Radiological manifestations of benign mesenteric lipoma that presented with acute intestinal obstruction: A case report

Background Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies. Case presentation We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well. Conclusions Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

LOW WEIGHT GAIN, BETTER GLYCAEMIA AND NO CENTRAL OBESITY ACHIEVED THROUGH A HIGH-PROTEIN DIET

A compendium of metabolic diseases associated with unhealthy habits plague the modern world today. Weight gain, hyperglycemia and excess adiposity are some of the metabolic diseases plaguing our modern society. Unhealthy dietary habits coupled with a sedentary lifestyle are recognized as important factors for the development of some metabolic illnesses. Cardiovascular diseases, diabetes mellitus, hypertension, and dyslipidemia were recognized as stemming from metabolic dysregulation due to the consumption of excess calories from certain macronutrients. Our objective in this study is to find out which diet most affects circulating blood glucose levels, body weight, and visceral fat tissue deposition. 35 male Sprague - Dawley rats were separated into five groups and were given five distinct diets for the duration of 8 weeks. The five diets are normal rat feed, high-fat, high-protein, high-sugar, and high-starch. The feeding provided was ad libitum with tap water given as drinking water. Every week, each rat was weighed, and blood were sampled for glucose. Post-sacrifice, mesenteric fat was harvested, fixed, and stained for histological analysis. The results revealed a high-protein diet significantly reduces body weight gain, improved blood sugar with no development of central obesity. At the same time, a high-fat diet was shown to be a promoter of mesenteric fat tissue hypertrophy. It was concluded that the consumption of a high-protein diet was found to achieve low weight gain, better glycaemia with no central obesity.

Reverse translation approach generates a signature of penetrating fibrosis in Crohn’s disease that is associated with anti-TNF response

ObjectiveFibrosis is a common feature of Crohn’s disease (CD) which can involve the mesenteric fat. However, the molecular signature of this process remains unclear. Our goal was to define the transcriptional signature of mesenteric fibrosis in CD subjects and to model mesenteric fibrosis in mice to improve our understanding of CD pathogenesis.DesignWe performed histological and transcriptional analysis of fibrosis in CD samples. We modelled a CD-like fibrosis phenotype by performing repeated colonic biopsies in mice and analysed the model by histology, type I collagen-targeted positron emission tomography (PET) and global gene expression. We generated a gene set list of essential features of mesenteric fibrosis and compared it to mucosal biopsy datasets from inflammatory bowel disease patients to identify a refined gene set that correlated with clinical outcomes.ResultsMesenteric fibrosis in CD was interconnected to areas of fibrosis in all layers of the intestine, defined as penetrating fibrosis. We found a transcriptional signature of differentially expressed genes enriched in areas of the mesenteric fat of CD subjects with high levels of fibrosis. Mice subjected to repeated colonic biopsies showed penetrating fibrosis as shown by histology, PET imaging and transcriptional analysis. Finally, we composed a composite 24-gene set list that was linked to inflammatory fibroblasts and correlated with treatment response.ConclusionWe linked histopathological and molecular features of CD penetrating fibrosis to a mouse model of repeated biopsy injuries. This experimental system provides an innovative approach for functional investigations of underlying profibrotic mechanisms and therapeutic concepts in CD.

APENDICITIS AGUDA IZQUIERDA; UNA PRESENTACIÓN POCO HABITUAL DE UNA PATOLOGÍA MUY COMÚN EN LA POBLACIÓN ECUATORIANA. REVISIÓN BIBLIOGRÁFICA Y REPORTE DE UN CASO.

Introduction Acute appendicitis is one of the most common urgent surgical pathologies in the Ecuadorian population, and the atypical presentation of the appendix on the left side is presented as a diagnostic challenge, since it is observed more frequently in congenital anomalies such as malrotation of the midgut, a rare disorder with an incidence of one in 10,000 individuals. Case description We present the clinical case of an 8-year-old girl with no significant pathological history, admitted to the Pediatrics service with a 48-hour history of abdominal pain located in the left hemiabdomen, accompanied by nausea, vomiting, abdominal distention and thermal rise; tender abdomen on palpation in the flank and left iliac fossa, positive Mussy's sign. The patient presented with leukocytosis and neutrophilia; imaging examinations revealed thickening of the mesenteric fat at the level of the left iliac fossa and air-fluid levels at an elevation of the colonic framework. She underwent surgery and the findings were an appendicular plastron made up of a perforated appendix in the distal third and undamaged appendicular base, omentum and distal third of the descending colon; her postsurgical evolution was favorable. Conclusion Acute appendicitis can present with atypical symptoms due to unusual locations of the appendix, one of the unusual presentations can present in malrotation. Most cases are asymptomatic until the development of acute complications and require imaging for diagnosis, becoming a challenge when defining the appropriate and timely treatment.

Mesenteric Lipoma as an Uncommon Cause of Abdominal Discomfort

Lipoma is the most frequent benign mesenchymal tumor that resembles normal white fat. Gastrointestinal tract lipomas are rare. The small bowel is the second predilection site of lipomas following the colon. Mesenteric lipomas mainly occur in adults without gender predilection. They are usually asymptomatic and discovered incidentally. However; these tumors may present with intussusception and intestinal bleeding. CT is the key imaging modality to diagnose mesenteric lipoma. They typically present as well-circumscribed, non-enhancing masses with homogeneous fatty attenuation, which are often contained and separate from free mesenteric fat (Figure 1 and 2: white arrows). On MRI, mesenteric lipomas demonstrate homogeneous signal intensity identical to that of fat. Thin fibrous septa of low signal intensity on T1- and T2-weighted images may be present.

Dietary selenium (Se) sources differentially regulate Se concentration, mRNA and protein expression of representative selenoproteins in various tissues of yellow catfish Pelteobagrus fulvidraco

The study was conducted to determine effects of three dietary selenium (Se) sources, such as sodium-selenite (S-S), seleno-yeast (S-Y) and seleno-methionine (S-M), on Se concentration, GPX and TXNRD activities, and mRNA expression of 15 representative selenoproteins, and protein expression of four endoplasmic reticulum (ER)-resided selenoproteins in a wide range of tissues of yellow catfish. Compared with S-S and S-M group, dietary S-Y significantly decreased growth performance and feed utilization of yellow catfish. Dietary Se sources significantly influenced Se contents in the spleen, dorsal muscle and the kidney, GPX activities in spleen, kidney, intestine, muscle and mesenteric fat, and TXNRD activities in the heart, intestine and mesenteric fat. Among 10 tested tissues, dietary Se sources influenced mRNA expression of GPX4 and SELENOK in 3 tissues, GPX3, SELENOS and TXNRD2 in 4 tissues, SELENOF, SELENON and DIO2 in 5 tissues, SELENOM, GPX1/2 and TXNRD3 in 6 tissues, SELENOW in 7 tissue, SELENOP and SELENOT in 8 tissues. Based on these observations above, sodium-selenite and seleno-methionine seem to be suitable Se sources for improving growth performance and feed utilization of yellow catfish. Dietary Se sources differentially influence the expression of selenoproteins in various tissues of yellow catfish. For the first time, we determined the expression of selenoproteins in fish in responses to dietary Se sources, which contributes to a better understanding of the functions and regulatory mechanisms of selenoporteins.

Development of an Optimized Clearing Protocol to Examine Adipocyte Subpopulations in White Adipose Tissue

Organic solvent dibenzyl ether (DBE)-based protocols have been widely used in adipose tissue clearing. However, benzyl alcohol/benzyl benzoate (BABB)-based clearing has been shown to offer better transparency in other tissues. The addition of diphenyl ether (DPE) to BABB (BABB-D4) is often included to preserve fluorescent signals, but its effects on adipose tissue transparency and shrinkage have not been explored. Distinct adipocyte subpopulations contribute to its cellular composition and biological activity. Here, we compared clearing solvents to create an optimized clearing methodology for the study of adipocyte subpopulations. Adipose tissues were cleared with BABB, BABB-D4, and DBE, and post-clearing transparency and tissue shrinkage were measured. An optimized protocol, including BABB-D4 clearing, delipidation, and extensive immunofluorescence blocking steps, was created to examine the spatial distribution of Wt-1 positive progenitor-derived (Type-1) adipocytes in intact mesenteric fat. Both BABB and BABB-D4 lead to significantly increased tissue transparency with reduced tissue shrinkage compared to DBE-cleared adipose tissue. Type-1 adipocytes are found in a clustered distribution with predominant residence in fat associated with the ileum and colon. This paper details an optimized clearing methodology for adipose tissue with increased tissue transparency and reduced shrinkage, and therefore will be a useful tool for investigating adipose tissue biology.

P050 Effect of biological treatments (anti-TNFs) in the creeping fat of Crohn’s disease patients

Background Crohn’s disease (CD) is characterized by persistent inflammation and ulcerations at the small or large bowel, provoking chronic low-grade systemic inflammation. Adipose tissue (AT) is believed to play an active role in the pathogenesis of CD, as the expansion of mesenteric fat attached to the inflamed segments of the intestine, also known as “creeping fat,” is a hallmark of the disease that seems to be directly related to disease activity. We demonstrated that adipose-stem cells (ASC) isolated from the creeping fat of CD patients showed a proinflammatory phenotype and increased the proliferation, migration, and phagocytic capacities of these cells. Taking into account the widely described effects of TNFalpha on the biology and functionality of adipocytes, we believe that biological therapies based on anti-TNF agents modify the inflammatory status of creeping fat. In this context, the effect of anti-TNF treatment on mesenteric fat is poorly studied, and the results are divergent. Methods Creeping fat biopsies were obtained from active CD patients that underwent surgery for symptomatic complications: 10 patients were on anti-TNF therapy (at least 6-months prior to surgery) and 10 patients never received any biological therapy. The groups were comparable in age, sex, and body mass index. We isolated from AT biopsies: AT explants, ASC, and adipose tissue macrophages (ATM). Adipose tissue was fixed in 10% phosphate-buffered formalin and embedded in paraffin for histological studies. The proliferation of ASC was performed using the CellTraceTM Violet Cell proliferation kit using flow cytometry and the cell migration of ASC was analyzed using a Tranwell system (8 mmpore polycarbonate membrane). Results Histological studies revealed that AT of patients treated with anti-TNF therapy recovered adipocytes morphology and showed lower infiltration of immune cells. Interestingly, we found a significant decrease in the gene expression of pro-inflammatory cytokines (IL1B, IL6, TNFA) in the creeping fat of CD patients treated with anti-TNF (Figure 1A). Furthermore, ATMs isolated from patients treated with anti-TNF showed a significant decrease in the gene expression of antigen-presenting markers (CD74, CIITa, HLA-DPB and HLA-DM) (Figure 1B). To note, ASC isolated from patients with anti-TNF therapy has significantly decreased their proliferation and migration capacities as well as the pro-inflammatory gene expression. Moreover, the anti-inflammatory gene expression and secretion were significantly increased in these cells (Figure 1C). Conclusion Anti-TNF therapies impact on the creeping fat of CD patients improving the phenotype of this tissue and this may cause a beneficial effect on CD.

Metabolic PCOS Features Are Ameliorated by Mitochondrial Uncoupler BAM15 in a PCOS Mouse Model

Polycystic ovary syndrome (PCOS) is a prevalent endocrine condition characterized by endocrine, reproductive and metabolic dysfunction. At present, there is no cure for PCOS and current treatments are suboptimal. Obesity and adverse metabolic features are prevalent in women with PCOS, with weight loss having a beneficial effect on PCOS features. The use of dietary interventions aimed at weight loss have low long-term compliance in women suffering from PCOS. Recent data from animal studies has shown that a small molecule mitochondrial uncoupler, BAM15, is an effective method to pharmacologically treat obesity and metabolic diseases. Therefore, the aim of this study was to investigate the efficacy of BAM15 to ameliorate PCOS-traits in a hyperandrogenic PCOS mouse model. As expected, exposure of female mice to dihydrotestosterone (DHT) induced the PCOS metabolic features of increased body weight (P<0.05), lean mass (P<0.001), increased parametrial and mesenteric fat pad weights (both P<0.05) and adipocyte hypertrophy (P<0.05). Additionally, DHT-induced PCOS mice exhibited insulin resistance measured by HOMA-IR, increased cholesterol and fasting triglyceride levels and hepatic steatosis (all P<0.05). In contrast, DHT-induced PCOS females treated with BAM15 displayed body weights which were comparable with controls, a significant decrease in parametrial and mesenteric fat depot weights (P<0.05) and reduced adipocyte hypertrophy. Furthermore, BAM15 treatment decreased insulin resistance, cholesterol and fasting triglyceride levels, as well as the degree of hepatic steatosis observed in PCOS females, to levels comparable with controls. PCOS mice presented the reproductive PCOS traits of irregular cycles and ovulatory dysfunction, however BAM15 did not improve these PCOS traits. These findings demonstrate that the pharmacologic mitochondrial uncoupler BAM15 is able to ameliorate metabolic PCOS features in a hyperandrogenic PCOS mouse model. These data provide compelling evidence to support BAM15 as a potential innovative and viable therapeutic approach to manage metabolic traits associated with PCOS.