Abstract
Normal stem cells from tissues often exhibiting radiation injury are highly radiosensitive and exhibit a muted DNA damage response, in contrast to differentiated progeny. These radioresponses can be attributed to unique epigenetic regulation in stem cells, identifying potential therapeutic targets for radioprotection. Normal tissue injury resulting from cancer radiotherapy is often associated with diminished regenerative capacity. We examined the relative radiosensitivity of normal stem cell populations compared with non–stem cells within several radiosensitive tissue niches and culture models. We found that these stem cells are highly radiosensitive, in contrast to their isogenic differentiated progeny. Of interest, they also exhibited a uniquely attenuated DNA damage response (DDR) and muted DNA repair. Whereas stem cells exhibit reduced ATM activation and ionizing radiation–induced foci, they display apoptotic pannuclear H2AX-S139 phosphorylation (γH2AX), indicating unique radioresponses. We also observed persistent phosphorylation of H2AX-Y142 along the DNA breaks in stem cells, which promotes apoptosis while inhibiting DDR signaling. In addition, down-regulation of constitutively elevated histone-3 lysine-56 acetylation (H3K56ac) in stem cells significantly decreased their radiosensitivity, restored DDR function, and increased survival, signifying its role as a key contributor to stem cell radiosensitivity. These results establish that unique epigenetic landscapes affect cellular heterogeneity in radiosensitivity and demonstrate the nonubiquitous nature of radiation responses. We thus elucidate novel epigenetic rheostats that promote ionizing radiation hypersensitivity in various normal stem cell populations, identifying potential molecular targets for pharmacological radioprotection of stem cells and hopefully improving the efficacy of future cancer treatment.
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Affiliation(s)
- Keith M Jacobs
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108
| | - Sandeep Misri
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108
| | - Barbara Meyer
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108
| | - Suyash Raj
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108
| | - Cheri L Zobel
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108
| | - Barry P Sleckman
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63108 Department of Pathology, Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, MO 63108
| | - Dennis E Hallahan
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108 Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63108
| | - Girdhar G Sharma
- Department of Radiation Oncology, Cancer Biology Division, Washington University School of Medicine, St. Louis, MO 63108 Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63108
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Cagin YF, Parlakpinar H, Polat A, Vardi N, Atayan Y, Erdogan MA, Ekici K, Yildiz A, Sarihan ME, Aladag H. The protective effects of apocynin on ionizing radiation-induced intestinal damage in rats. Drug Dev Ind Pharm 2015; 42:317-24. [PMID: 26072994 DOI: 10.3109/03639045.2015.1052080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Radiation colitis typically emerges during radiotherapy of intra-abdominal malignancies. While the underlying mechanism remains unclear, it is considered that free oxygen radicals act like cellular mediators to cause colonic damage. Apocynin (APO) prevents oxidative stress and apoptotic cell death by inhibiting NADPH oxidase, and preventing the formation of free oxygen radicals. The aim of the present study was to investigate the protective effect of APO, a strong antioxidant and antiinflammatory agent, on radiation induced colonic oxidative damage in rats. MATERIALS AND METHODS Rats were randomly divided into four groups (n = 8/group). Group I (control group); Group II (Group RAD) received a single dose of 800 cGy ionizing radiation to the whole abdomen with a linear accelerator (LINAC); Group III (Group APO) received a single dose of 20 mg/kg of APO intraperitoneally for five days; Group IV (Group APO+RAD) received APO for five days before radiation exposure (similar to Group III), (similar to Group II). RESULTS APO treatment prior to radiation led to protection in the biochemical and histopathological parameters. CONCLUSIONS Our study shows that APO treatment before radiation improves radiation induced colonic injury in rats, by decreasing oxidative stress and apoptosis.
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Affiliation(s)
| | | | | | - N Vardi
- d Department of Histology and Embryology
| | - Y Atayan
- a Department of Gastroenterology
| | | | - K Ekici
- e Department of Radiation Oncology , and
| | - A Yildiz
- d Department of Histology and Embryology
| | - M E Sarihan
- f Department of Emergency Medicine, Medical Faculty , Inonu University , Malatya , Turkey , and
| | - H Aladag
- g Department of Obstetric & Gynecology , Hayat Hospital , Malatya , Turkey
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Hogan NM, Kerin MJ, Joyce MR. Gastrointestinal complications of pelvic radiotherapy: medical and surgical management strategies. Curr Probl Surg 2013; 50:395-407. [PMID: 23930906 DOI: 10.1067/j.cpsurg.2013.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Niamh M Hogan
- Department of Colorectal Surgery, University College Hospital Galway, Ireland
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Akpolat M, Gulle K, Topcu-Tarladacalisir Y, Safi Oz Z, Bakkal BH, Arasli M, Ozel Turkcu U. Protection by L-carnitine against radiation-induced ileal mucosal injury in the rat: pattern of oxidative stress, apoptosis and cytokines. Int J Radiat Biol 2013; 89:732-740. [PMID: 23510242 DOI: 10.3109/09553002.2013.787176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE In this study, we tested the effects of L-carnitine (LC) on radiation-induced ileal mucosal damage. MATERIALS AND METHODS Thirty Wistar albino rats were divided into five groups. The control group received physiological saline intraperitoneally (i.p.). Radiation-1 and radiation-2 groups received whole-body X-irradiation of 8.3 Gy as a single dose. These groups were sacrificed at the 6th hour and 4th day after irradiation, respectively. The Radiation-1 + LC and the radiation-2 + LC groups received the same dose irradiation plus a daily dose of 200 mg/kg LC. LC was applied one day before and for four days after irradiation. RESULTS The levels of serum monocyte chemotactic protein-1 (MCP-1) and interferon gamma (IFN-γ) were significantly higher in the radiation groups when compared with the control. Treatment with LC decreased the serum MCP-1 and IFN-γ levels considerably. In the radiations groups, the Chiu score was significantly elevated compared with that of the control group. However, LC administered prior to the irradiation reduced the severity of mucosal damage. The number of apoptotic cells of the ileal crypt in the irradiated rats increased from the 6th hour after irradiation and then decreased at 4th day. CONCLUSIONS Our data demonstrated that LC may be beneficial to radiation enteritis.
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Affiliation(s)
- Meryem Akpolat
- Department of Histology and Embryology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
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The effect of synbiotics on acute radiation-induced diarrhea and its association with mucosal inflammatory and adaptive responses in rats. Dig Dis Sci 2013; 58:2487-98. [PMID: 23695868 DOI: 10.1007/s10620-013-2700-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 04/24/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous clinical studies advocated that probiotics beneficially affect acute radiation-induced diarrhea. These encouraging results were attributed to the restoration of the intestinal flora; however, there is lack of evidence if and how probiotics influence the underlying pathophysiological mechanisms. AIMS The present study was conducted to investigate the potential supporting role of a synbiotic preparation (combination of pro- and pre-biotics) on experimentally-induced acute radiation diarrhea from the perspective of mucosal inflammation and histological injury. METHODS Ninety adult Wistar rats were randomly assigned into six groups. Group A (non-irradiated), group B (non-irradiated/synbiotic supplemented), group C (irradiated), and group D (irradiated/synbiotic supplemented) were followed up to a week after the beginning of the experiment. Group E (irradiated) and group F (irradiated/synbiotic supplemented) were followed up for four days. On the last day of the experiments tissues were harvested for structural and molecular assessments. RESULTS Synbiotic administration could not avert the occurrence of diarrhea, but significantly attenuated its severity. This effect was associated with the significant downregulation of neutrophil accumulation and lipid peroxidation during the acute phase. During the subacute phase, synbiotic treatment significantly improved both the histological profile and radiation mucositis. These mechanisms significantly contributed to the rehabilitation of the intestinal absorptive function as further indicated from the significantly reduced weight loss. CONCLUSIONS Given the optimization of the intestinal flora exerted by synbiotics, the resolution of diarrhea relies on the suppression of the "reactive" and the augmentation of "regenerative" components of acute radiation-induced intestinal response.
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Radioprotection to small intestine of the mice against ionizing radiation by semiquinone glucoside derivative (SQGD) isolated from Bacillus sp. INM-1. Mol Cell Biochem 2012; 370:115-25. [DOI: 10.1007/s11010-012-1403-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 07/25/2012] [Indexed: 12/13/2022]
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Lefevre JH, Amiot A, Joly F, Bretagnol F, Panis Y. Risk of recurrence after surgery for chronic radiation enteritis. Br J Surg 2011; 98:1792-7. [DOI: 10.1002/bjs.7655] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2011] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Approximately one-third of patients with chronic radiation enteritis (CRE) require surgery, which is associated with a high morbidity rate and a high risk of reoperation. The aim of this study was to report outcome after surgery for CRE.
Methods
Patients with CRE who underwent operation with extensive small bowel resection between 1980 and 2009 were included in the study. Postoperative morbidity and mortality, reoperation for recurrent enteritis and risk factors for reoperation were analysed.
Results
Of 107 patients (94 women; 87·8 per cent) with CRE included in the study, the main indication for surgery was symptomatic stricture (82 patients; 76·6 per cent). Forty-nine ileocaecal resections (45·8 per cent) were performed. Overall and surgical morbidity rates were 74·8 per cent (80 patients) and 28·0 per cent (30) respectively. Fourteen patients (13·1 per cent) underwent reoperation for complications. Reoperation rates for CRE at 1 and 3 years of follow-up were 37 and 54 per cent respectively. Risk factors for reoperation for recurrent enteritis were: emergency surgery (odds ratio (OR) 2·72, 95 per cent confidence interval 1·57 to 4·86), anastomotic leakage (OR 2·53, 1·54 to 4·42) and male sex (OR 3·57, 1·82 to 7·29). The only protective factor for reoperation was ileocaecal resection during the first surgical procedure (OR 4·48, 2·52 to 8·31).
Conclusion
Ileocaecal resection was the only factor that protected against reoperation for recurrent CRE, demonstrating the importance of resecting all damaged tissue in these patients. These results suggest that there is little place for intestinal bypass surgery or adhesiolysis.
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Affiliation(s)
- J H Lefevre
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - A Amiot
- Department of Gastroenterology and Nutritive Assistance, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - F Joly
- Department of Gastroenterology and Nutritive Assistance, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - F Bretagnol
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - Y Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
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Spyropoulos BG, Misiakos EP, Fotiadis C, Stoidis CN. Antioxidant properties of probiotics and their protective effects in the pathogenesis of radiation-induced enteritis and colitis. Dig Dis Sci 2011; 56:285-94. [PMID: 20632107 DOI: 10.1007/s10620-010-1307-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 06/14/2010] [Indexed: 12/20/2022]
Abstract
Radiation therapy has become one of the most important treatment modalities for human malignancy, but certain immediate and delayed side-effects on the normal surrounding tissues limit the amount of effective radiation that can be administered. After exposure of the abdominal region to ionizing radiation, nearly all patients experience transient symptoms of irradiation of the bowel. Acute-phase symptoms may persist for a short time, yet long-term complications can represent significant clinical conditions with high morbidity. Data from both experimental studies and clinical trials suggest the potential benefit for probiotics in radiation-induced enteritis and colitis. On the other hand, it is well evidenced that both useful and harmful effects of therapeutic applications of ionizing radiation upon living systems are ascribed to free-radical production. Therefore, the hypothesis that probiotics reinforce antioxidant defense systems of normal mucosal cells exposed to ionizing radiation may explain to an extent their beneficial action. The aim of this review is threefold: First, to make a short brief into the natural history of radiation injury to the intestinal tract. Second, to describe the primary interaction of ionizing radiation at the cellular level and demonstrate the participation of free radicals in the mechanisms of injury and, third, to try a more profound investigation into the antioxidant abilities of probiotics and prebiotics based on the available experimental and clinical data.
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Affiliation(s)
- Basileios G Spyropoulos
- 1st Department of Propaedeutic Surgery, University of Athens School of Medicine, Hippokration Hospital, Athens, Greece.
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Akpolat M, Kanter M, Uzal MC. Protective effects of curcumin against gamma radiation-induced ileal mucosal damage. Arch Toxicol 2008; 83:609-17. [PMID: 18754102 PMCID: PMC2695547 DOI: 10.1007/s00204-008-0352-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/07/2008] [Indexed: 12/15/2022]
Abstract
The major objective of this study was to test curcumin as a potential radioprotectant for the ileum goblet cells of the rat. Wistar albino rats were used in the study. Group A was the control group and group B was the single dose radiation group. Group C was the two dose radiation group (4 days interval). The rats in groups D and E were given a daily dose of 100 mg/kg of curcumin for 14 and 18 days, respectively. During the curcumin administration period, the rats in group D were exposed to abdominal area gamma (γ)-ray dose of 5 Gy on the 10th day and group E was exposed to same dose radiation on the 10th and 14th day. Irradiation and treatment groups were decapitated on the 4th day after exposure to single or two-dose irradiation and ileum tissues were removed for light and electron microscopic investigation. Single or two dose 5 Gy γ-irradiation caused a marked intestinal mucosal injury in rats on the 4th day. Radiation produced increases in the number of goblet cells. Curcumin appears to have protective effects against radiation-induced damage, suggesting that clinical transfer is feasible.
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Affiliation(s)
- Meryem Akpolat
- Department of Histology and Embryology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mehmet Kanter
- Department of Histology and Embryology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mustafa Cem Uzal
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Guney Y, Hicsonmez A, Uluoglu C, Guney HZ, Ozel Turkcu U, Take G, Yucel B, Caglar G, Bilgihan A, Erdogan D, Nalca Andrieu M, Kurtman C, Zengil H. Melatonin prevents inflammation and oxidative stress caused by abdominopelvic and total body irradiation of rat small intestine. Braz J Med Biol Res 2007; 40:1305-14. [PMID: 17713655 DOI: 10.1590/s0100-879x2006005000156] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 05/14/2007] [Indexed: 11/22/2022] Open
Abstract
We investigated the day-night differences in intestinal oxidative-injury and the inflammatory response following total body (TB) or abdominopelvic (AP) irradiation, and the influence of melatonin administration on tissue injury induced by radiation. Rats (male Wistar, weighing 220-280 g) in the irradiated groups were exposed to a dose of 8 Gy to the TB or AP region in the morning (resting period - 1 h after light onset) or evening (activity span - 13 h after light onset). Vehicle or melatonin was administered immediately before, immediately after and 24 h after irradiation (10, 2.0 and 10 mg/kg, ip, respectively) to the irradiated rats. AP (P < 0.05) and TB (P < 0.05) irradiation applied in the morning caused a significant increase in thiobarbituric acid reactive substance (TBARS) levels. Melatonin treatment in the morning (P < 0.05) or evening (P < 0.05) decreased TBARS levels after TB irradiation. After AP irradiation, melatonin treatment only in the morning caused a significant decrease in TBARS levels (P < 0.05). Although we have confirmed the development of inflammation after radiotherapy by histological findings, neither AP nor TB irradiation caused any marked changes in myeloperoxidase activity in the morning or evening. Our results indicate that oxidative damage is more prominent in rats receiving TB and AP irradiation in the morning and melatonin appears to have beneficial effects on oxidative damage irrespective of the time of administration. Increased neutrophil accumulation indicates that melatonin administration exerts a protective effect on AP irradiation-induced tissue oxidative injury, especially in the morning.
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Affiliation(s)
- Y Guney
- Department of Radiation Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey.
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Demirer S, Ulusu NN, Aslim B, Kepenekci I, Ulusoy C, Andrieu MN, Erkek B, Aydintug S. Protective effects of Lactobacillus delbrueckii subsp bulgaricus B3 on intestinal enzyme activities after abdominal irradiation in rats. Nutr Res 2007. [DOI: 10.1016/j.nutres.2007.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Demirer S, Aydintug S, Aslim B, Kepenekci I, Sengül N, Evirgen O, Gerceker D, Andrieu MN, Ulusoy C, Karahüseyinoglu S. Effects of probiotics on radiation-induced intestinal injury in rats. Nutrition 2006; 22:179-86. [PMID: 16459231 DOI: 10.1016/j.nut.2005.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 07/25/2005] [Accepted: 08/09/2005] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Radiotherapy is an important aspect of multimodal cancer therapy, but radiation-induced acute intestinal injury is a common and serious problem. Disruption of morphologic mucosal integrity and normal bacterial microflora after abdominal radiation leads to malabsorption and bacterial translocation. METHODS Lactobacillus bulgaricus strain isolated from yogurt was given as a probiotic to rats subjected to radiotherapy. On postradiation day 8 rats were killed. Mesenteric lymph nodes, liver, and spleen were excised for microbiologic examinations. Segments of jejunum, ileum, and colon were evaluated for the presence of inflammation, vascularity, and mucus cells. RESULTS The results of this study suggest that probiotics may have a protective effect on intestinal mucosa. CONCLUSION Probiotics added as substrates can be given by an oral or enteral route to patients who undergo radiotherapy to prevent radiation-induced enteritis and related malnutrition.
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Affiliation(s)
- Seher Demirer
- Ankara University School of Medicine, Ankara, Turkey.
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Onodera H, Nagayama S, Mori A, Fujimoto A, Tachibana T, Yonenaga Y. Reappraisal of Surgical Treatment for Radiation Enteritis. World J Surg 2005; 29:459-63. [PMID: 15770376 DOI: 10.1007/s00268-004-7699-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although radiation enteritis is a well-recognized sequel of therapeutic irradiation, the standard surgical method is not universally agreed upon. Not only the short-term effect but also the long-term effect after a surgical intervention has been fairly well reported. To reassess the surgical therapy for radiation enteritis, we retrospectively analyzed 48 patients (5 males and 43 females, mean age 58.6 years) who had been operated on in our department. These patients were divided into two types according to the time of surgery or the clinical manifestation, and operative methods were analyzed. Patient's status such as bowel movement, body weight, and serum albumin value after surgery were analyzed, together with the patients survival. Our surgical methods were small intestinal resection for the intestinal obstruction, and pull-through reconstruction for proctitis. Two patients died of multiple organ failure caused by perforated peritonitis irrespective of emergent operation. Although the overall morbidity was 21.7%, there was no leakage when bowels were anastomosed. Overall survival after radiation-related complication in patients without previous neoplastic disease recurrence was 89%, 79%, and 69%, at 1, 3, and 5 years after surgery, respectively. Bowel motility, serum albumin level, and body weight recovered gradually soon after the operation and reached satisfactory levels within 6 months. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowel followed by careful anastomosis of the disease-free ends, while rectal resection is best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage.
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Affiliation(s)
- Hisashi Onodera
- Department of Surgery & Surgical Basic Science, Kyoto University, 54 Shogoin Kawara cho, Sakyo ku, Kyoto 606-8507, Japan
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Zhang B, Su YP, Ai GP, Liu XH, Wang FC, Cheng TM. Differentially expressed proteins of gamma-ray irradiated mouse intestinal epithelial cells by two-dimensional electrophoresis and MALDI-TOF mass spectrometry. World J Gastroenterol 2003; 9:2726-31. [PMID: 14669322 PMCID: PMC4612041 DOI: 10.3748/wjg.v9.i12.2726] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the differentially expressed proteins involved in ionizing radiation in mice and to explore new ways for studying radiation-related proteins.
METHODS: Bal B/c mice grouped as sham-irradiation, 3 h and 72 h irradiation were exposed to 9.0Gy single dose of γ-irradiation. Intestinal epithelia were isolated from mice, and total proteins were extracted with urea containing solution. A series of methods were used, including two-dimensional electrophoresis, PDQuest 2-DE software analysis, peptide mass fingerprinting based on matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and SWISS-PROT database searching, to separate and identify the differential proteins. Western blotting and RT-PCR were used to validate the differentially expressed proteins.
RESULTS: Mouse intestine was severely damaged by 9.0 Gy γ-irradiation. Image analysis of two-dimensional gels revealed that averages of 638 ± 39, 566 ± 32 and 591 ± 29 protein spots were detected in 3 groups, respectively, and the majority of these protein spots were matched. About 360 protein spots were matched between normal group and 3 h irradiation group, and the correlation coefficient was 0.78 by correlation analysis of gels. Also 312 protein spots matched between normal group and 72 h irradiation group, and 282 protein spots between 3 h and 72 h irradiation groups. Twenty-eight differential protein spots were isolated from gels, digested with trypsin, and measured with MALDI-TOF-MS. A total of 25 spots yielded good spectra, and 19 spots matched known proteins after database searching. These proteins were mainly involved in anti-oxidation, metabolism, signal transduction, and protein post-translational processes. Western-blotting confirmed that enolase was up-regulated by γ-irradiation. Up-regulation of peroxiredoxin I was verified by applying RT-PCR technique, but no change occurred in Q8VC72.
CONCLUSION: These differentially expressed proteins might play important roles when mouse intestine was severely injured by γ-irradiation. It is suggested that differential proteomic analysis may be a useful tool to study the proteins involved in radiation damage of mouse intestinal epithelia.
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Affiliation(s)
- Bo Zhang
- Institute of Combined Injury of PLA, Third Military Medical University, Chongqing 400038, China
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18
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Effect of Qingre Buyi Decoction on nitric oxide and histomorphology of intestinal mucosa in rats with radiation enteritis. Chin J Integr Med 2003. [DOI: 10.1007/bf02838564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Regimbeau JM, Panis Y, Gouzi JL, Fagniez PL. Operative and long term results after surgery for chronic radiation enteritis. Am J Surg 2001; 182:237-42. [PMID: 11587684 DOI: 10.1016/s0002-9610(01)00705-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND About one third of patients with chronic radiation enteritis will need to be operated on during follow-up. Morbidity and life expectancy after resection and conservative surgical management for chronic radiation enteritis have not been well documented. METHODS From 1984 to 1994, 109 patients were operated on with a mean follow-up of 40 months (range 1 to 293). Postoperative mortality, early and late morbidity, long-term survival were studied in patients after resection (n = 65) and after conservative surgical management (n = 42), and in patients after planned or emergency procedure. Existence of possible risk factors for reoperation after a first surgical procedure was analyzed. RESULTS Five (5%) patients died in the postoperative course. Operative mortality was significantly higher when the procedure was performed as an emergency (P <0.05). Although not statistically significant, mortality was higher in the resection group (5% versus 0%). Thirty-three (30%) patients experienced postoperative complications including anastomotic leak in 11. Morbidity was not statistically related to the nature of the treatment (ie, conservative versus resection) or to the indication (emergency versus elective). During follow-up, reoperation was required in 40% of the patients, because of recurrence of digestive symptoms suggestive of chronic radiation enteritis; the reoperation rate was higher in the patients of the conservative group (50% versus 34%). Overall survival, after a mean follow-up of 40 months in patients without cancer recurrence was 85% at 1 year and 69% at 5 years after surgery, respectively. Overall survival was influenced by the nature of the treatment with 51% and 71% 5-year survival after conservative and resection treatment, respectively. CONCLUSIONS Despite high initial mortality and morbidity rates, life expectancy in patients with chronic radiation enteritis without recurrence of their previous neoplastic disease was good. Resection seems to provide a smaller reoperation rate and a better 5-year survival, but a higher postoperative mortality.
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Affiliation(s)
- J M Regimbeau
- Department of Surgery, Lariboisiere Hospital, Paris, France
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20
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Mutlu-Türkoğlu U, Erbil Y, Oztezcan S, Olgaç V, Toker G, Uysal M. The effect of selenium and/or vitamin E treatments on radiation-induced intestinal injury in rats. Life Sci 2000; 66:1905-13. [PMID: 10821115 DOI: 10.1016/s0024-3205(00)00516-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cytotoxic effects of ionizing radiation on gastrointestinal epithelium may be related to oxidative stress. In this study, we wanted to investigate the effects of selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury. Irradiation caused increased lipid peroxide and decreased GSH levels in the intestine. Intestinal superoxide dismutase and glutathione peroxidase activities were increased, but glutathione transferase activity decreased following irradiation. Selenium and/or vitamin E pretreatments ameliorated these disturbances in prooxidant-antioxidant balance. This amelioriation has been verified with histopathological findings. These results indicate that antioxidant pretreatments prior to irradiation may have some beneficial effects against irradiation-induced intestinal injury.
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Affiliation(s)
- U Mutlu-Türkoğlu
- Department of Biochemistry, Istanbul Medical Faculty, University of Istanbul, Turkey.
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21
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Sezeur A, Martella L, Abbou C, Gallot D, Schlienger M, Vibert JF, Touboul E, Martel P, Malafosse M. Small intestine protection from radiation by means of a removable adapted prosthesis. Am J Surg 1999; 178:22-5; discussion 25-6. [PMID: 10456697 DOI: 10.1016/s0002-9610(99)00112-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A prosthesis has been designed to protect intestinal loops from radiation when postsurgical radiotherapy is necessary in cancer treatment. It is a silicone balloon that allows the small bowel to be pushed back away from the radiation field, and it is easily removed at the conclusion of radiotherapy. METHODS The device was used in 22 patients: 5 retroperitoneal tumors and 17 pelvic cancers. After surgical resection of the tumor, the device is placed either in the retroperitoneal area or in the pelvic cavity. A polyglactine 910 mesh is placed between the spacer and the bowel to prevent incarceration of the loops. The prosthesis can be filled or emptied between each radiation course and finally removed by means of a short incision under local or locoregional anesthesia. RESULTS The tolerance of the small intestine to radiation therapy has been satisfactory in each case, with a mean follow-up of 24.5 months (range 10 to 73). No modification of biological parameters was observed during the pelvic radiation therapy at 30, 45, and 65 Gy. CONCLUSION This device should appears to efficient for prevention of bowel injury during postsurgical radiation in successful treatment of abdominal, pelvic, or retroperitoneal tumors when indicated.
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Affiliation(s)
- A Sezeur
- Service de Chirurgie Générale, Hôpital Rothschild, Paris, France
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22
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Perrin, Panis, Messing, Matuchanski, Valleur. Aggressive initial surgery for chronic radiation enteritis: long-term results of resection vs non-resection in 44 consecutive cases. Colorectal Dis 1999; 1:162-7. [PMID: 23577765 DOI: 10.1046/j.1463-1318.1999.00037.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE One third of patients with chronic radiation enteritis will require surgery. There is, however, no consensus on the best surgical strategy. The long-term results of intestinal resection vs a `conservative' procedure, including stoma, bypass, and/or adhesiolysis, were reviewed with special reference to reoperation rates and the ultimate need for long-term parenteral nutrition. PATIENTS AND METHODS Forty-four patients operated for chronic radiation enteritis were divided into two groups: Group I resection (n = 21) and Group II conservative (n = 23). Twenty patients had received preoperative total parenteral nutrition, 16 (76%) in the resection group vs four (17%) in the conservative group (P < 0.001). In the resection group, intestinal resection was combined with a stoma in six patients. In the conservative group, 10 patients underwent adhesiolysis, five a bypass procedure, and eight diverting stoma. RESULTS Post-operative mortality was similar in both groups (9.5% vs 8.5%). Mean follow up was 53 and 55 months for Group I and Group II, respectively. The reoperation rate was significantly lower in Group I: 9 (47%) vs 19 (86%), P < 0.01. Although not significant, the ultimate need for long-term parenteral nutrition rate was lower in Group I than in Group II: 6 (32%) vs 10 (48%). CONCLUSION Resection resulted in better treatment outcomes than `conservative' surgery for chronic radiation enteritis.
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Affiliation(s)
- Perrin
- Department of Surgery, Lariboisière Hospital, Paris, France Department of Gastroenterology, Saint-Lazare Hospital, Paris, France
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23
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Leiper K, London IJ, Rhodes JM. Management of the first presentation of severe acute colitis. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1997; 11:129-51. [PMID: 9192065 DOI: 10.1016/s0950-3528(97)90058-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Prompt diagnosis and exclusion of infection requires a minimum of rigid sigmoidoscopy, rectal mucosal biopsy and stool culture. Admission to hospital is mandatory for patients with features of severe disease, or who are in their first attack of ulcerative colitis and have bloody diarrhoea, even if the criteria for severe disease are not met. Once admitted, the patient should be monitored by plain abdominal X-ray, full blood count, serum albumin and C reactive protein on alternate days; temperature and pulse rate should be recorded four times per day. Treatment should be instituted as soon as the diagnosis is made with an intravenous corticosteroid (hydrocortisone 100 mg intravenously, four times daily, or equivalent). Antibiotics may be included if infection cannot be confidently excluded. Free diet can be allowed but attention should be given to nutritional, fluid and electrolyte status with intravenous replacement if necessary. Any evidence of colonic dilatation occurring despite maximal therapy should be regarded as an absolute indication for colectomy. The patient should be kept fully informed from an early stage about the likely natural history of the condition and about the possible therapeutic options including surgery. Cyclosporin therapy should be reserved for patients who have a poor response to the first 3-4 days of corticosteroid therapy, particularly those with serum C reactive protein > 45 mg/l and who do not yet have absolute indications for colectomy. Most patients who have not convincingly responded within 10 days of starting full medical therapy should undergo colectomy, although partial responders who are afebrile may reasonably continue for up to 14 days before a final decision. Approximately 30-40% of patients with severe colitis will need colectomy within the first 6 months. With optimal management, mortality should be zero, but better medical therapies are urgently needed to reduce the colectomy rate.
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Affiliation(s)
- K Leiper
- Department of Medicine, University of Liverpool, UK
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Silvain C, Besson I, Ingrand P, Beau P, Fort E, Matuchansky C, Carretier M, Morichau-Beauchant M. Long-term outcome of severe radiation enteritis treated by total parenteral nutrition. Dig Dis Sci 1992; 37:1065-71. [PMID: 1618054 DOI: 10.1007/bf01300288] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The outcome of 31 patients with severe radiation enteritis treated by total parenteral nutrition (TPN) was analyzed. Before initiation of parenteral nutrition, 18 of the patients had not had abdominal surgery, while 13 had either a resection or an intestinal bypass for radiation enteritis. Median follow-up was 2 1/2 years (range: 1 month to 12 years) from the time of initiation of parenteral nutrition. Surgery was required in 15 cases because parenteral alimentation could not be continued. Only eight of these 15 were able to resume a normal oral intake. Total parenteral nutrition allowed oral feeding to be resumed in 11 (36%) after a median follow-up of 40 months (range: 6-142 months). In general, total parenteral nutrition was well tolerated and was associated with low morbidity. Eighteen patients died, 13 of complications due to radiation therapy, four of cancer recurrence, and one of an unrelated cause. Survival probability was 58% at one year and 36% at five years. When possible, prognostic factors present either before or at initiation of total parenteral nutrition were analyzed. Age, predisposing vascular factors (hypertension, diabetes mellitus, or vascular disease), and enteric fistula and/or perforation were found to have prognostic value. The probability of clinical radiation enteritis recurrence was 34% at one year and 47% at two years. A clinical recurrence of symptoms was more frequent but not significantly so after parenteral nutrition as compared to surgical therapy of radiation enteritis. Although TPN corrected denutrition and allowed deferred surgery in some patients, severe radiation enteritis remains a poorly predictable progressive disease with numerous relapses.
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Affiliation(s)
- C Silvain
- Service d'Hépato-gastroentérologie et d'Assistance Nutritive, Hôpital Jean Bernard, Poitiers, France
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25
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Narayanan R, Bhargava B. Short-bowel radiation injury. Lancet 1989; 2:873. [PMID: 2571807 DOI: 10.1016/s0140-6736(89)93049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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