The relative abundance of fecal bacterial species belonging to the Firmicutes and Bacteroidetes phyla is related to plasma levels of bile acids in young adults.

BACKGROUND: Gut bacteria play a crucial role in the metabolism of bile acids (BA). Whether an association exists between the fecal microbiota composition and circulating BA levels in humans is poorly understood. Here, we investigated the relationship between fecal microbiota diversity and composition with plasma levels of BA in young adults. METHODS: Fecal microbiota diversity/composition was analyzed with 16S rRNA sequencing in 80 young adults (74% women; 21.9 ± 2.2 years old). Plasma levels of BA were measured using liquid chromatography-tandem mass spectrometry. PERMANOVA and Spearman correlation analyses were used to investigate the association between fecal microbiota parameters and plasma levels of BA. RESULTS: Fecal microbiota beta (P = 0.025) and alpha diversity indexes of evenness (rho = 0.237, P = 0.033), Shannon (rho = 0.313, P = 0.004), and inverse Simpson (rho = 0.283, P = 0.010) were positively associated with plasma levels of the secondary BA glycolithocholic acid (GLCA). The relative abundance of genera belonging to the Firmicutes and Bacteroidetes phyla was positively correlated with plasma levels of GLCA (all rho ≥ 0.225, P ≤ 0.049). However, the relative abundance of species from Firmicutes and Bacteroidetes phyla were negatively correlated with plasma levels of primary and secondary BA (all rho ≤ - 0.220, P ≤ 0.045), except for the relative abundance of Bacteroides vulgatus, Alistipes onderdonkii, and Bacteroides xylanisolvens species (Bacteroidetes phylum) that were positively correlated with the plasma levels of GLCA. CONCLUSIONS: The relative abundance of specific fecal bacteria species is associated with plasma levels of BA in young adults. However, further investigations are required to validate whether the composition of the gut microbiota can regulate the plasma concentrations of BA in humans.

A bout of endurance and resistance exercise transiently decreases plasma levels of bile acids in young, sedentary adults.

Circulating bile acids (BA) are signaling molecules that control glucose and lipid metabolism. However, the effects of acute exercise on plasma levels of BA in humans remain poorly understood. Here, we evaluate the effects of a bout of maximal endurance exercise (EE) and resistance exercise (RE) on plasma levels of BA in young, sedentary adults. Concentration of eight plasma BA was measured by liquid chromatography-tandem mass spectrometry before and 3, 30, 60, and 120 min after each exercise bout. Cardiorespiratory fitness (CRF) was assessed in 14 young adults (21.8 ± 2.5 yo, 12 women); muscle strength was assessed in 17 young adults (22.4 ± 2.5 yo, 11 women). EE transiently decreased plasma levels of total, primary, and secondary BA at 3 and 30 min after exercise. RE exerted a prolonged reduction in plasma levels of secondary BA (p < 0.001) that lasted until 120 min. Primary BA levels of cholic acid (CA) and chenodeoxycholic acid (CDCA) were different across individuals with low/high CRF levels after EE (p ≤ 0.044); CA levels were different across individuals with low/high handgrip strength levels. High CRF individuals presented higher levels of CA and CDCA 120 min after exercise vs baseline (+77% and +65%) vs the low CRF group (-5% and -39%). High handgrip strength levels individuals presented higher levels of CA 120 min after exercise versus baseline (+63%) versus the low handgrip strength group (+6%). The study findings indicate that an individual's level of physical fitness can influence how circulating BA respond to both endurance and resistance exercise. Additionally, the study suggests that changes in plasma BA levels after exercising could be related to the control of glucose homeostasis in humans.

Plasma Levels of Bile Acids Are Related to Cardiometabolic Risk Factors in Young Adults.

CONTEXT: Bile acids (BA) are known for their role in intestinal lipid absorption and can also play a role as signaling molecules to control energy metabolism. Prior evidence suggests that alterations in circulating BA levels and in the pool of circulating BA are linked to an increased risk of obesity and a higher incidence of type 2 diabetes in middle-aged adults. OBJECTIVE: We aimed to investigate the association between plasma levels of BA with cardiometabolic risk factors in a cohort of well-phenotyped, relatively healthy young adults. METHODS: Body composition, brown adipose tissue, serum classical cardiometabolic risk factors, and a set of 8 plasma BA (including glyco-conjugated forms) in 136 young adults (age 22.1 ± 2.2 years, 67% women) were measured. RESULTS: Plasma levels of chenodeoxycholic acid (CDCA) and glycoursodeoxycholic acid (GUDCA) were higher in men than in women, although these differences disappeared after adjusting for body fat percentage. Furthermore, cholic acid (CA), CDCA, deoxycholic acid (DCA), and glycodeoxycholic acid (GDCA) levels were positively, yet weakly associated, with lean body mass (LBM) levels, while GDCA and glycolithocholic acid (GLCA) levels were negatively associated with 18F-fluorodeoxyglucose uptake by brown adipose tissue. Interestingly, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and GUDCA were positively associated with glucose and insulin serum levels, HOMA index, low-density lipoprotein cholesterol, tumor necrosis factor alpha, interleukin (IL)-2, and IL-8 levels, but negatively associated with high-density lipoprotein cholesterol, ApoA1, and adiponectin levels, yet these significant correlations partially disappeared after the inclusion of LBM as a confounder. CONCLUSION: Our findings indicate that plasma levels of BA might be sex dependent and are associated with cardiometabolic and inflammatory risk factors in young and relatively healthy adults.

Dilatación quística de la vía biliar Todani Ic / Todani Ic cystic dilatation of the bile duct

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Todani Ic cystic dilatation of the bile duct.

The congenital dilation of the bile duct is an infrequent pathology in western countries and is associated with the female sex. It is usually diagnosed clinically with complementary tests and evaluated at an early age and also appears frequently in adults. These dilatations are grouped into five types according to Todani's classification, including type Ic (Figure 1). The treatment of choice for dilatations of the biliary duct Todani type I is the complete excision of the biliary tract due to the susceptibility of malignant degeneration. A reconstruction is performed via a hepaticojejunostomy with a Roux-en-Y loop. Although in non-malignant cases, a papillotomy with prophylactic stent placement using ERCP can be performed as an alternative. We present the case of a 54-year-old female with a history of high blood pressure, she was examined due to generalized abdominal pain which was unrelated to food intake. The blood test did not identify any alterations of interest. Ultrasound identified a fusiform dilation of the common bile duct occupied by lithiasis. ERCP was attempted due to choledocholithiasis, but the procedure was abandoned as it was not feasible to channel the duodenal papilla. The study was completed with NMR cholangiography (transverse plane [Figure 2] and coronal plane [Figure 3]), identifying a diffuse fusiform dilatation of the common bile duct and common hepatic duct, compatible with congenital cystic lesion Todani type Ic. Finally, the patient underwent a hepaticojejunostomy after sectioning of the main bile duct and extraction of choledocholithiasis.

Duodenectomía parcial como opción terapéutica de un tumor del estroma gastrointestinal duodenal múltiple, asociado a neurofibromatosis tipo 1 / Partial duodenectomy as a therapeutic option in multiple duodenal gastrointestinal stromal tumour associated with neurofibromatosis type 1

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Colecistitis aguda por Listeria monocytogenes en paciente inmunocompetente / Listeria monocytogenes cholecystitis in an immunocompetent patient

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Isquemia intestinal transitoria por espasmo aórtico / Transient intestinal ischemia caused by aortic spasm

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Activating brown adipose tissue through exercise (ACTIBATE) in young adults: Rationale, design and methodology.

AIMS: The energy expenditure capacity of brown adipose tissue (BAT) makes it an attractive target as a therapy against obesity and type 2 diabetes. BAT activators namely catecholamines, natriuretic peptides and certain myokines, are secreted in response to exercise. ACTIBATE will determine the effect of exercise on BAT activity and mass measured by positron emission tomography/computed tomography (PET/CT, primary outcome) in young adults. ACTIBATE will also investigate the physiological consequences of activating BAT (secondary outcomes). METHODS: ACTIBATE will recruit 150 sedentary, healthy, young adults (50% women) aged 18-25 years. Eligible participants will be randomly assigned to a non-exercise group (n ≈ 50) or one of two exercise groups (n=50 each). Participants in the exercise groups will perform aerobic and strength training 3-4 days/week at a heart rate equivalent to 60% of heart rate reserve (HRres), and at 50% of 1 repetition maximum (RM) for the moderate-intensity group, and at 80% of HRres and 70% RM for the vigorous-intensity group. Laboratory measures completed at baseline and 6 months include BAT activity and mass, resting energy expenditure, meal and cold-induced thermogenesis, body temperature regulation and shivering threshold, body composition and cardiovascular disease risk factors. We will also obtain biopsies from abdominal subcutaneous white adipose tissue and skeletal muscle to analyse the expression of genes encoding proteins involved in the thermogenic machinery. DISCUSSION: Findings from ACTIBATE will have significant implications for our understanding of exercise and its protective effects against the development of type 2 diabetes, obesity and related metabolic diseases. ClinicalTrials.gov ID: NCT02365129.

Adenomiomatosis de la vía biliar, incidencia de 10 años y revisión de la bibliografía actual / Adenomyomatosis of the biliary tree, ten-year incidence and review of current literature

Introducción. La adenomiomatosis es una entidad anatomo-clínica de difícil diagnóstico. Se puede clasificar en generalizada, segmentaria y localizada. Suele presentarse con síntomas de colelitiasis, aunque puede variar desde ser completamente asintomática hasta sugerir una lesión maligna. El objetivo de este estudio fue revisar la afectación adenomiomatosa de la vesícula biliar y los conductos biliares intrahepáticos y extrahepáticos, así como su diagnóstico y tratamiento. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de 10 años de duración en los servicios de Cirugía Digestiva y Anatomía Patológica del Hospital Universitario San Cecilio en Granada, España. Se incluyeron todos los pacientes que presentaban afectación adenomiomatosa de la vesícula biliar y del sistema biliar intrahepático y extrahepático. Resultados, Entre los años 2000 y 2010, se identificaron 24 pacientes, 19 mujeres y 5 hombres, con adenomiomatosis de un total de 5.141 piezas quirúrgicas. Las manifestaciones clínicas fueron de colelitiasis en 20 (83,3 %) pacientes, de colecistitis en 2 (8,35 %) y de obstrucción (ictericia) en 2 (8,35 %), y correspondieron con los hallazgos histopatológicos: se encontraron 20 lesiones localizadas en el fondo de la vesícula, dos en el conducto cístico y dos en el colédoco distal. En la mayoría de los casos se practicó colecistectomía laparoscópica simple; los últimos dos se sometieron a duodenopancreatectomía cefálica u operación de Whipple, por sospecharse afectación maligna. Conclusión. Esta enfermedad puede presentarse con ausencia completa de síntomas, o con manifestaciones de colelitiasis, colecistitis o de síndrome colestásico. En los casos en que se sospeche una afectación maligna, lo adecuado es hacer un examen histopatológico intraoperatorio, antes de practicar cirugías complejas.

Introduction: Adenomyomatosis of the gallbladder and biliary ducts is an anatomic and medical entity of difficult diagnosis. It can be classified as generalized, segmentary or localized. Typical clinical presentation includes symptoms of cholelithiasis, but it can range from completely asymptomatic to suspicion of malignancy. The aim of this study was to review the gallbladder and intra and extrahepatic biliary ducts affectation by adenomyomatosis, its diagnosis and treatment. Patients and Method: Ten-year retrospective study, held at San Cecilio University Hospital's Digestive Surgery and Pathology Services in Granada, Spain. All patients with gallbladder and intra and extrahepatic biliary ducts adenomyomatosis were included. Results: 24 patients with adenomyomatosis were identified out of 5,141 surgical specimen in the ten-year period 2000-2010; 19 were female and five male. Twenty (83.3%) patients presented with symptoms of cholelithiasis, two (8.35%) with symptoms of cholecystitis, and two (8.35%) with obstructive signs (jaundice),all of which were consistent with the pathology findings: 20 lesions were located in the gallbladder fundus, two in the cystic duct, and two in the distal common bile duct. Laparoscopic cholecystectomy was performed in all but the last two cases, in which a cephalic pancreatico-duodenectomy, or Whipple procedure, was perfomed for suspected malignancy. Conclusion: This entity's clinical condition can present as totally asymptomatic, or with symptoms of cholelithiasis, cholecystitis, or cholestatic syndrome. When malignancy is suspected, intra-operative pathological confirmation is recommended before undertaking a complex surgical procedure.