Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review

Background

The primary therapeutic strategy for the management of bile duct stones (BDS) is endoscopic retrograde cholangiopancreatography. However, there may be a recurrence of BDS on follow-up. Multiple risk factors have been studied for the prediction of BDS recurrence. We aimed to analyze the incidence of symptomatic BDS recurrence, systematically review the risk factors, and analyze the most important risk factors among those.

Methods

A comprehensive search of three databases was conducted from inception to November 2022 for studies reporting the recurrence of BDS recurrence after endoscopic retrograde cholangiopancreatography with clearance, along with an analysis of risk factors.

Results

A total of 37 studies with 12,952 patients were included in the final analysis. The pooled event rate for the recurrence of BDS stones was 12.6% (95% confidence interval: 11.2-13.9). The most important risk factor was a bile duct diameter ≥15 mm, which had a significant association with recurrence in twelve studies. Other risk factors with significant association with recurrence in three or more studies were the reduced angulation of the bile duct, the presence of periampullary diverticulum, type I periampullary diverticulum, in-situ gallbladder with stones, cholecystectomy, multiple stones in the bile duct, use of mechanical lithotripsy, and bile duct stent placement.

Conclusion

Around one out of seven patients have BDS recurrence after the initial endoscopic retrograde cholangiopancreatography. Bile duct size and anatomy are the most important predictors of recurrence. The assessment of risk factors associated with recurrence may help keep a close follow-up in high-risk patients.

Successful Endoscopic Treatment of a Pancreatic Pseudocyst in a Patient with Situs Inversus Totalis and Upper GI Duplication

BACKGROUND Duplication of the gastrointestinal tract is a rare congenital malformation that can develop in any part of the digestive tract. These duplications may be asymptomatic into adult age. Situs inversus totalis is a rare congenital anomaly characterized by a mirror transposition of thoracic and abdominal organs. We present a case of a pancreatic pseudocyst in a patient with a combination of situs inversus totalis and doubling of the esophagus, stomach, and first part of the duodenum. CASE REPORT A 64-year-old woman presented with epigastric pain. Abdominal computed tomography revealed a pancreatic pseudocyst and a previously identified duplication of the esophagus, stomach, and duodenum with situs inversus totalis. The patient underwent esophagogastroduodenoscopy (EGD) with endoscopic ultrasonography for pseudocyst drainage. During EGD, a bifurcation of the esophagus was found. Duplication of the esophagus, stomach, and first part of the duodenum was evident on further advancement. A week later, there was repeated filling of the pseudocyst with a liquid component, and the patient underwent cystogastrostomy with stenting. Five months after discharge, the stent was removed without complications. CONCLUSIONS Duplication of the gastrointestinal tract and situs inversus totalis are very rare congenital malformations that require early diagnosis. While situs inversus totalis does not represent any medical disadvantage, physicians should be aware of abnormal anatomy before procedures to prepare specialists for this in case of the need for special techniques. Endoscopic treatment of pancreatic pseudocysts is safe and effective even in such rare cases. The use of endoscopic methods also minimizes intervention and decreases the length of the patients' stays in the hospital.

Coagulation Parameters in Post-Covid-19 Condition in Relation to Various Titers of Anti-SARS-CoV-2 IgG in Blood Plasma

Background and Objectives

Post-COVID-19 condition is thought to affect 10-20% of people at least 3 months after a diagnosis of COVID-19 and two months of symptoms. Post-COVID-19 condition presents itself with many clinical effects with varying degrees of severity ranging from a mild cough to a life-threatening coagulopathy. Our study aimed to identify a relationship between the titers of anti-SARS-CoV-2 IgG and anticoagulation parameters: antithrombin III (ATIII), protein C (PC) and thrombomodulin (TM).

Materials and Methods

Blood plasma was collected from healthy donors aged 25-45 who had recovered from COVID-19 3-6 months ago and their titers of anti-SARS-CoV-2 IgG and ATIII, PC, and TM were measured.

Results

We found that concentrations and activities of key anticoagulation parameters (ATIII, PC, and TM) measured in donor plasma during the post-COVID-19 varied in relation to the titers of anti-SARS-CoV-2 IgG.

Conclusion

While we identified a dysfunction of anticoagulation parameters in patients with post-COVID-19, we aim to explore the subpopulation antibody IgG fraction directly using in vivo and in vitro experiments with the possibility to contribute to the development of treatment options for post-COVID-19 conditions.

A Rare Case of Cardiac Tamponade Induced by Chronic Lymphocytic Leukemia

While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context of chronic hematologic malignancies, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), are rarely observed. A 66-year-old male, with a history of stage IV CLL/SLL, presented with three weeks of worsening edema, orthopnea, and dyspnea. Two days after admission, an echocardiogram revealed a large circumferential pericardial effusion. Given the concern about early signs of pericardial tamponade, the patient underwent emergent pericardiocentesis with the removal of 700 cc of sanguineous fluid. A pericardial biopsy and flow cytometry of the pericardial fluid confirmed the diagnosis of CLL/SLL with pericardial involvement. There were no signs of large cell lymphoma transformation at that point. This rare case demonstrates the importance of considering cardiac complications in CLL/SLL patients who present with worsening edema, orthopnea, and dyspnea.

Evaluation of proteolytic activity and serine proteases distribution in plasma from patients with bladder cancer

Background

Bladder cancer (BC) is an aggressive disease with a poor prognosis. A bladder tumor, like other malignant neoplasms, is characterized by the presence of both cancer cells and stromal cells which secrete cytokines, chemokines, growth factors, and proteolytic enzymes. One such class of proteolytic enzymes are serine proteases, which take part in the tumor microenvironment formation via supporting and contributing to tumor progression. This study aims to evaluate the proteolytic activity and serine protease contribution in plasma from BC patients.

Methods

The research involved patients of Alexandrovsky city clinical hospital aged 52-76 with transitional cell carcinoma of the bladder. All examined patients were divided into five groups: the control group included conditionally healthy donors, while other patients were grouped according to their tumor stage (I, II, III and IV). Plasma plasminogen levels were determined by enzyme-linked immunosorbent assay, and the potential activity was measured by chromogenic plasminogen assay. Serine proteases fractions were obtained by the affinity chromatography method, and enzyme concentration in the selected fractions were determined by the Bradford method. Serine proteases distribution was investigated by electrophoresis in a polyacrylamide gel.

Results

It was determined that the concentration, potential activity of plasminogen, and the total amount of serine proteases in plasma from BC patients were greater than the values of the corresponding indicators in healthy donors. This could be one of the factors contributing to increased proteolysis seen in the process of carcinogenesis. Plasminogen concentration in BC patients with stage IV disease; however, displayed a tendency to be reduced compared to earlier stages, and the potential activity of plasminogen was significantly lower in patients with stages III - IV BC. Futhermore, a tumor stage specific gradual decline in the serine protease plasma content was shown. The results of electrophoretic analysis established a significant diminishment in the percentage of high molecular weight components (under non-reducing conditions) and their complete disappearance (under reducing conditions) in plasma serine protease fractions from BC patients. A decline in the percentage of heavy and light plasmin chains in BC patients was also observed. Additionally, a rise in the degraded forms of plasminogen/plasmin content was seen in BC samples, as well as the presence of fractions corresponding to trypsin and NE (under non-reducing conditions) that were absent in the control samples.

Conclusion

The results indicate significant changes in the proteolytic activity of plasma, from BC patients when compared to healthy controls, which is accompanied by alterations in serine protease distribution caused by tumor microenvironment pecularlities at the different stages of oncopathology.

Spontaneous Celiac Artery Pseudoaneurysm in a Patient With Viral Myocarditis: Coincidence or Consequence?

Spontaneous pseudoaneurysm formation in the celiac artery is a very infrequent occurrence in the absence of trauma or descending aortic dissection. If it continues to progress, it can lead to visceral organ infarction or life-threatening hemoperitoneum. Management is conservative in select cases; however, most patients require an endovascular or surgical approach. The definitive etiology of spontaneous celiac artery pseudoaneurysm remains unclear. We present an intriguing case of a 67-year-old female who presented to the hospital with sudden chest pain preceded by viral prodromal symptoms. She was discharged as a case of viral myocarditis and was re-admitted the same day with acute abdominal pain. Computed tomography with intravenous contrast showed an enlarging eight-millimeter celiac artery pseudoaneurysm managed with endovascular coil embolization. This case report demonstrates spontaneous celiac artery pseudoaneurysm workup and management. We are also investigating whether a unifying diagnosis exists to explain both viral myocarditis and celiac artery pseudoaneurysm or if both conditions are sporadic occurrences.

Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett's Esophagus: A Systemic Review and Meta-Analysis

Background/Aims

Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett's esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE.

Methods

A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics.

Results

A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC.

Conclusions

High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

The effect of laser radiation on glial fibrillary acidic protein and allograft inflammatory factor-1 expression in severed and surgically repaired sciatic nerve

OBJECTIVE

Determine the effect of different spectrum laser radiations on the expression of Glial Fibrillary Acidic Protein (GFAP) and allograft inflammatory factor-1 (Iba-1) in the sciatic nerve during regeneration.

METHODS

The experiment was performed on 60 lab Wistar rats weighing 200-250 g. The left sciatic nerve was severed and subsequent end-to-end epineural suturing was performed 10, 20, 30, and 45 minutes after neurotomy. Western blot and immunohistochemistry analyses were performed by means of polyclonal anti-GFAP antibodies (Thermo Fisher Scientific, USA) and anti-Iba-1 antibodies (Invitrogen, USA) 90 days after nerve repair.

RESULTS

The use of green and blue spectrum laser radiation significantly increased GFAP protein expression regardless of the time when surgical nerve repair was performed after injury. The expression of Iba-1 and tubulin after blue spectrum laser radiation with a wavelength of 470 nm was significantly higher than the control values by 5.1-11.0 times. An increase in the expression of Iba-1 and tubulin was noted when a green spectrum laser with a wavelength of 560 nm was utilized and nerve suturing was performed 10 and 20 minutes after nerve injury. The green spectrum laser with a wavelength of 520 nm had no significant effect on the expression of Iba-1 and tubulin. Morphologically, the highest proliferative reaction of glia was recorded when using a blue spectrum laser.

CONCLUSIONS

Laser radiation with blue (470 nm) and green (560 nm) spectra, promoted the activation of GFAP-positive Schwann cells and nerve regeneration. Activation of microglia is a necessary component of nerve regeneration and the content of Iba-1 represented the efficiency of regeneration.

Circulating levels of inflammatory cytokines and angiogenesis-related growth factors in patients with osteoarthritis after COVID-19

Background

The disease COVID-19, caused by SARS-CoV-2 infection, has a systemic effect and is associated with a number of pathophysiological mechanisms that mobilize a wide range of biomolecules. Cytokines and growth factors (GFs) are critical regulators of tissue damage or repair in osteoarthritis (OA) and are being recognized as key players in the pathogenesis of COVID-19. A clear understanding of the long-term consequences of SARS-CoV-2 infection, especially in patients with concomitant chronic diseases, is limited and needs to be elucidated. The study aimed to evaluate the degree of inflammation and levels of pro-angiogenic and hypoxic factors, as well as heat shock proteins HSP60 and HSP70 in plasma, of patients with OA after recovery from COVID-19.

Methods

The research involved patients of an orthopedic specialty clinic aged 39 to 80 diagnosed with knee OA. All examined patients were divided into three groups: the Control group included conditionally healthy donors, group OA included patients with knee OA mainly stage II or III and the group of OA and COVID-19 included patients with OA who had COVID-19. The plasma levels of pro-inflammatory molecules IL-1β, IL-6, TNF-α, NF-κB, angiogenic factors VEGF, FGF-2, PDGF, hypoxic factor HIF-1α and molecular chaperones HSP60 and HSP70 were measured by enzyme-linked immunosorbent assay.

Results

The study showed that in both groups of patients, with OA and convalescent COVID-19, there was an increase in the plasma level of IL-1β and a decrease in TNF-α and NF-κB levels when compared to healthy controls. Systemic deregulation of the cytokine profile was accompanied by reduction in plasma levels of pro-angiogenic growth factors, most pronounced in cases of VEGF and PDGF. This analysis did not reveal any significant difference in the plasma level of HIF-1α. A decrease in the level of stress protein HSP60 in the blood of patients with OA, as well as those patients who have had SARS-CoV-2 infection, has been established.

Conclusion

The results suggest the potential role pro-inflammatory cytokines and angiogenesis-related growth factors in pathogenesis of both joint pathologies and long-term systemic post-COVID-19 disorders.

A Case Report of Leukocytoclastic Vasculitis: Diagnostic Approach and Treatment

BACKGROUND Leukocytoclastic vasculitis is a small-vessel vasculitis associated with infections, autoimmune disorders, and certain drugs, but it may also be idiopathic. CASE REPORT We report the case of a 37-year-old woman with no significant past medical history who presented with a chief concern of a full-body rash. Before the rash appeared, she had been treated for group A Streptococcus with amoxicillin and prednisone. An outpatient skin biopsy revealed findings concerning for early leukocytoclastic vasculitis. On admission, she had a diffuse palpable rash on the trunk and upper and lower extremities. Laboratory test results were notable for neutrophilic leukocytosis with a left shift, reticulocytosis with normal hemoglobin, thrombocytosis, and elevated ESR and CRP. An infectious diseases workup was negative, serum levels of complement C3 and C4 were normal, and no evidence of hemolysis was found on blood smear. Results of schistocytes review, LDH, and haptoglobin were not consistent with hemolysis, and IgG, IgA, and IgM were all within normal limits. The patient was initially started on antibiotics due to concern for bullous impetigo, but the treatment regimen was changed to steroids because IgA vasculitis and leukocytoclastic vasculitis were suspected. Biopsy results were received 1 week later and did not reveal definitive findings of acute leukocytoclastic vasculitis. Staining with antibodies to human IgG, IgA, IgM, C3, fibrinogen, and albumin was negative. CONCLUSIONS Leukocytoclastic vasculitis can be triggered by penicillins, cephalosporins, sulfonamides, phenytoin, and allopurinol acting as haptens and stimulating an immune response, resulting in development of vasculitis.

A Rare Case of Disseminated Histoplasmosis in an Adult With Alcoholic Liver Cirrhosis

Histoplasmosis, also known as "Darling's disease," is caused by the dimorphic fungus Histoplasma capsulatum, which is distributed all over the world but is more common in Northern America. In this paper, we present the case of an adult patient with decompensated liver cirrhosis who had positive antigen test results for H. capsulatum and Blastomyces dermatitidis. Disseminated histoplasmosis was confirmed by means of additional antibody testing in a patient with septic shock complicated by multiorgan failure and duodenal perforation. A high index of suspicion is required for the detection of disseminated histoplasmosis.

Lung Expression of Macrophage Markers CD68 and CD163, Angiotensin Converting Enzyme 2 (ACE2), and Caspase-3 in COVID-19

Background and Objectives: The coronavirus (SARS-CoV-2) damages all systems and organs. Yet, to a greater extent, the lungs are particularly involved, due to the formation of diffuse exudative inflammation in the form of acute respiratory distress syndrome (ARDS) with next progression to pulmonary fibrosis. SARS-associated lung damage is accompanied by the pronounced activation of mononuclear cells, damage of the alveoli and microvessels, and the development of organized pneumonia. To study the expression of macrophage markers (CD68 and CD163), angiotensin-converting enzyme-2 (ACE2), and caspase-3 on the results of two fatal clinical observations of COVID-19. Materials and Methods: In both clinical cases, the female patients died from complications of confirmed COVID-19. Conventional morphological and immunohistochemical methods were used. Results: There was an acute exudative hemorrhagic pneumonia with the formation of hyaline membranes, focal organization of fibrin, stromal sclerosis, stasis, and thrombus formation in the lung vessels. Signs such as the formation of hyaline membranes, organization, and fibrosis were more pronounced in severe disease activity. The activation of CD68+/CD163+ macrophages could cause cell damage at an early stage of pneumonia development, and subsequently cause fibrotic changes in lung tissue. ACE2 expression in lung tissue was not detected in severe pneumonia, while in moderate pneumonia, weak expression was noted in individual cells of the alveolar epithelium and vascular endothelium. Conclusions: This finding could show the dependence of ACE2 expression on the severity of the inflammatory process in the lungs. The expression of caspase-3 was more pronounced in severe pneumonia.

Hydralazine-Associated Vasculitis and Pulmonary Hemorrhage

Hydralazine is a potent vasodilating medication used as adjunctive therapy for the treatment of hypertension. Rarely, hydralazine may cause the development of antineutrophil cytoplasmic antibody vasculitis with the pulmonary-renal syndrome. We are presenting a case of hydralazine-associated vasculitis and pulmonary hemorrhage.

Jejunal lipoma: A rare cause of small bowel bleeding

Prompt endoscopic recognition as well as histopathological examination are crucial for establishing the diagnosis and management of small bowel lipomas complicated by bleeding.

Association between intestinal microflora and obesity

Obesity has become one of modern society's most serious health problems. Studies from the last 30 years revealed a direct relationship between imbalanced energy intake and increased healthcare costs related to the treatment or management of obesity. Recent research has highlighted significant effects of gut microbial composition on obesity. We aimed to report the current knowledge on the definition, composition, and functions of intestinal microbiota. We have performed an extensive review of the literature searching for the following key words: metabolism, gut microbiota, dysbiosis, and obesity. There is evidence that an association between intestinal microbiota and obesity exists at any age. There are complex genetic, metabolic, and inflammatory mechanisms involved in the pathogenesis of obesity. Revision of indications for use of probiotics, prebiotics, and antibiotics in obese patients should be considered. Microbial composition of the gut may be an important factor involved in the development of obesity. Changes in the gut microbiota may result in changes in human metabolism and weight loss.

A Clinical Case of a Celiac Crisis in an Adult With Type 1 Diabetes and Neurological Symptoms

We are reporting a case of a severe variant of celiac disease (celiac crisis) in an otherwise healthy 34-year-old woman presenting a history of weight loss, and neurological and metabolic disorders. After starting a gluten-free diet, the patient's condition improved significantly, and ascites and hydrothorax disappeared. The celiac crisis remains a rare manifestation of celiac disease among the adult population, however, a gluten-free diet should be considered in patients with marked metabolic disturbances even without significant osmotic diarrhea.

Eosinophilic Esophagitis in the Setting of Prior Caustic Ingestion

A seven-year-old male presented with complaints of food refusal, dysphagia, and odynophagia for three weeks. He also had a history of caustic ingestion six months prior to the presentation. Diagnostic esophagogastroduodenoscopy (EGD) revealed post-burn esophageal stricture, and biopsy confirmed eosinophilic esophagitis (EoE). In this report, we discuss the diagnosis and management of these pathologies. We suspect that the damage sustained from caustic ingestion laid the groundwork for the development of EoE in this patient.

Wohlfahrtiimonas chitiniclastica: A rare infection reported in an adult with liver cirrhosis

We present a case of a 60-year-old female with a history of liver cirrhosis, alcohol abuse, and chronic venous insufficiency who presented with maggot-infested wounds on her legs, bilateral buttocks, and groin area. Two sets of blood cultures grew Wohlfahrtiimonas chitiniclastica. She underwent wound debridement and treatment with cefazolin.

CHRONIC EFFECTS OF CADMIUM CHLORIDE ON RAT EMBRYOGENESIS

The purpose of this study was to analyze the effects of cadmium toxicity on rat embryogenesis when exposed to other heavy metal citrates. Despite the variety of scientific publications discussing the influence of cadmium on mammalian postnatal development, the effect of this metal on embryogenesis has not yet been sufficiently studied. In this experimental study, cadmium chloride was administered to experimental pregnant female Wistar rats at a daily dose of 1.0 mg/kg. Rats were allocated at random into groups receiving either cadmium chloride alone or additional zinc citrate, cerium citrate, or nanocomposite (based on iodine, sulfur, and selenium citrate). The control group received distilled water at an equivalent volume. In each group, operational intervention occurred at the 13th and 20th day of gestation to assess numbers of live fetuses, corpora lutea, pre-implantation losses, post-implantation losses, and total implantation losses. When cadmium chloride alone was administered, a pronounced embryotoxic effect was observed, manifested as a significant decrease in the number of live fetuses. Experimental groups which received cadmium chloride with zinc citrate, cerium citrate, or nanocomposite had an increased number of live fetuses and corpora lutea, as well as a decreased number of implantation losses, compared to the group which only received cadmium chloride. Each combination of cerium, zinc, and selenium nanocomposite citrates demonstrated a compensatory effect on all measures of embryogenesis impacted by cadmium embryotoxicity. Thus, administration of the citrates of cerium, zinc, and selenium nanocomposite reduces cadmium embryotoxicity and its accumulation in the body.

Case of Vibrio Vulnificus bacteremia in a patient heterozygous for HFE p.C282Y mutation and alcoholic liver cirrhosis

Vibrio vulnificus is a Gram-negative bacterium, a member of the Vibrionaceae family. V. vulnificus is the main cause of seafood-related deaths in the United States because it can cause severe wound infections or sepsis. This microorganism is highly dependent on iron availability. Therefore, patients with high body iron levels are more susceptible to the infection. Prompt treatment with cephalosporins as well as doxycycline is usually administered. We present a case of V. vulnificus bacteremia in a patient heterozygous for HFE p.C282Y mutation and underlying alcoholic liver cirrhosis.

The impact of the COVID-19 pandemic on patients with migraine

Objectives

The aim of our work was to assess the impact of the COVID-19 pandemic and quarantine measures on migraine patients in regards to the activity of the disease, the psycho-emotional background of the patients and their quality of life.

Methods

his study included 133 patients with established diagnosis of migraine. All study participants were divided into two clinical groups: A-patients with chronic and episodic forms of migraine, who had a history of positive PCR test for COVID-19, and B-patients with chronic and episodic forms of migraine who did not have a history of coronavirus disease.

Results

We detected increase in the number of antimigraine medication (p = 0.04), frequency of headache attacks (p = 0.01), and the psycho-emotional state deterioration (increase in the Hamilton anxiety scale score) (p = 0.002) in patients after recovery from the coronavirus disease. There was no significant difference in the headache's intensity according to the VAS scale (p = 0.51) as well as in the dynamics of the Beck depression scale score (p = 0.09) before and after the COVID-19 infection.

Conclusion

Patients with a history of migraine who recovered from COVID-19 showed increased frequency of migraine headache attacks and anxiety.

CHEMOTHERAPY-DRIVEN GUT DYSBIOSIS IN PATIENTS WITH MULTIPLE MYELOMA

Many experimental studies have investigated various treatment options for patients with multiple myeloma; however, bortezomib, lenalidomide, dexamethasone (RVD regimen) is still considered a gold-standard therapy. This regimen can lead to a wide range of side effects, one of which is enterotoxicity. Significantly efficacious enteroprotective interventions have not yet been developed or implemented into clinical practice. This literature review assesses the development of chemotherapy-driven dysbiosis through Toll-like receptors (TLRs) and explores the hypothesis that the gut microbiome could provide significant enteroprotection. A systematic review was performed by utilizing articles published between 2015-2022 from the following databases: Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Science Direct, and Cochrane Library databases. In conclusion, we found further studies of gut microbiome variety and function are necessary and could be used in development of treatment and prevention strategy of chemotherapy enterotoxicity.