Microbiota Implementation to Reduce Anastomotic Colorectal Leaks (MIRACLe)
Ontology highlight
ABSTRACT:
DISEASE(S): Microbial Substitution,Colorectal Cancer,Lap,Anastomotic Leak
PROVIDER: 2398917 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Surgical treatment of colorectal diseases typically involves excising the diseased portion of the bowel and anastomosing the remaining sections to re-establish continuity. Surgical suturing has limitations in preventing anastomotic leakage and postoperative adhesion. To address these challenges, a tissue-adhesive, antibacterial, and antioxidant hydrogel was designed to cover and seal colorectal anastomotic wounds. The hydrogel was formed in situ by simply mixing oxidized hyaluronic acid (OHA), adipic acid dihydrazide-modified hyaluronic acid (HA-ADH), ε-poly-L-lysine (ε-PLL), and tannic acid (TA). The hydrogel exhibited a rapid gelation rate and self-healing ability. Compared with commercial fibrin glue, the hydrogel had superior tissue adhesive strength and wound sealing performance. The hydrogel displayed potent reactive oxygen species scavenging ability and antibacterial activity against both gram-positive and gram-negative bacteria. The hydrogel also exhibited good biodegradation and biocompatibility. In a cecum-abdominal wall adhesion model in rats, the hydrogel attached firmly to the injured tissues and served as a physical barrier to prevent adhesion formation. In anastomotic leakage models after colon resection in rats and rabbits, the hydrogel effectively sealed the anastomotic leakage, prevented postoperative adhesion, and promoted anastomotic healing. Thus, this multifunctional hydrogel has strong clinical potential for preventing anastomotic leakage and adhesion formation after colorectal surgery.
2025-11-05 | GSE281599 | GEO
Project description:Anastomotic leakage is serious morbidity that can develop in patients operated on for colorectal cancer and can reach potentially life-threatening dimensions. Many international studies have been conducted to reduce and eliminate this postoperative complication that may have a mortal course. In these studies, preoperative, perioperative and postoperative factors of the patient, operation techniques, structure of the material used in the operation and multiple factors belonging to the surgeon were held responsible. Intraabdominal sepsis secondary to late anastomotic leakage and subsequent multiorgan failure can cost the patient’s life. Anastomotic leaks that develop in patients who have been operated for colorectal cancer; In order to detect patients’ postoperative clinical findings, laboratory examinations, imaging tests, and to eliminate them before intraabdominal sepsis develops, studies including many different laboratory and imaging methods have been carried out. Although previous studies have shown that there are many laboratory examinations and imaging methods that can predict anastomotic leaks early, they have many advantages over each other in terms of efficiency, sensitivity, specificity, and cost.
The investigators aimed to investigate the effectiveness of C reactive protein and blood sodium value, as well as their superiority, among the tests that can predict postoperative anastomotic leakage, especially in patients who have undergone a single anastomosis following resection for non-metastatic colorectal cancer.
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Project description:Feed-additive probiotics accelerate yet antibiotics delay intestinal microbiota maturation in broiler chicken
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Project description:Background: Clinical failure of arteriovenous fistulae (AVF) is frequently due to juxta-anastomotic neointimal hyperplasia (JANIH). Although the mouse AVF model recapitulates human AVF maturation, previous studies focused on the outflow vein distal to the anastomosis. We hypothesized that the juxta-anastomotic area (JAA) has increased NIH compared to the outflow vein. Method: AVF were created in C57BL/6 mice without or with chronic kidney disease (CKD). Temporal and spatial changes of the JAA were examined using histology and immunofluorescence. Computational techniques were used to model the AVF. RNA-seq and bioinformatic analyses were performed to compare the JAA with the outflow vein. The jugular vein to carotid artery AVF model was created in Wistar rats. Result: The neointima in the JAA shows increased volume compared to the outflow vein. Computational modeling shows increased volume of disturbed flow at the JAA compared to the outflow vein. Endothelial cells are immediately lost from the wall contralateral to the fistula exit, followed by thrombus formation and JANIH. Gene Ontology (GO) enrichment analysis of the 1862 differentially expressed genes (DEG) between the JANIH and the outflow vein identified 525 overexpressed genes. The rat jugular vein to carotid artery AVF showed changes similar to the mouse AVF. Conclusion: Disturbed flow through the JAA correlates with rapid endothelial cell loss, thrombus formation, and JANIH; late endothelialization of the JAA channel correlates with late AVF patency. Early thrombus formation in the JAA may influence later development of JANIH.
2023-12-08 | GSE249267 | GEO
Project description:FastQ files from 16S sequencing of fecal samples from pancreatic cancer xenografted mice not treated (CTRL) and treated with chemotherapy (GEM+nab-PTX), probiotics (PRO) and chemotherapy + probiotics (GEM+nab-PTX+PRO)
2024-09-14 | E-MTAB-12171 | biostudies-arrayexpress
Project description:The study is based on the hypothesis that patients with postoperative anastomotic leakage have a different bacterial profile contributing to poor tissue healing, and that patients operated for colon cancer presumably have a different preoperative microbiota than healthy patients. This different composition is probably induced by the high heme level in the light intestinal tract that tumor spoliation generates.
The objective of the study is to evaluate the feasibility of a larger study to evaluate the difference between microbiota composition of patients with and without colorectal cancer, with inflammatory bowel disease and those with and without anastomotic leakage postoperatively of a colonic resection.
Stool samples will be taken from 20 patients, including 5 without intestinal pathology, 5 with colorectal cancer undergoing colorectal surgery, 5 with inflammatory bowel disease and 5 with anastomotic leakage after colectomy for colorectal cancer or inflammatory bowel disease.
The stool samples will be analyzed at CRCHUM to draw up a profile of the bacteria that make up the microbiota of each patient.
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Project description:This study aims to demonstrate that a preoperative combination of mechanical bowel preparation and oral antibiotics, before elective laparoscopic colon cancer surgery, is associated with a reduction of postoperative surgical site infection rate, as compared to mechanical bowel preparation alone, oral antibiotics alone, or no colonic preparation.
Our Hypothesis is that a preoperative colonic preparation including a combination of mechanical bowel preparation and oral antibiotics before elective laparoscopic colon cancer surgery is associated with a reduced rate of 30-day postoperative surgical site infection, as compared to mechanical bowel preparation alone, oral antibiotics alone, or no colonic preparation.
| 2269131 | ecrin-mdr-crc
Project description:Interventions: Drug : 1. experimental group (A)
- mechanical bowel preparation (PEG) + IV antibiotics
2. control group (B)
- mechanical bowel preparation (PEG) + IV antibiotics + oral antibiotics (rifaximin + metronidazole)
3. pre-operative preparation
3.1. mechanical bowel preparation
- PEG prefered
- water only permitted on the day before operation
3.2. oral antibiotics
- 14, 16, 22 hour the day before surgery
- 400mg rifaximin + 500mg metronidazole
3.3. IV antibiotics
- 2nd generation cephalosporin
- venous injection within 30 minutes before surgery
- additional dose is at the discretion of the operators
Primary outcome(s): surgical site infection rate during first 30 days
Primary Purpose : Prevention, Intervention Model : Factorial, Blinding/Masking : Open, Allocation : RCT
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Project description: Not available
| S-EPMC9174113 | biostudies-literature
Project description:BackgroundLarge-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe Anastomosis proGramme in CoLorectal SurgEry (EAGLE), intended to reduce anastomotic leak following right colectomy, and reflect on lessons learned about the implementation of quality improvement programmes on an international scale.MethodsSurgical units were recruited and randomised in batches to receive a hospital-level education intervention designed to reduce anastomotic leak, either before, during, or following data collection. All consecutive patients undergoing right colectomy were included. Online learning, patient risk stratification and an in-theatre checklist constituted the intervention. The study was powered to detect an absolute risk reduction of anastomotic leak from 8.1 to 5.6%. Statistical efficiency was optimised using an incomplete stepped wedge trial design and study batches analysed separately then meta-analysed to calculate the intervention effect. An established collaborative group helped nurture strong working relationships between units/countries and a prospectively designed process evaluation will enable evaluation of both the intervention and its implementation.ResultsThe batched trial design allowed sequential entry of clusters, targeted research training and proved to be robust to pandemic interruptions. Staggered start times in the incomplete stepped wedge design with long lead-in times can reduce motivation and engagement and require careful administration.ConclusionEAGLE's robust but flexible study design allowed completion of the study across globally distributed geographical locations in spite of the pandemic. The primary outcome analysed in conjunction with the process evaluation will ensure a rich understanding of the intervention and the effects of the study design.Trial registrationNational Institute of Health Research Clinical Research Network portfolio IRAS ID: 272,250. Health Research Authority approval 18 October 2019.Clinicaltrialsgov, identifier NCT04270721, protocol ID RG_19196.
| S-EPMC10184073 | biostudies-literature