Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin‐converting enzyme 2 (ACE2). As a result of SARS‐CoV‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT₁R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT₁R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects, helpful in mitigating COVID‐19 severity.

Single Stapler Parachute Technique (SSPT): a new procedure for large hemorroidal prolapse

Procedure for Prolapse and Hemorrhoids (PPH or Longo procedure), a stapled circumferential anal mucosectomy, has proven to be very popular as it is considered safe and successful. However, a high haemorrhoid recurrence rate is reported, specially due to insufficient mucosal resection. The authors have come up with a technical modification to the mucoprolapsectomy, notably the Single Stapler Parachute Technique (SSPT), in order to obtain more abundant mucosal resection. In this study they will present the results obtained in 80 patients treated for muco-haemorrhoidal prolapse, 40 of whom underwent traditional PPH, while the remaining 40 patients underwent SSPT, both performed in two different specialised centres located in Rome, Italy.

Feasibility of stapled haemorrhoidopexy in day surgery

The aim of this study was to report the results of a stapled haemorrhoidopexy for patients with second to fourth degree of rectal prolapse, with reference to its feasibility as a day-surgery procedure. Between January 2005 and December 2007, 203 patients with symptomatic hemorrhoids have been operated for stapled haemorrhoidopexy. Surgery was performed between the 8:00 to 9:00 am using a standard sedation and a regional perianal local block. All the patients were discharged from the hospital at 18:00 of the same day of the surgery. Postoperative analgesia with a disposable device for infusion, after 24 hours was removed at home. Four patients after 3 hours from the operation have had an anal bleeding in the hospital. Four patients have had an anal bleeding at home during the night. One patient has had an important anal pain at home during the night. Stapled haemorrhoidopexy in day surgery may be a viable addition to the therapy for rectal prolapse with the advantages of an early discharge and a lower cost than a longer hospitalization. With this procedure, performed in a single day, we provided a value-added service to the patients with less cost and without a significant compromise on safety and efficacy.

Fissurectomy with posterior midline sphincterotomy and anoplasty (FPSA) in the management of chronic anal fissures

Although lateral internal sphincterotomy is widely accepted as the treatment of choice for anal fissures, we report our experience of successfully treating 195 consecutive patients with posterior chronic anal fissures by performing fissurectomy with midline sphincterotomy and anoplasty (FPSA). The surgical technique is described and its indications and results are briefly discussed.

The biofragmentable anastomosis ring in elective colon resections

METHODS

Sixty-eight patients underwent elective colon resection and intraperitoneal anastomosis with the biofragmentable anastomosis ring (BAR).

RESULTS

Anastomotic dehiscence occurred in 3 patients (4.4%). Two of them had an end-to-end ileocolostomy using a 31 mm BAR. The anastomosis failure was due to ischaemic lesion of the small bowel close to the ileocolostomy, probably caused by a mismatch between the size of small bowel and that of the BAR. Another patient experienced anastomosis dehiscence probably due to a faecal impaction into the BAR. Forty-eight patients (70.5%) experienced troublesome constipation and evacuated after the sixth postoperative day. A bowel obstruction proximal to the BAR was documented in 4 cases who have been treated conservatively.

CONCLUSIONS

The low rate of major complications justify the use of the BAR in elective colon surgery, but the surgeon must be aware of tedious postoperative obstructive episodes frequently encountered in this series.

[Hemorrhoidectomy by a modified Lentini method. The authors' own caseload]

Haemorrhoidectomy by high-frequency electric bistoury was introduced by Prof. Lentini: this technique is based on the capacity of this electric bistoury to make an effective coagulation avoiding ligatures. The authors describe a new technique by the same electric bistoury introducing principles of the French school and discuss the results of their experience.

[Complex perianal fistula: diagnosis and treatment]

After a detailed discussion of the question of perianal fistulas, the authors use their own experience to examine complex perianal fistulas (trans-sphincteric with involvement of the puborectal muscle, high intersphincteric, extrasphincteric and supersphincteric) which represent 5-15% of cases. They affirm that elective treatment consists of surgical silk to ensure the optimal drainage of the fistula and provoke sclerosis of adjacent tissues, followed after 9 weeks by either the slow section of the fistula using a silicone ligature or direct fistulotomy. No cases of incontinence or recidivation were observed using this method in 29 cases treated between 1990 and 1992 who were followed up for between 6-24 months.

Is acetylcholine release from striatal nerve endings regulated by muscarinic autoreceptors?

The presence in cholinergic nerve endings of muscarinic autoreceptors regulating the release of acetylcholine elicited by depolarizing stimuli was investigated in different areas of the rat brain. Synaptosomes prepared from cerebral cortex, hippocampus or corpus striatum were prelabeled with [3H]choline and the inhibitory effect of exogenous acetylcholine on the Ca2+-dependent release of [3H]acetylcholine evoked by 15 mM KCl was analyzed by superfusion. While acetylcholine was equally active in reducing its own release in hippocampus and cortex, it was much less effective in striatal synaptosomes. In contrast the values of several presynaptic cholinergic parameters ([3H]choline uptake, [3H]acetylcholine synthesis and release) were the highest in the striatum. Since experiments with slices showed that autoregulation of acetylcholine release through muscarinic receptors appeared to occur as efficiently in the striatum as in the two other areas, the present results suggest that in the striatum the autoregulation of acetylcholine release may not necessarily require the activation of autoreceptors located on cholinergic nerve terminals.

Calcium-dependent [3H]acetylcholine release and muscarinic autoreceptors in rat cortical synaptosomes during development

A number of presynaptic cholinergic parameters (high affinity [3H]choline uptake, [3H]acetylcholine synthesis, [3H]acetylcholine release, and autoinhibition of [3H]acetylcholine release mediated by muscarinic autoreceptors) were comparatively analyzed in rat brain cortex synaptosomes during postnatal development. These various functions showed a differential time course during development. At 10 days of age the release of [3H]acetylcholine evoked by 15 mM KCl from superfused synaptosomes was Ca2+-dependent but insensitive to the inhibitory action of extrasynaptosomal acetylcholine. The muscarinic autoreceptors regulating acetylcholine release were clearly detectable only at 14 days, indicating that their appearance may represent a criterion of synaptic maturation more valuable than the onset of a Ca2+-dependent release.

Gonadal influences on the sexual differentiation of monoamine oxidase type A and B activities in the rat brain

The sex-dependent differentiation of monoamine oxidase (MAO) in the hypothalamus of 60-day-old, Charles River rats was found to involve only type A (MAO-A), and not type B (MAO-B) enzyme. In vivo inhibition of type A by clorgyline, and type B by (--)deprenyl, however, tended to decrease the specific activity of both types of MAO to a smaller extent in the female than in the male hypothalamus. When masculinization was prevented by neonatal administration of estradiol (E) to males, hypothalamic MAO-A and MAO-B activities increased in both control and MAO-inhibited rats. Androgenization of females, however, had little effect on the MAO activity. Whereas the effects of neonatal estrogenization were attributable neither to a direct influence of E nor to a sexual difference in the peripheral clearance of the MAO-inhibitor used, single, high doses of steroids to adult, but not to newborn rats, did acutely affect the kinetics of MAO-A. The activity of MAO-A was also decreased by high concentrations of E or TS in vitro. The imprinting for patterns of hypothalamic MAO-A and MAO-B in the two sexes results, probably, from genetic predetermination. Neonatal changes in the homeostasis of gonadal hormones may result in type-MAO nonspecific effects in adulthood, whereas the short-term effects of high concentrations of steroids may be selective for the A form.