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      Histological analysis of the intestinal wall of newborn rats submitted to hypoxia and reoxygenation to evaluate the protective effect of N-Acetylcysteine

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          Abstract

          Abstract Purpose To evaluate the effect of N-Acetylcysteine (NAC) in newborn rats submitted to hypoxia and reoxygenation (H/R) conditions in an experimental model of necrotizing enterocolitis. Methods Eight pregnant rats and their 70 cubs were used (5 groups) and exposed to H/R conditions and received NAC at different times. The animals in the H/R groups were placed in a gas chamber (100% CO2) for 10 minutes and then reoxygenated for 10 minutes (100% O2), twice a day for the first three days of life, with a six-hour span between events. On the third day of life, the animals were anesthetized, laparotomized and the intestines were resected. Results The H/R and NAC groups showed changes in the intestinal wall in relation to the number, height and width of the villi when compared to the control group (p<0.0001), but with better preservation of structures in the NAC group. There were no differences between groups regarding the number (%) of mitoses. Conclusion The administration of NAC decreased the lesions in the intestinal wall of rats submitted to H/R, therefore suggesting that this drug can be used to prevent the development of necrotizing enterocolitis in newborns.

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          Necrotising enterocolitis.

          Necrotising enterocolitis is one of the most common gastrointestinal emergencies in newborn infants. Here we review the epidemiology, clinical presentation, and pathophysiology of the disease, as well as strategies for diagnosis, management, and prevention. Necrotising enterocolitis is one of the most devastating and unpredictable diseases affecting premature infants. Despite decades of research, its pathogenesis remains unclear; diagnosis can be difficult; and treatment is challenging. We will need to improve our understanding of intestinal defences in premature infants, dietary and bacterial factors, and genetic effects that could predispose infants to necrotising enterocolitis before we can develop new strategies for prevention and treatment.
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            Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies

            Background Necrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality. Better insight into prognostic values of the many reported factors associated with NEC is needed to enable identification of neonates at risk for NEC. The aim was to systematically review the literature to identify independent risk factors for NEC from the literature. Methods Medline, Cochrane, Embase, Pubmed and Google Scholar were searched systematically for cohort studies reporting prognostic factors for NEC in neonates using multivariable analysis. Studies were scored with the Quality In Prognosis Studies tool (QUIPS). Results From 5154 initial hits, 14 prognostic studies were included, with various designs. Study quality was rated high in three studies, moderate or low in the 11 others. Significant prognostic factors for NEC reported in at least two studies were: low birth weight, small for gestational age, low gestational age, assisted ventilation, premature rupture of membranes, black ethnicity, sepsis, outborn, hypotension (all increased risk), surfactant therapy (conflicting results) and cesarean section (lower risk). Meta-analysis was considered not feasible. Conclusion High quality studies on prognostic factors for NEC are rare. Several prognostic factors, that are not necessarily causal, are associated with NEC. High quality prognostic research is necessary to establish the predictive values of these factors. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0847-3) contains supplementary material, which is available to authorized users.
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              The sequence of development of intestinal tissue injury after strangulation ischemia and reperfusion.

              Tissue injury at reperfusion has been reported after partial ischemia. However, previous attempts to demonstrate a component of injury caused by reperfusion after total ischemia have failed. This study was performed to evaluate the hypothesis that in such situations the extent of the tissue injury caused by ischemia itself prevented detection of a reperfusion component. Rats were subjected to near-total intestinal ischemia by means of a hydrostatic pressure clamp that produced preferential venous occlusion (strangulation) for periods from 1 to 90 minutes. Tissue injury was evaluated microscopically by a blinded examiner. Ischemic periods of 20 minutes or less did not induce detectable tissue injury. Longer durations of ischemia caused villous injury: the longer the period of ischemia, the more extensive the tissue injury. However, there was no exacerbation of injury seen after reperfusion, regardless of the duration of ischemia. In a separate series of rats, total arterial occlusion was employed without concomitant venous congestion. Such isolation arterial occlusion of 40 to 60 minutes' duration was followed by a statistically significant exacerbation of tissue injury at reperfusion. Thus total intestinal ischemia may be followed by reperfusion injury if there is no concomitant congestion and if ischemic injury is not too extensive.
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                Author and article information

                Journal
                acb
                Acta Cirurgica Brasileira
                Acta Cir. Bras.
                Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo, SP, Brazil )
                0102-8650
                1678-2674
                2020
                : 35
                : 4
                : e202000401
                Affiliations
                [2] Sao Paulo SP orgnameUNIFESP orgdiv1Department of Obstetrics Brazil
                [4] Sao Paulo SP orgnameUNIFESP orgdiv1Division of Pediatric Surgery Brazil
                [6] Sao Paulo SP orgnameUNIFESP orgdiv1Department of Obstetrics Brazil
                [5] orgnameUniversidade de São Paulo orgdiv1Division of General and Trauma Surgery Brazil
                [3] Sao Paulo SP orgnameUNIFESP orgdiv1Department of Morphology and Genetics Brazil
                [7] Sao Paulo SP orgnameUNIFESP orgdiv1Division of Pediatric Surgery Brazil
                [1] orgnameUniversidade Federal de São Paulo orgdiv1Postgraduate Program in Obstetrics Brazil
                Article
                S0102-86502020000400206 S0102-8650(20)03500400206
                10.1590/s0102-865020200040000001
                15094acb-7994-49c6-962e-bdf3b9c981df

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 11 March 2020
                : 12 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 0
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Original Articles

                Rats,Enterocolitis, Necrotizing,Hypoxia,Acetylcysteine
                Rats, Enterocolitis, Necrotizing, Hypoxia, Acetylcysteine

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