Intravenous misplacement of the nephrostomy catheter following percutaneous nephrolithotomy: A case report and review of 26 cases in the literature.

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrolithotomy (PCNL) is severe and extremely rare, and little information is available about this complication. Because the patient's prognosis may be poor, sufficient attention should be paid to early identification and treatment of this complication. We report a case with intravenous misplacement of nephrostomy catheter and severe bleeding from the catheter after PCNL was transferred to our hospital. The patient was successfully managed using a two-step intervention. First, the patient underwent embolization of the pseudoaneurysms in renal parenchyma, then underwent catheter withdrawal under digital subtraction angiography (DSA) and control bleeding by pushing the absorbable hemostatic material (Surgicel) into the tunneled renal drainage. There were no severe complications. Withdrawal could be performed by open surgery or under the supervision of imaging modalities. Some reports showed that minimally invasive management was safer and less invasive than open surgery.

Preschool-age children maintain a distinct memory CD4+ T cell and memory B cell response after SARS-CoV-2 infection.

The development of the human immune system lasts for several years after birth. The impact of this maturation phase on the quality of adaptive immunity and the acquisition of immunological memory after infection at a young age remains incompletely defined. Here, using an antigen-reactive T cell (ARTE) assay and multidimensional flow cytometry, we profiled circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-reactive CD3+CD4+CD154+ T cells in children and adults before infection, during infection, and 11 months after infection, stratifying children into separate age groups and adults according to disease severity. During SARS-CoV-2 infection, children younger than 5 years old displayed a lower antiviral CD4+ T cell response, whereas children older than 5 years and adults with mild disease had, quantitatively and phenotypically, comparable virus-reactive CD4+ T cell responses. Adults with severe disease mounted a response characterized by higher frequencies of virus-reactive proinflammatory and cytotoxic T cells. After SARS-CoV-2 infection, preschool-age children not only maintained neutralizing SARS-CoV-2-reactive antibodies postinfection comparable to adults but also had phenotypically distinct memory T cells displaying high inflammatory features and properties associated with migration toward inflamed sites. Moreover, preschool-age children had markedly fewer circulating virus-reactive memory B cells compared with the other cohorts. Collectively, our results reveal unique facets of antiviral immunity in humans at a young age and indicate that the maturation of adaptive responses against SARS-CoV-2 toward an adult-like profile occurs in a progressive manner.

Size-dependent As(V) adsorption of reduced graphene oxide/magnetite nanocomposites.

Arsenic (As(V)) contamination in aqueous resources poses a significant environmental, and public health risk due to its high toxicity. To address this challenge, we synthesized and characterized novel reduced graphene oxide/magnetite (rGO/Fe3O4) nanocomposites, which are efficient adsorbents for removing As(V). Using a co-precipitation method, we obtained three distinct sizes of rGO/Fe3O4 nanocomposites by controlling the salt concentration (Fe2+: Fe3+) ratios. Analysis of the adsorption ability of the samples shows that the adsorption efficiency can reach up to 98.10% within 90 min, and the adsorption capacity value reaches 20.55 mg/g. Furthermore, these test data are ably consistent with both the pseudo-second-order model and the Langmuir model, based on which the adsorption mechanism has been proposed. These results show that the rGO/Fe3O4 nanocomposites that we synthesized are a potential adsorbent for the removal of heavy metals from water.

Redox-Driven Formation of Mn(III) in Ice.

Redox-driven reactions involving Mn(II) species adsorbed at Mn(IV) oxide surfaces can release Mn(III) in the form of dissolved Mn(III)-ligand species in natural waters. Using pyrophosphate (PP) as a model ligand, we show that freezing accelerates and enhances Mn(III) formation in the form of Mn(III)-PP complexes. This freeze-promoted reaction is explained by the concentration of Mn(IV) oxides and solutes (Mn(II), Na+, and Cl-) into the minute fractions of liquid water locked between ice (micro)crystals - the Liquid Intergrain Boundary (LIB). Time-resolved freezing experiments at -20 °C showed that Mn(III) yields were greatest at low salt (NaCl) content. In contrast, high salt content promoted Mn(III) formation through chloride complexation, although yields became lower as the cryosalt mineral hydrohalite (NaCl·2H2O) dehydrated the LIB by drawing water into its structure. Consecutive freeze-thaw cycles also showed that dissolved Mn(III) concentrations increased within the very first few minutes of each freezing event. Because each thaw event released unreacted PP previously locked in ice, each sequential freeze-thaw cycle increased Mn(III) yields, until ∼80% of the Mn was converted to Mn(III). This was achieved after only seven cycles. Finally, temperature-resolved freezing experiments down to -50 °C showed that the LIB produced the greatest quantities of Mn(III) at -10 °C, where the volumes were greater. Reactivity was however sustained in ice formed below the eutectic (-21.3 °C), down to -50 °C. We suspect that this sustained reactivity was driven by persistent forms of supercooled water, such as Mn(IV) oxide-bound thin water films. By demonstrating the freeze-driven production of Mn(III) by comproportionation of dissolved Mn(II) and Mn(IV) oxide, this study highlights the potentially important roles these reactions could play in the production of pools of Mn(III) in natural water and sediments of mid- and high-latitudes environments exposed to freeze-thaw episodes.

Inhibition of Soluble Epoxide Hydrolase by Cembranoid Diterpenes from Soft Coral Sinularia maxima: Enzyme Kinetics, Molecular Docking, and Molecular Dynamics.

Soluble epoxide hydrolase (sEH) is essential for converting epoxy fatty acids, such as epoxyeicosatrienoic acids (EETs), into their dihydroxy forms. EETs play a crucial role in regulating blood pressure, mediating anti-inflammatory responses, and modulating pain, making sEH a key target for therapeutic interventions. Current research is increasingly focused on identifying sEH inhibitors from natural sources, particularly marine environments, which are rich in bioactive compounds due to their unique metabolic adaptations. In this study, the sEH inhibitory activities of ten cembranoid diterpenes (1-10) isolated from the soft coral Sinularia maxima were evaluated. Among them, compounds 3 and 9 exhibited considerable sEH inhibition, with IC50 values of 70.68 µM and 78.83 µM, respectively. Enzyme kinetics analysis revealed that these two active compounds inhibit sEH through a non-competitive mode. Additionally, in silico approaches, including molecular docking and molecular dynamics simulations, confirmed their stability and interactions with sEH, highlighting their potential as natural therapeutic agents for managing cardiovascular and inflammatory diseases.

Phytochemical Profiles and Biological Activities of Five Wild Camellia Species from Ta Dung, Vietnam.

The C. luuana (TD3), C. furfuracea (TD4), C. bidoupensis (TD6), C. sinensis (L.) (TD7), and C. kissii (TD8), have been traditionally used as a health-promoting beverage by local people in Ta Dung, Dak Nong. Despite their potential health benefits, further scientific data on biological and phytochemical properties of these plants is needed. This study aimed to investigate phytochemical and biological properties of five Camellia species extracts, using DPPH, ABTS radical scavenging, copper chelating (Cu-chelator), and tyrosinase inhibition (TI), α-amylase (Al-AI), and α-glucosidase (Al-GI) analyses. Ten compounds were identified using UPLC method, in which catechins (mainly EGCG and catechin (Cat)), were the most prevalent, and followed by chlorogenic acid (ChlA), quercitrin (Querci), rutin, and quercetin (Querce). Multiple factor analysis (MFA) also revealed that TD7, TD3, and TD4 containing high TPC, TFC, EGCG, ChlA, and caffeine were responsible for their high DPPH, ABTS radical scavenging activities and TI, Al-AI and Al-GI. TD6 and TD8, possessing elevated levels of Apig, Querce, Rutin, Querce, Cat, and EA, exhibited a high Cu-chelator property, but a weak enzyme inhibition. From all above-mentioned results, the antioxidative and enzyme inhibitory potentials of Camellia species extracts were scientifically demonstrated paving a pathway to develop health supplement in further studies.

Vitamin Solutions Effects on Reproduction of Broodstock, Growth Performance, and Survival Rate of Pangasius Catfish Fingerlings.

This study evaluates the effect of different diets supplemented with vitamin solutions on Pangasius catfish broodstock reproduction, growth performances, and the survival rates of fish larvae and fingerling. The growth and reproductive performances of breeders fed with different test diets showed significant differences among the six tested diets (p < 0.05). The highest final body weight (FBW), weight gain (WG), daily weight gain (DWG), specific growth rate (SGR) of broodstock, and survival rate of Pangasius fingerlings were found in Treatment 5, which contained 0.6% H-OVN mixed with 12.6% algal oil, and Treatment 3, which contained 0.6% vitamin premix H-OVN. The average gonadosomatic index (GSI), relative fecundity index (RFI), fertilized eggs, hatching rates of eggs, and survival rate of fingerlings was 9.1 ± 2.8 (6.7-12.8%), 133,224 ± 39,090 (104,267-199,512 eggs/kg), 77.9 ± 22.2 (62.2-93.6%), and 45.3 ± 17.4 (22.0-66.3%), respectively. The findings of this study showed that the diet containing 35% CP contents supplemented with 0.6% vitamin premix H-OVN mixed with algal oils showed the highest results in terms of growth, reproductive performance indices, and survival rates of Pangasius catfish fingerlings.

Fostering the Job Performance of Nurses: A Responsibility of an Ethical Hospital.

Introduction: Corporate social responsibility (CSR) practices refer to the deliberate actions and strategies implemented by a company or organization to generate positive outcomes for its stakeholders beyond the sole objective of profit maximization. Internal CSR is a significant management and investment concept within enterprises, such as hospitals, that enhances organizational performance excellence. Objectives: The article aims to trace how hospitals thrive in nurses' job performance by leveraging internal CSR practices. Methods: Cross-sectional design quantitative research through structured questionnaire interviews on 215 nurses in Vietnam. Data collection was conducted from May 2023 to August 2023. Partial least squares structural equation modeling was applied to test the hypotheses. Results: The study has proven that a hospital's internal CSR practices impact nurses' job performance. Income and benefits, human resource training and development, and work-related quality of life directly and significantly impact three dimensions of a nurse's job performance (competence to practice patient care, attitude to performance work, and management and professional development capacity). Connection and trust in the workplace and health and safety at work significantly affect two dimensions of a nurse's job performance (namely, competence to practice patient care and attitude to performance work). Diversity in the workplace impacts nurses' competence in practicing patient care and their management and professional development capacity. Demographic variables did not correlate statistically significantly with dimensions of internal CSR and nurses' job performance. Conclusion: The study presents significant findings on the influence of internal CSR on nurses' job performance within the hospital management theory of an emerging market. The results of the present study contribute to a better understanding of the benefits of hospitals' socially responsible actions and contribute further to resource management in hospitals, especially nursing. If the nursing staff positively perceives the hospital's internal CSR practices, they will be more able to perform their job, impacting the hospital's overall performance. This study has certain limitations regarding the representative nature of the sample, the use of the self-report survey instrument, and the use of cross-sectional data.

Evaluation of the conformity of intensity-modulated radiation therapy and volumetric modulated arc therapy using AAPM TG 119 protocol.

The aim of this work was to evaluate the conformity of intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), and verify the accuracy of the planning and delivery system used in this work based on the AAPM TG-119 protocol. The Eclipse 13.6 treatment planning system (TPS) was used to plan the TG-119 test suite, which included four test cases: MultiTarget, Prostate, Head/Neck, and C-Shape for IMRT and VMAT techniques with 6 MV and 10 MV acceleration voltages. The results were assessed and discussed in terms of the TG-119 protocol and the results of previous studies. In addition, point dose and planar dose measurements were done using a semiflex ion chamber and an electronic portal imaging device (EPID), respectively. The planned doses of all test cases met the criteria of the TG-119 protocol, except those for the spinal cord of the C-Shape hard case. There were no significant differences between the treatment planning doses and the doses given in the TG-119 report, with p-values ranging from 0.974 to 1 (p > 0.05). Doses to the target volumes were similar in the IMRT and VMAT plans, but the organs at risk (OARs) doses were different depending on the test case. The planning results showed that IMRT is more conformal than VMAT in certain cases. For the point dose measurements, the confidence limit (CLpoint) of 0.030 and 0.021 were better than the corresponding values of 0.045 and 0.047 given in the TG-119 report for high-dose and low-dose areas, respectively. Regarding the planar dose measurements, the CLplanar value of 0.38 obtained in this work was lower than that given in the TG-119 report (12.4). It is concluded that the dosimetry measurements performed in this study showed better confidence limits than those provided in the TG 119 report. IMRT remains more conformal in certain circumstances than the more progressive VMAT. When selecting the method of delivering a dose to the patient, several factors must be considered, including the radiotherapy technique, energy, treatment site, and tumour geometry.

Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study.

BACKGROUND: Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare. METHODS: A mixed-method realist study was conducted, comprising 22 in-depth interviews, four focus group discussions (total participants n = 44), and a self-administered questionnaire completed by 639 pregnant women. A parallel convergent model for mixed methods analysis was employed. Data were analyzed using the realist logic of analysis, an iterative process aimed at refining identified theories. Survey data underwent analysis using SPSS 22 and descriptive analysis. Qualitative data were analyzed using configurations of context, mechanisms, and outcomes to elucidate causal links and provide explanations for complexity. RESULTS: Nearly half of pregnant women (43.5%) would try to hide their mental health issues and 38.3% avoid having help from a mental health professional, highlighting the substantial extent of stigma affecting health-seeking and accessing care. Four key areas highlight the role of stigma in maternal mental health: fear and stigmatizing language contribute to the concealment of mental illness, rendering it unnoticed; unconsciousness, normalization, and low literacy of maternal mental health; shame, household structure and gender roles during pregnancy; and the interplay of regulations, referral pathways, and access to mental health support services further compounds the challenges. CONCLUSION: Addressing mental health-related stigma could influence the decision of disclosure and health-seeking behaviors, which could in turn improve responsiveness of the local health system to the needs of pregnant women with mental health needs, by offering prompt attention, a wide range of choices, and improved communication. Potential interventions to decrease stigma and improve access to mental healthcare for pregnant women in Vietnam should target structural and organizational levels and may include improvements in screening and referrals for perinatal mental care screening, thus preventing complications.

Dual Antimicrobial and Anticancer Activity of Membrane-Active Peptide BP52.

The linear undecapeptide BP52 was previously reported to have antibacterial activity against phytopathogenic bacteria species. Due to the structural similarities to naturally occurring cationic helical antimicrobial peptides, it was speculated that this peptide could potentially target microbial pathogens and cancer cells found in mammals. Consequently, this study aims to further investigate the structural and biological properties of this peptide. Our findings indicate that BP52 exhibits strong antimicrobial and anticancer activity while displaying relatively low levels of hemolytic activity. Hence, this study suggests that BP52 could be a potential lead compound for drug discovery against infectious diseases and cancer. Besides, new insights into the relationships between the structure and the multifunctional properties of antimicrobial peptides were also explored.

Multi-modal, Label-free, Optical Mapping of Cellular Metabolic Function and Oxidative Stress in 3D Engineered Brain Tissue Models.

Brain metabolism is essential for the function of organisms. While established imaging methods provide valuable insights into brain metabolic function, they lack the resolution to capture important metabolic interactions and heterogeneity at the cellular level. Label-free, two-photon excited fluorescence imaging addresses this issue by enabling dynamic metabolic assessments at the single-cell level without manipulations. In this study, we demonstrate the impact of spectral imaging on the development of rigorous intensity and lifetime label-free imaging protocols to assess dynamically over time metabolic function in 3D engineered brain tissue models comprising human induced neural stem cells, astrocytes, and microglia. Specifically, we rely on multi-wavelength spectral imaging to identify the excitation/emission profiles of key cellular fluorophores within human brain cells, including NAD(P)H, LipDH, FAD, and lipofuscin. These enable development of methods to mitigate lipofuscin's overlap with NAD(P)H and flavin autofluorescence to extract reliable optical metabolic function metrics from images acquired at two excitation wavelengths over two emission bands. We present fluorescence intensity and lifetime metrics reporting on redox state, mitochondrial fragmentation, and NAD(P)H binding status in neuronal monoculture and triculture systems, to highlight the functional impact of metabolic interactions between different cell types. Our findings reveal significant metabolic differences between neurons and glial cells, shedding light on metabolic pathway utilization, including the glutathione pathway, OXPHOS, glycolysis, and fatty acid oxidation. Collectively, our studies establish a label-free, non-destructive approach to assess the metabolic function and interactions among different brain cell types relying on endogenous fluorescence and illustrate the complementary nature of information that is gained by combining intensity and lifetime-based images. Such methods can improve understanding of physiological brain function and dysfunction that occurs at the onset of cancers, traumatic injuries and neurodegenerative diseases.

Effective Management of Severe Amlodipine/Atenolol Overdose with Intravenous Calcium, Hyperinsulinemic Euglycemia Therapy, and Continuous Veno-Venous Hemodialysis: A Case Report.

BACKGROUND Amlodipine, a calcium channel blocker, and atenolol, a beta blocker, are commonly used as a fixed drug combination (FDC) to treat hypertension. Intentional or non-intentional overdose of amlodipine-atenolol results in hypotension and myocardial depression with a high risk of mortality. This report describes a 64-year-old man with an overdose of amlodipine-atenolol, presenting as an emergency with hypotension, bradycardia, and severe metabolic acidosis. He was successfully treated with intravenous calcium chloride infusion, hyperinsulinemia euglycemia therapy (HIE), and continuous veno-venous hemodialysis (CVVHD). CASE REPORT A 64-year-old man was diagnosed with essential hypertension 1 week prior to the admission. He had been prescribed 1 FDC tablet of amlodipine and atenolol (5+50 mg) per day; however, he took 1 table of the FDC per day for 3 days and then took 3-4 tablets each day during the next 4 days. He was brought to the hospital with hypotension, bradycardia, and severe metabolic acidosis and was diagnosed with amlodipine-atenolol overdose. He was treated with intravenous calcium chloride infusion, HIE, and CVVHD. His hemodynamics started to improve after administering these therapies for 6 h. Inotropes were gradually tapered off and stopped. He was extubated on day 5 and recovered completely. CONCLUSIONS This report shows the serious effects amlodipine-atenolol overdose and the challenges of emergency patient management. An overdose of FDC of amlodipine and atenolol can cause cardiovascular collapse and severe metabolic acidosis. Timely and aggressive management with intravenous calcium infusion, HIE, and CVVHD is essential.

Assessment of the level and risk of radioactive hazards in coastal sediments in northern Vietnam.

Radioactivity in coastal sediments in northern Vietnam was examined using data from five sediment cores to assess radioactivity concentrations and radiation risk indices. Radiation risk indices included radium equivalent activity (Raeq), the absorbed dose rate (ADR), the annual effective dose equivalent (AEDE), the activity utilization index (AUI), the external hazard index (Hex), the representative level gamma index (Iγr), and the annual gonadal effective dose rate (AGDE). The radioactivity concentrations of 40K, 232Th, 226Ra, 238U, and 137Cs were 567, 56.1, 35.1, 37.9, and 1.18 Bq/kg, respectively. The average concentrations of 40K, 232Th, 226Ra, and 238U were above the global average at five sites, except for 137Cs, which was low. The Raeq, Hex, and AUI indices were below the recommended values, while the AEDE, ADR, AGDE, and Iγr indices were above the recommended values. Moreover, 40K, 232Th, 226Ra, and 238U had significant impacts on the radiation hazard indices Raeq, ADR, AEDE, Iγr, AUI, Hex, and AGDE. There are three coastal sediment groups on the northern coast of Vietnam: Group 1 has a higher radioactivity and radiation risk index than Group 2 but a lower value than Group 3. Group 3 had the highest radioactivity and radiation risk index. The values of 40K, 232Th, 226Ra, and 238U and the ADR, AUI, Iγr, and AGDE indices in the sediment threaten the living environment.

Effects of cutting tool geometry on material removal of a gradient nanograined CoCrNi medium entropy alloy.

CoCrNi medium-entropy alloys (MEAs) have attracted extensive attention and research because of their superior mechanical properties, such as higher ductility, strength, and toughness. This study uses molecular dynamics (MD) simulations to investigate the cutting behavior of a gradient nanograined (GNG) CoCrNi MEA. Moreover, it explores the influence of relative tool sharpness and rake angle on the cutting process. The results show that an increase in the average grain size of the GNG samples leads to a decrease in the average resultant cutting force, as predicted by the Hall-Petch relationship. The deformation behavior shows that grain boundaries are crucial in inhibiting the propagation of strain and stress. As the average grain size of the GNG sample increases, the range of shear strain distribution and average von Mises stress decreases. Moreover, the cutting chips become thinner and longer. The subsurface damage is limited to a shallow layer at the surface. Since thermal energy is generated in the high grain boundary density, the temperature of the contact zone between the substrate and the cutting tool increases as the GNG size decreases. The cutting chips removed from the GNG CoCrNi MEA substrates will transform into a mixed structure of face-centered cubic and hexagonally close-packed phases. The sliding and twisting of grain boundaries and the merging of grains are essential mechanisms for polycrystalline deformation. Regarding the cutting parameters, the average resultant force, the material accumulation, and the chip volume increase significantly with the increase in cutting depth. In contrast to sharp tools, which mainly use shear deformation, blunt tools remove material by plowing, and the cutting force increases with the increase in cutting-edge radius and negative rake angle.

Evaluation of Selective Culling as a Containment Strategy for African Swine Fever at a Vietnamese Sow Farm.

Selective culling, also known as the "tooth extraction approach", is a strategy for controlling African swine fever (ASF) by removing only sick and suspect animals instead of the entire herd in Vietnam. This method prioritizes preserving healthy animals, particularly valuable breeding pigs. Despite its implementation in various forms, no standardized protocol based on scientific principles has been established. Farms typically adapt this strategy based on their understanding, which can vary significantly. In implementing of selective culling that is not based on scientific principles, there is a significant risk of spreading the disease. The aim of this study is to evaluate the consequences of selective culling as currently implemented in Vietnam. Our analysis on a large sow farm revealed that current practices rely heavily on clinical observations without laboratory confirmations. This approach allows ASF-infected animals to remain on the farm longer, potentially exacerbating the spread of the virus. Thus, selective culling poses a substantial risk by potentially exacerbating the spread of disease. Our findings emphasize that early diagnosis of ASF and systematic removal of infected pigs are critical components for the effective implementation of selective culling strategies and that a high level of fragmentation to minimize contact between animals plays a key role. The optimal approach is to test conspicuous animals and separate them. Under no circumstances should suspect animals be left in the herd for several days before they become severely ill and succumb to the disease.

Production, Purification, and Characterization of a Cellulase from Paenibacillus elgii.

Cellulases are one of the most essential natural factors for cellulose degradation and, thus, have attracted significant interest for various applications. In this study, a cellulase from Paenibacillus elgii TKU051 was produced, purified, and characterized. The ideal fermentation conditions for cellulase productivity were 2% carboxymethyl cellulose (CMC) as the growth substrate, pH = 8, temperature of 31 °C, and 4 days of culturing. Accordingly, a 45 kDa cellulase (PeCel) was successfully purified in a single step using a High Q column with a recovery yield of 35% and purification of 42.2-fold. PeCel has an optimal activity at pH 6 and a temperature of 60 °C. The activity of cellulase was significantly inhibited by Cu2+ and enhanced by Mn2+. The PeCel-catalyzed products of the CMC hydrolysis were analyzed by high-performance liquid chromatography, which revealed chitobiose and chitotriose as the major products. Finally, the clarity of apple juice was enhanced when treated with PeCel.

A case of giant labia majora lipoma in an adult.

Lipomas are common benign adipose tissue tumors but are infrequently found in the labia majora, especially at a large size. We report a case of a giant lipoma of the labia majora in a 37-year-old woman diagnosed by imaging methods and successfully treated by surgery. This case highlights the importance of considering lipoma in the differential diagnosis of labial masses and underscores the role of imaging in diagnosis. They need to be differentiated from liposarcoma or omental herniation into Nuck's canal. It also demonstrates the effectiveness of surgical management for large lipomas in sensitive areas, with attention to both medical and aesthetic outcomes.

Rare complications of chronic cholangitis: Pseudoaneurysm of the hepatic artery causing serious gastrointestinal bleeding.

Gastrointestinal bleeding due to hemobilia is a rare condition but can be very serious, even life-threatening. The main causes of biliary bleeding are invasive procedures in treatment, trauma, or malignant diseases. Chronic obstruction of the biliary tract can cause inflammation, erosion, and leakage of adjacent vascular structures and lead to pseudoaneurysm or hemorrhage, but this is very rare. In this article, we present a clinical case of upper gastrointestinal bleeding due to a pseudoaneurysm of the hepatic artery believed to have formed due to chronic cholangitis. An 81-year-old female patient with a medical history of chronic cholangitis was admitted to the hospital with recurrent inflammation accompanied by progressive upper gastrointestinal bleeding, potentially life-threatening. Ultrasound images and blood tests confirmed that the patient had anemia and cholangitis caused by stones. Gastrointestinal endoscopy showed bleeding suspected to be from the biliary tract. Hepatobiliary computed tomography confirmed that the common hepatic artery pseudoaneurysm located at the upper end of the common bile duct had active bleeding.

The Human Microbiome as a Therapeutic Target for Metabolic Diseases.

The human microbiome functions as a separate organ in a symbiotic relationship with the host. Disruption of this host-microbe symbiosis can lead to serious health problems. Modifications to the composition and function of the microbiome have been linked to changes in host metabolic outcomes. Industrial lifestyles with high consumption of processed foods, alcoholic beverages and antibiotic use have significantly altered the gut microbiome in unfavorable ways. Therefore, understanding the causal relationship between the human microbiome and host metabolism will provide important insights into how we can better intervene in metabolic health. In this review, I will discuss the potential use of the human microbiome as a therapeutic target to improve host metabolism.