Trimethylamine N-oxide levels are associated with NASH in obese subjects with type 2 diabetes.

AIMS: Trimethylamine N-oxide (TMAO), choline and betaine serum levels have been associated with metabolic diseases including type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). These associations could be mediated by insulin resistance. However, the relationships among these metabolites, insulin resistance and NAFLD have not been thoroughly investigated. Moreover, it has recently been suggested that TMAO could play a role in NAFLD by altering bile acid metabolism. We examined the association between circulating TMAO, choline and betaine levels and NAFLD in obese subjects. METHODS: Serum TMAO, choline, betaine and bile acid levels were measured in 357 Mexican obese patients with different grades of NAFLD as determined by liver histology. Associations of NAFLD with TMAO, choline and betaine levels were tested. Moreover, association of TMAO levels with non-alcoholic steatohepatitis (NASH) was tested separately in patients with and without T2D. RESULTS: TMAO and choline levels were significantly associated with NAFLD histologic features and NASH risk. While increased serum TMAO levels were significantly associated with NASH in patients with T2D, in non-T2D subjects this association lost significance after adjusting for sex, BMI and HOMA2-IR. Moreover, circulating secondary bile acids were associated both with increased TMAO levels and NASH. CONCLUSIONS: In obese patients, circulating TMAO levels were associated with NASH mainly in the presence of T2D. Functional studies are required to evaluate the role of insulin resistance and T2D in this association, both highly prevalent in NASH patients.

[Differential sperm aspiration. Apropos our first clinical pregnancy]. / Microaspiración espermática deferencial. A propósito de nuestro primer embarazo clínico.

It is now one year since we started our microsurgical venture. The idea was to round-off the care coverage of our Reproduction Unit since, in June 92, we had launched the FIV-TE program. The Unit Incorporates professionals from different services (urology, gynaecology, laboratory) imbued by the notion that it is not the isolated individual but the couple who, at any particular time, have a fertility problem. Approach to the study is, therefore, done in an integrate and concurrent way to both members of the couple, progressing then to establishment of diagnosis and the outline of a therapeutic alternative. We introduce below the case of a couple which may well be an example of the above statements. The couple refers a 4-year evolution of primary sterility. The 34-year-old male is a long-evolution insulin-dependent diabetic with erectile dysfunction and backward ejaculation. The erectile dysfunction is successfully managed with PGE1 self-injections. In their wish for fertility and after failure of spermatozoa recovery both in urine following orgasm and intravesical Menezo, we attempt MAE (12 million of spermatozoa with motility, after swim-up) + FIC-TE in a FSHp- and HCG-induced cycle, securing the uptake, by ultrasound-guided follicular puncture under local anaesthetics, of 5 mature ovocytes 4 of which were fertilized; the same four undergoing intrauterine transferral with the result of pregnancy, this being the second one to be accomplished in the country and the first one In our Unit, by microaspiration of spermatozoa at the deferent level In a situation of primary sterility by plain male factor.