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Background: Horseshoe fistula is a challenging benign anorectal condition to treat. The aim of this study was to assess the utilization and success of different definitive fistula repair techniques in the treatment of horseshoe fistula., Methods: This was a retrospective case series which included all patients who were treated for horseshoe fistula from 2006 to 2019 at a single, tertiary care center and whom had at least one follow-up visit. Patients were excluded if < 18 years of age or carried a diagnosis of Crohn's disease. Patients were assessed for fistula recurrence and incontinence., Results: Sixty-eight patients were identified. On average, they were 47 years old, 63% male, and 18% current smokers. Seventy-nine percent required seton during their treatment course. Of the 8 first attempts at fistula repair, the types of repair included flap (15%), LIFT (35%), fistulotomy (31%), plug (12%), and fistulotomy and immediate reconstruction (1%). Recurrence for these procedures was as follows: flap 30%, LIFT 21%, fistulotomy 14%, plug 88%, and fistulotomy and immediate reconstruction 0%. Twelve patients who recurred underwent 17 additional procedures to attempt to cure their fistula. Overall, of those who underwent any attempt at definitive repair, 82% of patients were cured of their fistula, 12% had a chronic seton, and 6% had a chronic fistula. Thirteen percent of those who were cured had incontinence. The mean follow-up time was 1.1 years. Patients required a median of 3 procedures (range 1-11)., Conclusion: Horseshoe fistula remains a complex anorectal condition. Successful repair can be performed in > 80% of patients. However, repair can often require multiple surgical procedures., (© 2021. The Society for Surgery of the Alimentary Tract.)

Background: Arterial hypertension (AH) is associated with heart and chronic kidney disease (CKD). However, the precise mechanisms of myocardial remodeling (MR) in the settings of CKD remain elusive. We hypothesized that TRPC6, calcineurin/NFAT, and Wnt/β-catenin signaling pathways are involved in the development of MR in the background of CKD and AH., Methods: Early CKD was induced by performing a 5/6 nephrectomy (5/6NE) in spontaneously hypertensive rats (SHR-NE). Sham-operated (SO) SHR (SHR-SO) and Wistar Kyoto (WKY-SO) rats served as controls. Systolic blood pressure (SBP), heart rate, myocardial mass index (MMI), serum creatinine, cardiomyocyte diameter (dCM), myocardial fibrosis (MF), serum and kidney α-Klotho levels, myocardial expression of calcineurin (CaN), TRPC6, and β-catenin were measured two months after 5/6NE or SO., Results: NE-induced kidney dysfunction corresponded to mild-to-moderate human CKD and was associated with an increase in FGF23 and a decrease in renal α-Klotho. The levels of SBP, MMI, dCM, and MF were higher in SHRs compared to WKY-SO as well as in SHR-NE vs. SHR-SO. The MR was associated with increased cardiomyocyte expression of CaN/NFAT and β-catenin along with its intracellular re-distribution. TRPC6 protein levels were substantially elevated in both SHR groups with higher Trpc6 mRNA expression in SHR-NE., Conclusions: The Wnt/β-catenin and TRPC6/CaN/NFAT hypertrophic signaling pathways seem to be involved in myocardial remodeling in the settings of AH and CKD and might be mediated by FGF23 and α-Klotho axis.

Background: We hypothesized that increasing body mass index is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of body mass index and surgical complications following surgery for diverticular disease., Methods: We used National Surgical Quality Improvement Program database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their body mass index (< 18.5, 18.6-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, 50.0-54.9, > 55). Outcomes of interest were complications of superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, pneumonia, ventilator dependence > 48 hours, acute renal failure, myocardial infarction, return to operating room, and 30-day mortality., Results: Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher American Society of Anesthesiologists classification and were more likely to have emergency and open cases. Interestingly, increased body mass index was inversely associated with age. Increasing body mass index was associated with worse outcomes including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to operating room. Risk of developing pneumonia didn't have similar correlation with body mass index. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of myocardial infarction were noted. Underweight patients also developed worse outcomes., Conclusion: Obesity is associated with a number of complications following surgery for diverticulitis. Elevated body mass index adds significant risk to procedures for diverticulitis and should be accounted for in risk stratification models. Patients should be counseled on weight reduction before undergoing elective surgery for diverticular disease., (© 2019 The Authors.)

Aging causes significant changes in the kidneys. One of the most important manifestations of an aging kidney is a reduction in glomerular filtration rate (GFR). Unfortunately, there is no generally accepted, adequate method for evaluating GFR in the elderly. The perspectivies of the relatively new approaches (BIS1, BIS2, FAS) are not clear and doubtful. The feasibility of standardization of GFR values by body surface area among of the older persons has not been determined. Possible that the diagnosis setting «chronic kidney disease» in elderly solely on the base of GFR decline may be an inadequate approach and promote a kind of «nephrological ageism».

Psychiatric disorders may be more common in burn-injured subjects than in the general population, and oftentimes contribute to the injury itself. Even in the absence of underlying psychiatric illnesses, burn patients may still benefit from a psychiatric evaluation during and after their hospitalization. In this regard, we included a dedicated psychiatry service in our multidisciplinary burn team. We review herein the course of burn patients that were offered psychiatric evaluation and highlight the benefits of such a program. We conducted an IRB-approved retrospective chart review of burn subjects admitted to our institution between June 15, 2009 and April 30, 2010 and identified 83 patients that were examined by our psychiatrist. Indications for consultation, history of psychiatric illness and substance abuse, as well as administered drugs, were recorded. Among the 83 evaluated patients, 48 (57.8%) had a preexisting psychiatric disorder and 36 (43.4%) suffered from substance abuse. The most common indications for consultation were pain (28.1%), alcohol dependence (25.8%), anxiety (24.7%), illicit drug abuse (16.8%), depression (15.7%), post-traumatic stress disorder (8.9%), and sleep disturbances (8.9%). Pharmacotherapy was initiated in 75 patients (90.3%). 31 (37.3%) had neither a psychiatric disorder nor a history of substance abuse, although 26 of them (83.9%) still received drugs for psychiatric conditions. The inclusion of a dedicated psychiatrist as part of our burn team has improved our comprehensive burn care. In the overwhelming majority of cases, even in the absence of preexisting psychiatric illnesses, consultation resulted in pharmacologic intervention and enhanced patient care.

Apomyolgobin (apoMb) is an important model for understanding the folding mechanism of helical proteins. This study focuses on a partially structured state of sperm whale apoMb populated at pH 4.2 (M-state), which structurally resembles a late kinetic intermediate in the formation of the native state (N) at higher pH. The thermodynamics and cooperativity of apoMb folding at pH 4.2 and 6.2 were studied by global analysis of the urea-induced unfolding transitions monitored by tryptophan fluorescence and circular dichroism. The kinetics of folding and unfolding of apoMb at pH 4.2 was measured over a time window from 40 to 850 μs, using fluorescence-detected continuous-flow measurements. Our observation of biphasic kinetics provides clear evidence for rapid (<100 μs) accumulation of previously unresolved intermediate states in both refolding and unfolding experiments. Quantitative kinetic modeling of the results, using a four-state mechanism with two intermediates on a direct route between the unfolded and folded states (U↔I↔L↔M), gave new insight into the conformational states and barriers that precede the rate-limiting step in the formation of the N-state of apoMb.

The authors summarize theoretical principles of increasing human resistence to toxic effects of inorganic compounds polluting occupational environment and habitat, exemplify practical use of this prophylactic trend.

The paper presents experimental and theoretical rationales for some methods and means of biological prevention of the toxic effects of a number of heavy metals (lead, chromium, arsenic, cadmium) that pollute the environment. Subchronic experiments were made on laboratory animals exposed to the above substances in combination with various biological agents (sodium glutaminate, the adaptogen saparal, pectin-containing enterosorbent, calcium, the multivitamin-multimineral preparation Pikovit, etc.). They have indicated that the complex use of preparations is more beneficial than they are used alone. The results of controlled trials of biologically preventive preparations on children residing in an area exposed to industrial pollution are presented.

The experiments on animals studied mutagenic activity of copper-nickel sulfide ore dust. Micronucleus test proved mild mutagenic activity of the ore under study. Chronic inhalation of the dust induced malignancies (mostly lung tumors and leukoses) in 52% of the experimental Wistar rats, that could be caused by dissolution of the dust components in the body fluids.

The study proved that the dust extracted from "Oktjabrsky" mine and containing 83.25% of nickel have marked carcinogenic effects, induces lung tumors and leukosis, if administered intratracheally to Wistar rats. Diagnosed leukosis suggests that carcinogens of the ores dissolve in the tissue liquids and circulate in the body.

Chronic experiment confirmed blastomogenic effect of nickel-containing dust. Hemoblastoses were most frequent of the blastomas. There were also adenocarcinomas, pulmonary adenomas and carcinomas, renal adenocarcinoma, cortical adenoma. The dust with nickel and resinous fraction had most activity.

The enzymatic activity/succinate-, lactate-, NADP-H2- and NAD-H2-dehydrogenase, alkali and acidic phosphatase/in renal and hepatic tissues has been studied on subtotally nephrectomized rats. Activation of hepatic functions and metabolism has been shown to occur during the development of experimental chronic renal insufficiency.

The vein contractility was shown not to depend on the nitrogen-excreting function of kidneys in rats with subtotal nephrectomy. The role of veins' increasing functional activity in the organism's compensatory-adaptive response after a decrease in renal functioning parenchymal mass, is discussed.

Mutagenic activity of 3 samples of nickel-containing dusts was experimentally studied in white random-bred rats. Quantity of micronuclei in polychromatophilic erythrocytes of bone marrow smear depended on nickel dust content. Micronuclear test could be used as a rapid method for the determination of potential carcinogenic activity of polymetallic nickel-containing dusts and also as a factor confirming oncologic hazard of chemical substances combined with epidemiologic studies and chronic experiment on animals.