Choledocoscopy in the surgery of mechanical jaundice

Universitatea de medicina si farmacie “Gr. T. Popa”, Iasi, clinica a IV-a chirurgie, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Scopul lucrării: Diversitatea etiopatogenică a icterului mecanic justifică explorarea coledocoscopică, necesară unui diagnostic de certitudine. Material şi metodă: Între anii 2002 - 2011 am utilizat coledocoscopul flexibil la 58 de pacienți internați cu icter mecanic. La 21 (36,2 %) dintre aceştia icterul s-au dovedit a fi de etiologie neoplazică: 5 (8,6 %) cazuri cu ampulom vaterian (care au beneficiat de duodenopancreatectomie cefalică), 14 (24,1 %) cazuri cu neoplasm al capului de pancreas şi două (3.4 %) cazuri cu colangiocarcinom). Ceilalți 37 (63,8 %) de pacienți au avut o etiologie litiazică, la care coledocolitotomia asistată coledocoscopic şi asociată colecistectomiei a permis vindecarea. Rezultate. Discuții: Dintre pacienții cu suspiciune de icter mecanic neoplazic, în două (3,4 %) cazuri a fost necesară coledocoscopia care a certificat diagnosticul de colangiocarcinom atât prin aspectul imagistic, dar mai ales datorită posibilității prelevării biopsiei şi examenului histopatologic. În explorarea icterului mecanic. cu etiologie litiazică examenul coledocoscopic permite vizualizarea calculilor în 16 (27,5 %) cazuri la care celelalte explorări imagistice erau neconcludente. În toate cazurile controlul coledocoscopic a certificat absența calculilor în calea biliarặ principalặ la finalul intervenției, oferind astfel siguranță privind acuratețea actului chirurgical. Concluzii: Coledocoscopia aduce siguranță în chirurgia căii biliare principale atât în ceea ce priveşte diagnosticul, permițând vizualizarea şi prelevarea biopsiei în leziunile tumorale ale căii biliare principale cât şi în tratamentul litiazei biliare, oferind posibilitatea controlului imediat (intraoperator) al căii biliare principale după coledocolitotomie.Abstract. Background. The diverse etiology of mechanical jaundice requires a choledocoscopy to allow a correct diagnosis. Methods: Between 2002 and 2011, we used flexible choledocoscope, in 58 patients with mechanical jaundice admitted in our clinic. 21 (36, 2 %) cases proved to be of neoplastic etiology: 5 (8, 6%) cases diagnosed with vaterian ampuloma (treated by cephalic duodenopancreatectomy), 14 (24, 1 %) cases with pancreatic head cancer and two (3, 4 %) cases with cholangiocarcinoma. The remaining 37 (63, 8 %) cases were caused by lithiasis, treated by choledocolhitotomy associated with choledocoscopy and cholecystectomy. Results. Discussion: Among patients with suspected neoplastic mechanical jaundice, in two (3.4 %) cases choledocoscopy was necessary, in order to sustained the diagnosis of colangiocarcinoma, by macroscopically appearance, and also by the biopsy sampling and histological examination. In mechanical jaundice of lithiasis etiology, the choledocoscopy permitted the visualization of stones in 16 (27, 5%) cases in which, other imagistic investigations were inconclusive. In all cases choledocoscopic control certified the absence of gallstones in the bile duct at the end of the surgical procedure, and thereby provides safety of the surgical act. Conclusions: Choledocoscopy adds certainty in the main bile duct surgery both in terms of correct diagnosis, allowing visualization and biopsy sampling of the main bile duct in tumor lesions and in treatment of gallstone disease, allowing immediate control of the main bile duct after choledocolithotomy

Extradural autologous temporal muscle graft mimicking a meningioma: Case report

Meningiomas are the most common dural tumour, but there are also many other dural masses which mimic their appearances, such as neoplastic and non-neoplastic lesions. In this paper we report another mass which may mimic a dural lesion, namely a muscle graft harvested from the temporal site and left in situ, used to achieve haemostasis in a posttraumatic temporal extradural hematoma in a young male patient. Solid knowledge of differentiating neuroimaging characteristics of dural masses, as well as its corroboration with the patient’s medical history are extremely helpful in establishing an accurate diagnostic

Metagenomic analysis of gut microbial communities from a Central Asian population

OBJECTIVE: Changes in the gut microbiota are increasingly recognised to be involved in many diseases. This ecosystem is known to be shaped by many factors, including climate, geography, host nutrition, lifestyle and medication. Thus, knowledge of varying populations with different habits is important for a better understanding of the microbiome. DESIGN: We therefore conducted a metagenomic analysis of intestinal microbiota from Kazakh donors, recruiting 84 subjects, including male and female healthy subjects and metabolic syndrome (MetS) patients aged 25-75 years, from the Kazakh administrative centre, Astana. We characterise and describe these microbiomes, the first deep-sequencing cohort from Central Asia, in comparison with a global dataset (832 individuals from five countries on three continents), and explore correlations between microbiota, clinical and laboratory parameters as well as with nutritional data from Food Frequency Questionnaires. RESULTS: We observe that Kazakh microbiomes are relatively different from both European and East Asian counterparts, though similar to other Central Asian microbiomes, with the most striking difference being significantly more samples falling within the Prevotella-rich enterotype, potentially reflecting regional diet and lifestyle. We show that this enterotype designation remains stable within an individual over time in 82% of cases. We further observe gut microbiome features that distinguish MetS patients from controls (eg, significantly reduced Firmicutes to Bacteroidetes ratio, Bifidobacteria and Subdoligranulum, alongside increased Prevotella), though these overlap little with previously published reports and thus may reflect idiosyncrasies of the present cohort. CONCLUSION: Taken together, this exploratory study describes gut microbiome data from an understudied population, providing a starting point for further comparative work on biogeography and research on widespread diseases. TRIAL REGISTRATION NUMBER: ISRCTN37346212; Post-results

Potential of fecal microbiota for early-stage detection of colorectal cancer

Several bacterial species have been implicated in the development of colorectal carcinoma (CRC), but CRC-associated changes of fecal microbiota and their potential for cancer screening remain to be explored. Here, we used metagenomic sequencing of fecal samples to identify taxonomic markers that distinguished CRC patients from tumor-free controls in a study population of 156 participants. Accuracy of metagenomic CRC detection was similar to the standard fecal occult blood test (FOBT) and when both approaches were combined, sensitivity improved > 45% relative to the FOBT, while maintaining its specificity. Accuracy of metagenomic CRC detection did not differ significantly between early- and late-stage cancer and could be validated in independent patient and control populations (N = 335) from different countries. CRC-associated changes in the fecal microbiome at least partially reflected microbial community composition at the tumor itself, indicating that observed gene pool differences may reveal tumor-related host-microbe interactions. Indeed, we deduced a metabolic shift from fiber degradation in controls to utilization of host carbohydrates and amino acids in CRC patients, accompanied by an increase of lipopolysaccharide metabolism

The fatty acid binding protein 7 (FABP7) is involved in proliferation and invasion of melanoma cells

<p>Abstract</p> <p>Background</p> <p>The molecular mechanisms underlying melanoma tumor development and progression are still not completely understood. One of the new candidates that emerged from a recent gene expression profiling study is <it>fatty acid-binding protein 7 </it>(<it>FABP7)</it>, involved in lipid metabolism, gene regulation, cell growth and differentiation.</p> <p>Methods</p> <p>We studied the functional role of FABP7 in human melanoma cell lines and using immunohistochemistry analyzed its expression pattern and clinical role in 11 nevi, 149 primary melanomas and 68 metastases.</p> <p>Results</p> <p>FABP7 mRNA and protein level is down-regulated following treatment of melanoma cell lines with a PKC activator (PMA) or MEK1 inhibitor (PD98059). Down-regulation of FABP7 using siRNA decreased cell proliferation and invasion but did not affect apoptosis. In clinical specimens, FABP7 was expressed in 91% of nevi, 71% of primary melanomas and 70% of metastases, with a cytoplasmic and/or nuclear localization. FABP7 expression was associated with tumor thickness in superficial spreading melanoma (P = 0.021). In addition, we observed a trend for an association between FABP7 expression and Ki-67 score (P = 0.070) and shorter relapse-free survival (P = 0.069) in this group of patients.</p> <p>Conclusion</p> <p>Our data suggest that FABP7 can be regulated by PKC and the MAPK/ERK1/2 pathway through independent mechanisms in melanoma cell lines. Furthermore, FABP7 is involved in cell proliferation and invasion <it>in vitro</it>, and may be associated with tumor progression in melanoma.</p

Current understanding of the human microbiome

Author Posting. © The Author(s), 2018. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature Medicine 24 (2018): 392–400, doi:10.1038/nm.4517.Our understanding of the link between the human microbiome and disease, including obesity, inflammatory bowel disease, arthritis and autism, is rapidly expanding. Improvements in the throughput and accuracy of DNA sequencing of the genomes of microbial communities associated with human samples, complemented by analysis of transcriptomes, proteomes, metabolomes and immunomes, and mechanistic experiments in model systems, have vastly improved our ability to understand the structure and function of the microbiome in both diseased and healthy states. However, many challenges remain. In this Review, we focus on studies in humans to describe these challenges, and propose strategies that leverage existing knowledge to move rapidly from correlation to causation, and ultimately to translation.Many of the studies described here in our laboratories were supported by the NIH, NSF, DOE, and the Alfred P. Sloan Foundation.2018-10-1

Antibiotics-induced monodominance of a novel gut bacterial order

OBJECTIVE: The composition of the healthy human adult gut microbiome is relatively stable over prolonged periods, and representatives of the most highly abundant and prevalent species have been cultured and described. However, microbial abundances can change on perturbations, such as antibiotics intake, enabling the identification and characterisation of otherwise low abundant species. DESIGN: Analysing gut microbial time-series data, we used shotgun metagenomics to create strain level taxonomic and functional profiles. Community dynamics were modelled postintervention with a focus on conditionally rare taxa and previously unknown bacteria. RESULTS: In response to a commonly prescribed cephalosporin (ceftriaxone), we observe a strong compositional shift in one subject, in which a previously unknown species, UBorkfalki ceftriaxensis, was identified, blooming to 92% relative abundance. The genome assembly reveals that this species (1) belongs to a so far undescribed order of Firmicutes, (2) is ubiquitously present at low abundances in at least one third of adults, (3) is opportunistically growing, being ecologically similar to typical probiotic species and (4) is stably associated to healthy hosts as determined by single nucleotide variation analysis. It was the first coloniser after the antibiotic intervention that led to a long-lasting microbial community shift and likely permanent loss of nine commensals. CONCLUSION: The bloom of UB. ceftriaxensis and a subsequent one of Parabacteroides distasonis demonstrate the existence of monodominance community states in the gut. Our study points to an undiscovered wealth of low abundant but common taxa in the human gut and calls for more highly resolved longitudinal studies, in particular on ecosystem perturbations