The gut microbiota changes in obese people: a new perspective for the modern medicine

: Obesity is one of the major health problems of the modern era. Obesity has been associated with rapidly rising growth rates that affect every age group of the population indiscriminately, particularly the younger ones. Undoubtedly, it is necessary to identify increasingly effective therapies in order to avoid the possible complications of the syndrome. In this context, the microbota can represent one of the therapeutic targets for prevention and treatment of obesity. We highlight the role of the microbiota as a therapeutic target in obesity.

Treatment patterns should be carefully chosen in different primary sites of GI-NECs.

Background: Neuroendocrine carcinomas (NECs) are heterogeneous and aggressive in gastrointestinal tract (GI). However, treatment patterns and related outcomes in different primary sites have not been well described. Methods: The SEER data was selected from 2010 to 2016 and 5-year survival was set as the end-point. Coarsened exact matching (CEM) was performed to match comparable patients. Patients were separated by treatment groups and then comparing survivals for treatment patterns used multivariate analysis in different primary sites. Results: 3975 patients with GI-NECs including stomach (13.41%), small intestinal (38.82%), colon (25.31%) and rectum (22.47%) were identified. In stomach, primary tumor resection benefits patients (HR=0.492; P= 0.011) in non-metastatic disease and primary surgery combine with systematic chemotherapy (HR=0.401; P= 0.041) benefit patients in metastatic disease comparing with only chemotherapy. In small intestinal, patients’ diagnosis age and tumor size were important factors affecting patients’ overall survival. Primary tumor resection benefits both non-metastatic and metastatic patients (HR=0.246; P= 0.002 vs HR= 0.551; P= 0.005). In colon, primary surgery with systematic chemotherapy benefit patients (HR= 0.633; P= 0.005). In rectum, primary tumor resection benefits non-metastatic patients (HR=0.398; P<0.001), while neither chemotherapy or primary tumor resection showed priority in prolong overall survival in metastatic disease. Pooling all patients received metastatic sites resection and comparing with reference group, metastatic sites resection in GI-NEC will bring survival benefits (HR=0.42; P=0.033). Conclusions: GI-NECs have different treatment patterns in different primary sites. Primary sites resection should be the basic treatment choices for GI-NECs. Chemotherapy should be cautious especially in non-metastatic patients and considered more clinical and biological characteristics. Patients with distant metastasis can benefit from metastatic site resection.

Jejunal Hemolymphangioma in a Patient Presenting with Gastrointestinal Bleeding

Background: Hemolymphangioma is rarely found in the small intestine. There have only been eight reports of hemolymphangiomas arising in the small intestine to date. The first patient was reported by Fang et al.in 2012. A small intestinal hemolymphangioma may lead to anemia and gastrointestinal bleeding. Case Presentation: We report a case of jejunal hemolymphangioma in a 49-year-old man. The patient presented with melena and anemia. He underwent double-balloon enteroscopy (DBE) via the antegrade approach, which demonstrated a 3.0 cm segment of jejunum with nearly 75% of the circumferential lesion with blood remnant. The raised soft lesion was in the middle of the jejunum with white patches on the surface of the mucosa. Endoscopic biopsy was not performed to avoid secondary bleeding. The patient underwent laparotomy, and partial small intestine resection was performed. A 5.0cm segment of jejunum was resected with primary anastomosis. The patient had an uneventful postoperative recovery. Macroscopic pathological examination showed a cavernous, soft and compressible tumor. Microscopic examination showed a tumor that was composed of blood and lymphatic vessels mainly located in the submucosa. The definitive histological diagnosis was jejunal hemolymphangioma. During a follow-up of 2 years, there was no further gastrointestinal bleeding. Conclusion: Small intestinal hemolymphangioma is a rare benign tumor of which clinical manifestations are nonspecific, and accurate preoperative diagnosis is challenging. Endoscopic biopsy is not recommended for hemolymphangioma of the gastrointestinal tract due to the risk of severe bleeding. Complete surgical resection of the hemolymphangioma is considered the most effective treatment for small intestinal hemolymphangioma.

Ectopic Embolism after Endoscopic Glue Injection

: A 55-year-old male with a 7-year history of liver cirrhosis was admitted to our department due to recurrent hematemesis and melena. He had been treated with endoscopic tissue glue injection and/or band ligation for gastroesophageal variceal bleeding. He denied any history of viral hepatitis infection or alcohol abuse. At this admission, his pulse rate was 88b.p.m., and blood pressure was 110/51mmHg. Hemoglobin concentration was 81g/L, platelet count was 38X109/L, total bilirubin was 28.4umol/L, and albumin was 24.2g/L. Except for ascites, splenomegaly, and portal vein thrombosis, contrast-enhanced computed tomography scans showed high density within gastric fundal varices, gastro-renal shunt, left renal vein, and inferior vena cava (arrows), suggesting a diagnosis of ectopic embolism from tissue glue injected during a prior endoscopic procedure. Upper gastrointestinal endoscopy demonstrated esophageal varices, post-endoscopic gastric fundal glue removal, and portal hypertensive gastropathy. Esophageal variceal ligation was performed. After that, he was discharged without any other complaints. Currently, endoscopic variceal therapy, mainly including variceal band ligation, sclerotherapy, glue injection, and haemostatic powder spraying is the mainstay treatment option of acute variceal bleeding in liver cirrhosis [1]. There is a benefit of endoscopic glue injection for gastric fundal variceal bleeding in terms of increasing the rate of initial hemostasis and reducing the rate of rebleeding as compared to variceal band ligation [2-3]. Therefore, endoscopic glue injection has been widely employed in cirrhotic patients with gastric variceal bleeding. However, there are some severe complications related to endoscopic glue injection [4-5], especially thromboembolism. The current case further showed a possibility of asymptomatic ectopic embolism after endoscopic glue injection, suggesting that a close surveillance of embolism within portosystemic collateral vessels should be necessary.

Deoxycholic and Ursodeoxycholic Acid Differentially Impact Cellular Steatosis and Lipid Peroxidation in Cultured Hepatoma Cells

Background: Bile acids (BAs) are the major lipid components of bile. They are synthesized from cholesterol in the liver and stored in the gallbladder. BAs have gained attention as drug candidates to control obesity and/or diabetic condition due to their role in lipid and glucose metabolism. Objective: This study aimed to evaluate the antisteatotic and antioxidant potential of deoxycholic acid (DCA) and ursodeoxycholic acid (UDCA), two BAs with opposite physico-chemical features. Methods: Different concentrations of DCA and UDCA in the micromolar range were tested on cultured hepatoma cells after loading with an excess of fatty acids to mimic non-alcoholic fatty liver disease (NAFLD) in vitro. Experimental analyses included cell viability, lipid accumulation and lipid peroxidation in steatotic hepatocytes before and after exposure to either DCA or UDCA. Results: Both UDCA and DCA improved lipid dysmetabolism and oxidative stress condition in the steatotic hepatocytes. However, while UDCA was more effective as lipid lowering agent, DCA showed a greater antioxidant effect. Conclusions: UDCA seems to have better protective and beneficial potential than DCA, as it is able to both alleviate lipid accumulation in the steatotic liver cells, but also to play antioxidant effect.

Focus on Controversies in Budd-Chiari Syndrome Management

: Budd–Chiari Syndrome (BCS) is characterized by significant clinical and pathophysiological aspects that seem to allow a sharp differentiation between a variant in the West from one in the East. The aim of this paper is to focus on the main issues and controversies about management of BCS in the West. The study discusses different treatment options and how research is trying to solve controversies about debated topics, such as timing of treatment. In fact, guidelines regarding management of BCS suggest a step-wise strategy starting with medical therapy, arriving to revascularization or TIPS as second step, and culminating to liver transplant as rescue therapy. However, long-term outcome is frequently dismal on sole medical therapy. In fact, it is matter of debate whether further intervention should be suggested only when hemodynamic consequences of portal hypertension are evident. However, as recently hypothesized, chronic micro-vascular ischemia due to impaired venous hepatic outflow could be the trigger of liver fibrosis, resulting in portal hypertension and progressive liver failure. Consequently, liver congestion relief through treatment might be useful as a preventive tool. Recently, early TIPS proved to improve BCS outcome. A direct comparison of early intervention versus step-wise strategy would seem advisable. Furthermore, further studies should address whether non-invasive tools could predict which patients benefit from early intervention.