Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, o...Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, ox and common carp biles approximately in the Zhou dynasty (c. 1046-256 BCE). Overall, different animal biles were prescribed principally for the treatment of liver, biliary, skin (including burns), gynecological and heart diseases, as well as diseases of the eyes, ears, nose, mouth and throat. We present an informed opinion of the clinical efficacy of the medicinal uses of the different animal biles based on their presently known principal chemical components which are mostly steroidal detergent-like molecules and the membrane lipids such as unesterified cholesterol and mixed phosphatidylcholines and sometimes sphingomyelin, as well as containing lipopigments derived from heme principally bilirubin glucuronides. All of the available information on the ethnopharmacological uses of biles in TCM were collated from the rich collection of ancient Chinese books on materia medica held in libraries in China and United States and the composition of various animal biles was based on rigorous separatory and advanced chemical identification techniques published since the mid-20<sup>th</sup> century collected via library (Harvard’s Countway Library) and electronic searches (PubMed and Google Scholar). Our analysis of ethnomedical data and information on biliary chemistry shows that specific bile salts, as well as the common bile pigment bilirubin and its glucuronides plus the minor components of bile such as vitamins A, D, E, K, as well as melatonin (N-acetyl-5-methoxytryptamine) are salutary in improving liver function, dissolving gallstones, inhibiting bacterial and viral multiplication, promoting cardiac chronotropsim, as well as exhibiting anti-inflammatory, anti-pyretic, anti-oxidant, sedative, anti-convulsive, anti-allergic, anti-congestive, anti-diabetic and anti-spasmodic effects. Pig, wild boar and human biles diluted with alcohol were shown to form an artificial skin for burns and wounds one thousand years ago in the Tang dynasty (618-907 CE). Although various animal biles exhibit several generic effects in common, a number of biles appear to be advantageous for specific therapeutic indications. We attempt to understand these effects based on the pharmacology of individual components of bile as well as attempting to identify a variety of future research needs.展开更多
The concentration of 26 elements in biles and gallstones from Chi-nese patients and the concentration of 10 elements from Japanese patients withgallstones were determined by inductively coupled plasma atomic emission ...The concentration of 26 elements in biles and gallstones from Chi-nese patients and the concentration of 10 elements from Japanese patients withgallstones were determined by inductively coupled plasma atomic emission spec-trometry (ICAP). Comparison of the level of elements between cholesterol andpigment gallstones revealed that Ca, Na, Fe, Cu, S, and Zn were higher inpigment gallstones than those in the cholesterol gallstones. Cholesterol stones aredivided into three subtypes: pure, mixed and combinated cholesterol stone.There were no significant difference among element contents. The levels of Ca,P, S, Li, and Ba in gallbladder biles were obviously higher in control groupthan in gallstone group. The element composition in gallbladder bile were similarto those in common bile duct bile. The former were 2～3 time high than the lat-ter.展开更多
Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related c...Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.展开更多
The gut microbiota has emerged as a pivotal regulator of host lipid metabolism and energy homeostasis.A growing body of evidence reveals that variations in the composition and metabolic activity of intestinal microbes...The gut microbiota has emerged as a pivotal regulator of host lipid metabolism and energy homeostasis.A growing body of evidence reveals that variations in the composition and metabolic activity of intestinal microbes are closely associated with differences in adipose tissue deposition across species.Notably,increased abundance of Firmicutes and a reduced proportion of Bacteroidetes and butyrate-producing bacteria have been linked to enhanced fat accumulation.Key microbial metabolites such as short-chain fatty acids(SCFAs)influence lipid metabolism through multiple pathways,including the activation of GPR41/43 receptors,modulation of the bile acid–FXR/TGR5 axis,and regulation of hepatic lipogenesis.Additionally,the gut–brain axis plays a critical role in controlling feeding behavior via neuroendocrine signaling.This review summarizes current advances in understanding the roles of dominant bacterial phyla and beneficial genera—including Clostridium butyricum and Faecalibacterium prausnitzii—in fat metabolism.We further explore the mechanisms by which gut microbiota modulate lipid synthesis and catabolism through SCFA production,bile acid signaling,and AMPK/PPAR-related pathways.These insights highlight the potential of microbiota-targeted strategies to restore lipid metabolic balance,offering novel opportunities for applications in health management,nutritional interventions,and microbial therapeutics.展开更多
Intramuscular fat(IMF)content serves as the key determinants of meat quality.Emerging evidence indicates that gut microbiota and their metabolites significantly influence IMF deposition levels by modulating host lipid...Intramuscular fat(IMF)content serves as the key determinants of meat quality.Emerging evidence indicates that gut microbiota and their metabolites significantly influence IMF deposition levels by modulating host lipid metabolism through multiple pathways,positioning microbial regulation as a pivotal target for meat quality improvement.However,existing studies remain fragmented,predominantly focusing on isolated mechanisms or correlations without a systematic view of the regulatory network.This review consolidates the core mechanisms through which microbiota-derived metabolites including short-chain fatty acids,bile acids,branched-chain amino acids,trimethylamine N-oxide,tryptophan derivatives,succinate,polyamines etc.,regulate IMF deposition and proposes a targeted intervention framework,the“gut microbiota/metabolites-IMF axis”.By integrating these insights,we provide a theoretical foundation and define practical research pathways to assess the potential of microbial-based strategies for improving meat quality in swine production.展开更多
This article systematically reviews the characteristics of gut microbiota dysbiosis in IBS-D and associated therapeutic modulation strategies.It elaborates on the biosynthetic and metabolic pathways of bile acids,the ...This article systematically reviews the characteristics of gut microbiota dysbiosis in IBS-D and associated therapeutic modulation strategies.It elaborates on the biosynthetic and metabolic pathways of bile acids,the phenotypes of bile acid dysregulation in IBS-D patients,and the related pathogenic molecular mechanisms.A primary focus is placed on dissecting the interaction mechanisms between the gut microbiota and bile acids,specifically the regulatory role of the gut microbiota in bile acid transformation and the influence of bile acids on the structure of the gut microbiota.Based on current research evidence,this article proposes the gut microbiota-bile acid axis as a potential therapeutic target for IBS-D.It aims to provide theoretical insights and novel perspectives for exploring innovative treatment strategies for IBS-D and elucidating its pathogenesis.展开更多
Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1]....Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.展开更多
Primary hepatic leiomyosarcoma is a very rare disease,accounting for less than 1%of all primary hepatic malignancies[1].As a malignant tumor of the smooth muscle,it originates in the hepatic blood vessels,bile ducts o...Primary hepatic leiomyosarcoma is a very rare disease,accounting for less than 1%of all primary hepatic malignancies[1].As a malignant tumor of the smooth muscle,it originates in the hepatic blood vessels,bile ducts or round ligaments of the liver[2,3].The clinical manifestations are nonspecific,and tumors are usually asymptomatic until they are relatively large in size.Primary hepatic leiomyosarcoma is characterized by a relatively poor prognosis and aggressive metastatic potential[3].The specific etiology and pathogenesis of primary hepatic leiomyosarcoma are still unclear.Several studies indicated that primary hepatic leiomyosarcoma might be related to acquired immune deficiency syndrome[4],Epstein-Barr virus[5],immunosuppression after organ transplantation[6],hepatitis virus[7,8],Hodgkin’s lymphoma[9]and other medical histories.Here,we present a case of primary hepatic leiomyosarcoma.展开更多
BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.展开更多
The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,...The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,when dysbiosis occurs,it can contribute to the pathogenesis of diseases,including osteoporosis.Osteoporosis,a systemic skeletal disease characterized by reduced bone mass and increased fracture risk,has attracted significant research attention concerning the role of gut microbes in its development.Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation,modulation of the gut-brain axis,and regulation of the intestinal barrier and nutrient absorption.These microbes can enhance bone mass by inhibiting osteoclast differentiation,inducing apoptosis,reducing bone resorption,and promoting osteoblast proliferation and maturation.Despite these promising findings,the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation.Notably,gut microbiota has been increasingly studied for their potential in early diagnosis,intervention,and as an adjunct therapy for osteoporosis,suggesting a growing utility in improving bone health.Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.展开更多
BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been exa...BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.展开更多
The association between dietary fat types and obesity is controversial,and the underlying mechanism remains unclear.This study aimed to evaluate the effect of different dietary fat sources(lard,corn oil or canola oil)...The association between dietary fat types and obesity is controversial,and the underlying mechanism remains unclear.This study aimed to evaluate the effect of different dietary fat sources(lard,corn oil or canola oil)on obesity in mice.The results revealed that lard-fed mice showed a lean phenotype,as well as lower serum cholesterol level compared with mice fed corn oil or canola oil.The 16S rRNA gene sequencing showed that the lard-fed mice had higherα-diversity of gut microbiota.In addition,the lard group had similar relative abundance of Lactobacillus,unclassified_f_Lachnospiraceae and Bacteroides compared with the control group.Targeted metabolomics analysis of caecal bile acid(BA)profile suggested the levels of chenodeoxycholic acid,lithocholic acid,deoxycholic acid and cholic acid in the lard group were higher than those in the corn oil and canola oil groups.Meanwhile,the levels of BA receptor farnesoid X receptor(Fxr)gene in lard-fed mice were higher than vegetable oil groups.These results suggested that lard could reduce the risk of obesity compared with corn oil and canola oil,which may be associated with more balanced gut microbiota and BA composition as well as activated FXR signaling.展开更多
Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate t...Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate the influence of punicalagin on hypercholesterolemia in mice and its related mechanisms.After 6 weeks'intervention,punicalagin significantly reduced serum total cholesterol and low-density lipoprotein cholesterol(LDL-C)levels in mice fed a high-fat high-cholesterol(HFHC)diet.Meanwhile,punicalagin supplementation lowered hepatic cholesterol level,which corresponded to the down-regulation of cholesterol synthesis genes(Fdps,Cyp51)and up-regulated bile acid synthesis genes(Cyp7a1,Cyp27a1).In addition,bile acid reabsorption was retarded in punicalagin-fed mice through down-regulating ileal apical sodium-dependent BA transporter(ASBT).Furthermore,intestinal farnesoid X receptor(FXR)-fibroblast growth factor 15(Fgf15)pathway was inhibited while hepatic FXR-small heterodimeric partner(SHP)pathway was activated in punicalagin group.Microbiota analysis and targeted metabolomics showed that punicalagin decreased the abundance of bile-salt hydrolase(BSH)-producing bacteria(Clostridiaceae and Bifidobacteriaceae)and the ratio of primary BAs to secondary BAs.In conclusion,the cholesterol-lowering effect of punicalagin partly through down-regulating cholesterol synthesis and increasing cholesterol catabolism,which could be achieved by regulating gut microbiota,altering bile acid composition and modulating FXR signaling pathway.These findings indicate the potential application of punicalagin-related products as an alternative strategy for hypercholesterolemia prevention and mitigation.展开更多
Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-ca...Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].展开更多
Background During the transition period,cows are prone to negative energy balance,which can lead to a decline in production performance and health in severe cases.In recent years,it has been discovered that bile acids...Background During the transition period,cows are prone to negative energy balance,which can lead to a decline in production performance and health in severe cases.In recent years,it has been discovered that bile acids(BAs)can act not only as fat emulsifiers but also as signaling molecules to regulate body metabolism.Although BAs have been used to some extent in monogastric and aquatic animals,their role in ruminants,particularly in transition cows,remains unclear.Therefore,this study aimed to determine the effects of BAs on the production performance,milk and plasma fatty acid and BA composition,and fecal microbiota in transition dairy cows.Results Forty-six healthy transition Holstein dairy cows with similar conditions were randomly divided into two groups and supplemented with 0 or 20 g/d of BAs from 21 d before the expected calving to 21 d after calving.The production performance was tracked until 60 d after calving.The results indicated that BA supplementation significantly improved postpartum milk fat content and yields as well as the yields of unsaturated fatty acids,monounsaturated fatty acids,and polyunsaturated fatty acids in milk.There was a significant increase in the concentration of triglyceride and the proportion of C≤16 fatty acids in the plasma of cows supplemented with BAs,while the concentration of β-hydroxybutyrate and the proportion of C>16 fatty acids in the plasma decreased significantly.BA supplementation significantly altered the composition of the fecal bacterial community and increased the relative abundance of bacteria beneficial for BA metabolism and transformation(Romboutsia,Clostridium sensu_stricto_6,and Clostridium sensu_stricto_1).Functional prediction analysis showed that the relative abundance of bile salt hydrolase,7 α-hydroxysteroid dehydrogenase,and BA inducible E as well as the pathways related to BA metabolism also significantly increased in cows supplemented BAs.In addition,BA supplementation significantly altered the composition of plasma and fecal BAs,particularly increasing circulating secondary BA concentration,which might induce the complete oxidation of fatty acids in the liver and further reduce the concentration of β-hydroxybutyrate.Conclusions These findings highlight the potential benefits of BA supplementation in improving milk yields and quality,as well as influencing metabolic pathways in transition dairy cows.Meanwhile,further studies are needed to elucidate the underlying mechanisms and explore the broader implications of these results by using more tissue samples.展开更多
BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmaphe...BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic ...Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic liver disease,is still unknown,treatment remains symptomatic.Knowledge of the physicochemical properties of various bile acids and the adaptive responses of cholangiocytes and hepatocytes to them has provided an important basis for the development of relatively effective drugs based on hydrophilic bile acids that can potentially slow the progression of the disease.Advances in the use of hydrophilic bile acids for the treatment of PBC are also associated with the discovery of pathogenetic mechanisms of the development of cholangiocyte damage and the appearance of the first signs of this disease.For 35 years,ursodeoxycholic acid(UDCA)has been the unique drug of choice for the treatment of patients with PBC.In recent years,the list of hydrophilic bile acids used to treat cholestatic liver diseases,including PBC,has expanded.In addition to UDCA,the use of obeticholic acid,tauroursodeoxycholic acid and norursodeoxycholic acid as drugs is discussed.The pathogenetic rationale for treatment of PBC with various bile acid drugs is discussed in this review.Emphasis is made on the mechanisms explaining the beneficial therapeutic effects and potential of each of the bile acid as a drug,based on the understanding of the pathogenesis of the initial stages of PBC.展开更多
Pu-erh tea has been shown to reduce gut inflammation in dextran sulfate sodium(DSS)-induced mice.Also,we found abnormal liver cholesterol metabolism in DSS-induced mice.However,it's not clear how Pu-erh tea improv...Pu-erh tea has been shown to reduce gut inflammation in dextran sulfate sodium(DSS)-induced mice.Also,we found abnormal liver cholesterol metabolism in DSS-induced mice.However,it's not clear how Pu-erh tea improves DSS-induced impaired liver cholesterol metabolism.Here,we established the DSS-induced model and clarified that DSS exacerbated gut inflammation accompanied by disorders of liver cholesterol metabolism.Pu-erh tea reshaped gut microbes,limited gut oxidative stress and inflammation(nicotinamide adenine dinucleotide phosphate oxidase 2/reactive oxygen species/myeloid differentiation primary response protein 88/nuclear factor kappa-B,24.97%-52.89%),reduced gut bile acid reabsorption(up-regulation of farnesoid X receptor(FXR)/fibroblast growth factor 15,24.53%-55.91%),and promoted liver bile acid synthesis(up-regulation of peroxisome proliferator-activated receptor-α/cholesterol 7-alpha hydroxylase,34.65%-79.14%),thereby partly restoring liver cholesterol metabolism(regulated FXR/small heterodimer partner/sterol-regulatory element binding proteins,53.19%-95.40%).Altered bile acid metabolic profiles(increased chenodeoxycholic acid,ursodeoxycholic acid,lithocholic acid,etc.)may also improve liver cholesterol metabolism by altering gut and liver inflammation.Thus,gut microbial reshaping and altered bile acid metabolism may be key targets of Pu-erh tea for improving DSS-induced liver cholesterol metabolism disorders via the gut-gut microbe-bile acid-liver axis.展开更多
基金Supported by Grants DK54012,DK73917,to Wang DQ-HDK36588,DK34854,and DK73687,to Carey MCall from the National Institutes of Health(US Public Health Service)
文摘Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, ox and common carp biles approximately in the Zhou dynasty (c. 1046-256 BCE). Overall, different animal biles were prescribed principally for the treatment of liver, biliary, skin (including burns), gynecological and heart diseases, as well as diseases of the eyes, ears, nose, mouth and throat. We present an informed opinion of the clinical efficacy of the medicinal uses of the different animal biles based on their presently known principal chemical components which are mostly steroidal detergent-like molecules and the membrane lipids such as unesterified cholesterol and mixed phosphatidylcholines and sometimes sphingomyelin, as well as containing lipopigments derived from heme principally bilirubin glucuronides. All of the available information on the ethnopharmacological uses of biles in TCM were collated from the rich collection of ancient Chinese books on materia medica held in libraries in China and United States and the composition of various animal biles was based on rigorous separatory and advanced chemical identification techniques published since the mid-20<sup>th</sup> century collected via library (Harvard’s Countway Library) and electronic searches (PubMed and Google Scholar). Our analysis of ethnomedical data and information on biliary chemistry shows that specific bile salts, as well as the common bile pigment bilirubin and its glucuronides plus the minor components of bile such as vitamins A, D, E, K, as well as melatonin (N-acetyl-5-methoxytryptamine) are salutary in improving liver function, dissolving gallstones, inhibiting bacterial and viral multiplication, promoting cardiac chronotropsim, as well as exhibiting anti-inflammatory, anti-pyretic, anti-oxidant, sedative, anti-convulsive, anti-allergic, anti-congestive, anti-diabetic and anti-spasmodic effects. Pig, wild boar and human biles diluted with alcohol were shown to form an artificial skin for burns and wounds one thousand years ago in the Tang dynasty (618-907 CE). Although various animal biles exhibit several generic effects in common, a number of biles appear to be advantageous for specific therapeutic indications. We attempt to understand these effects based on the pharmacology of individual components of bile as well as attempting to identify a variety of future research needs.
文摘The concentration of 26 elements in biles and gallstones from Chi-nese patients and the concentration of 10 elements from Japanese patients withgallstones were determined by inductively coupled plasma atomic emission spec-trometry (ICAP). Comparison of the level of elements between cholesterol andpigment gallstones revealed that Ca, Na, Fe, Cu, S, and Zn were higher inpigment gallstones than those in the cholesterol gallstones. Cholesterol stones aredivided into three subtypes: pure, mixed and combinated cholesterol stone.There were no significant difference among element contents. The levels of Ca,P, S, Li, and Ba in gallbladder biles were obviously higher in control groupthan in gallstone group. The element composition in gallbladder bile were similarto those in common bile duct bile. The former were 2～3 time high than the lat-ter.
基金supported by grants from the Taishan Scholars Program of Shandong Province(tsqn202312333)the National Natural Science Foundation of China(82470695).
文摘Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.
基金supported by National Key R&D Program of China(2024YFF1001500)Sichuan Science and Technology Program(2021YFYZ0007,2024NSFSC0298,SCCXTD-2025-8)+1 种基金China Agriculture Research System(CARS-35)National Natural Science Foundation of China(32421005)。
文摘The gut microbiota has emerged as a pivotal regulator of host lipid metabolism and energy homeostasis.A growing body of evidence reveals that variations in the composition and metabolic activity of intestinal microbes are closely associated with differences in adipose tissue deposition across species.Notably,increased abundance of Firmicutes and a reduced proportion of Bacteroidetes and butyrate-producing bacteria have been linked to enhanced fat accumulation.Key microbial metabolites such as short-chain fatty acids(SCFAs)influence lipid metabolism through multiple pathways,including the activation of GPR41/43 receptors,modulation of the bile acid–FXR/TGR5 axis,and regulation of hepatic lipogenesis.Additionally,the gut–brain axis plays a critical role in controlling feeding behavior via neuroendocrine signaling.This review summarizes current advances in understanding the roles of dominant bacterial phyla and beneficial genera—including Clostridium butyricum and Faecalibacterium prausnitzii—in fat metabolism.We further explore the mechanisms by which gut microbiota modulate lipid synthesis and catabolism through SCFA production,bile acid signaling,and AMPK/PPAR-related pathways.These insights highlight the potential of microbiota-targeted strategies to restore lipid metabolic balance,offering novel opportunities for applications in health management,nutritional interventions,and microbial therapeutics.
基金financially supported by the National Key Research and Development Program of China(2023YFD1301303)the National Natural Science Foundation of China(No.32202715)+1 种基金the National Natural Science Foundation of China(No.23DAA00403)Double first-class discipline promotion project under grant(No.2023B10564001)。
文摘Intramuscular fat(IMF)content serves as the key determinants of meat quality.Emerging evidence indicates that gut microbiota and their metabolites significantly influence IMF deposition levels by modulating host lipid metabolism through multiple pathways,positioning microbial regulation as a pivotal target for meat quality improvement.However,existing studies remain fragmented,predominantly focusing on isolated mechanisms or correlations without a systematic view of the regulatory network.This review consolidates the core mechanisms through which microbiota-derived metabolites including short-chain fatty acids,bile acids,branched-chain amino acids,trimethylamine N-oxide,tryptophan derivatives,succinate,polyamines etc.,regulate IMF deposition and proposes a targeted intervention framework,the“gut microbiota/metabolites-IMF axis”.By integrating these insights,we provide a theoretical foundation and define practical research pathways to assess the potential of microbial-based strategies for improving meat quality in swine production.
文摘This article systematically reviews the characteristics of gut microbiota dysbiosis in IBS-D and associated therapeutic modulation strategies.It elaborates on the biosynthetic and metabolic pathways of bile acids,the phenotypes of bile acid dysregulation in IBS-D patients,and the related pathogenic molecular mechanisms.A primary focus is placed on dissecting the interaction mechanisms between the gut microbiota and bile acids,specifically the regulatory role of the gut microbiota in bile acid transformation and the influence of bile acids on the structure of the gut microbiota.Based on current research evidence,this article proposes the gut microbiota-bile acid axis as a potential therapeutic target for IBS-D.It aims to provide theoretical insights and novel perspectives for exploring innovative treatment strategies for IBS-D and elucidating its pathogenesis.
文摘Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.
文摘Primary hepatic leiomyosarcoma is a very rare disease,accounting for less than 1%of all primary hepatic malignancies[1].As a malignant tumor of the smooth muscle,it originates in the hepatic blood vessels,bile ducts or round ligaments of the liver[2,3].The clinical manifestations are nonspecific,and tumors are usually asymptomatic until they are relatively large in size.Primary hepatic leiomyosarcoma is characterized by a relatively poor prognosis and aggressive metastatic potential[3].The specific etiology and pathogenesis of primary hepatic leiomyosarcoma are still unclear.Several studies indicated that primary hepatic leiomyosarcoma might be related to acquired immune deficiency syndrome[4],Epstein-Barr virus[5],immunosuppression after organ transplantation[6],hepatitis virus[7,8],Hodgkin’s lymphoma[9]and other medical histories.Here,we present a case of primary hepatic leiomyosarcoma.
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
文摘The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,when dysbiosis occurs,it can contribute to the pathogenesis of diseases,including osteoporosis.Osteoporosis,a systemic skeletal disease characterized by reduced bone mass and increased fracture risk,has attracted significant research attention concerning the role of gut microbes in its development.Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation,modulation of the gut-brain axis,and regulation of the intestinal barrier and nutrient absorption.These microbes can enhance bone mass by inhibiting osteoclast differentiation,inducing apoptosis,reducing bone resorption,and promoting osteoblast proliferation and maturation.Despite these promising findings,the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation.Notably,gut microbiota has been increasingly studied for their potential in early diagnosis,intervention,and as an adjunct therapy for osteoporosis,suggesting a growing utility in improving bone health.Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.
文摘BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.
基金funded by Basic Research Fund of Chinese Academy of Agricultural Sciences(CAAS)(1610072021001)the China Agriculture Research System(CARS-35)the Agricultural Science and Technology Innovation Program of CAAS。
文摘The association between dietary fat types and obesity is controversial,and the underlying mechanism remains unclear.This study aimed to evaluate the effect of different dietary fat sources(lard,corn oil or canola oil)on obesity in mice.The results revealed that lard-fed mice showed a lean phenotype,as well as lower serum cholesterol level compared with mice fed corn oil or canola oil.The 16S rRNA gene sequencing showed that the lard-fed mice had higherα-diversity of gut microbiota.In addition,the lard group had similar relative abundance of Lactobacillus,unclassified_f_Lachnospiraceae and Bacteroides compared with the control group.Targeted metabolomics analysis of caecal bile acid(BA)profile suggested the levels of chenodeoxycholic acid,lithocholic acid,deoxycholic acid and cholic acid in the lard group were higher than those in the corn oil and canola oil groups.Meanwhile,the levels of BA receptor farnesoid X receptor(Fxr)gene in lard-fed mice were higher than vegetable oil groups.These results suggested that lard could reduce the risk of obesity compared with corn oil and canola oil,which may be associated with more balanced gut microbiota and BA composition as well as activated FXR signaling.
基金supported in part by the National Key Research and Development Program of China(2022YFD2100104)the Science and Technology Program of Shaanxi Province,China(2022JM-111)Graduate Innovation Fund of Dalian Polytechnic University。
文摘Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate the influence of punicalagin on hypercholesterolemia in mice and its related mechanisms.After 6 weeks'intervention,punicalagin significantly reduced serum total cholesterol and low-density lipoprotein cholesterol(LDL-C)levels in mice fed a high-fat high-cholesterol(HFHC)diet.Meanwhile,punicalagin supplementation lowered hepatic cholesterol level,which corresponded to the down-regulation of cholesterol synthesis genes(Fdps,Cyp51)and up-regulated bile acid synthesis genes(Cyp7a1,Cyp27a1).In addition,bile acid reabsorption was retarded in punicalagin-fed mice through down-regulating ileal apical sodium-dependent BA transporter(ASBT).Furthermore,intestinal farnesoid X receptor(FXR)-fibroblast growth factor 15(Fgf15)pathway was inhibited while hepatic FXR-small heterodimeric partner(SHP)pathway was activated in punicalagin group.Microbiota analysis and targeted metabolomics showed that punicalagin decreased the abundance of bile-salt hydrolase(BSH)-producing bacteria(Clostridiaceae and Bifidobacteriaceae)and the ratio of primary BAs to secondary BAs.In conclusion,the cholesterol-lowering effect of punicalagin partly through down-regulating cholesterol synthesis and increasing cholesterol catabolism,which could be achieved by regulating gut microbiota,altering bile acid composition and modulating FXR signaling pathway.These findings indicate the potential application of punicalagin-related products as an alternative strategy for hypercholesterolemia prevention and mitigation.
文摘Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].
基金supported by the National Center of Technology Innovation for Dairy(No.2024-JSGG-021)the National Natural Science Foundation of China(No.32102570)the Key Research and Development Project of Ningxia(No.2024BBF01006).
文摘Background During the transition period,cows are prone to negative energy balance,which can lead to a decline in production performance and health in severe cases.In recent years,it has been discovered that bile acids(BAs)can act not only as fat emulsifiers but also as signaling molecules to regulate body metabolism.Although BAs have been used to some extent in monogastric and aquatic animals,their role in ruminants,particularly in transition cows,remains unclear.Therefore,this study aimed to determine the effects of BAs on the production performance,milk and plasma fatty acid and BA composition,and fecal microbiota in transition dairy cows.Results Forty-six healthy transition Holstein dairy cows with similar conditions were randomly divided into two groups and supplemented with 0 or 20 g/d of BAs from 21 d before the expected calving to 21 d after calving.The production performance was tracked until 60 d after calving.The results indicated that BA supplementation significantly improved postpartum milk fat content and yields as well as the yields of unsaturated fatty acids,monounsaturated fatty acids,and polyunsaturated fatty acids in milk.There was a significant increase in the concentration of triglyceride and the proportion of C≤16 fatty acids in the plasma of cows supplemented with BAs,while the concentration of β-hydroxybutyrate and the proportion of C>16 fatty acids in the plasma decreased significantly.BA supplementation significantly altered the composition of the fecal bacterial community and increased the relative abundance of bacteria beneficial for BA metabolism and transformation(Romboutsia,Clostridium sensu_stricto_6,and Clostridium sensu_stricto_1).Functional prediction analysis showed that the relative abundance of bile salt hydrolase,7 α-hydroxysteroid dehydrogenase,and BA inducible E as well as the pathways related to BA metabolism also significantly increased in cows supplemented BAs.In addition,BA supplementation significantly altered the composition of plasma and fecal BAs,particularly increasing circulating secondary BA concentration,which might induce the complete oxidation of fatty acids in the liver and further reduce the concentration of β-hydroxybutyrate.Conclusions These findings highlight the potential benefits of BA supplementation in improving milk yields and quality,as well as influencing metabolic pathways in transition dairy cows.Meanwhile,further studies are needed to elucidate the underlying mechanisms and explore the broader implications of these results by using more tissue samples.
文摘BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic liver disease,is still unknown,treatment remains symptomatic.Knowledge of the physicochemical properties of various bile acids and the adaptive responses of cholangiocytes and hepatocytes to them has provided an important basis for the development of relatively effective drugs based on hydrophilic bile acids that can potentially slow the progression of the disease.Advances in the use of hydrophilic bile acids for the treatment of PBC are also associated with the discovery of pathogenetic mechanisms of the development of cholangiocyte damage and the appearance of the first signs of this disease.For 35 years,ursodeoxycholic acid(UDCA)has been the unique drug of choice for the treatment of patients with PBC.In recent years,the list of hydrophilic bile acids used to treat cholestatic liver diseases,including PBC,has expanded.In addition to UDCA,the use of obeticholic acid,tauroursodeoxycholic acid and norursodeoxycholic acid as drugs is discussed.The pathogenetic rationale for treatment of PBC with various bile acid drugs is discussed in this review.Emphasis is made on the mechanisms explaining the beneficial therapeutic effects and potential of each of the bile acid as a drug,based on the understanding of the pathogenesis of the initial stages of PBC.
基金supported by the National Natural Science Foundation of China funded project(32172627)Chongqing Modern Tea Technology System for Efficient Agriculture in Mountainous Areas 2022[8]the Germplasm Creation Research Program of Southwest University。
文摘Pu-erh tea has been shown to reduce gut inflammation in dextran sulfate sodium(DSS)-induced mice.Also,we found abnormal liver cholesterol metabolism in DSS-induced mice.However,it's not clear how Pu-erh tea improves DSS-induced impaired liver cholesterol metabolism.Here,we established the DSS-induced model and clarified that DSS exacerbated gut inflammation accompanied by disorders of liver cholesterol metabolism.Pu-erh tea reshaped gut microbes,limited gut oxidative stress and inflammation(nicotinamide adenine dinucleotide phosphate oxidase 2/reactive oxygen species/myeloid differentiation primary response protein 88/nuclear factor kappa-B,24.97%-52.89%),reduced gut bile acid reabsorption(up-regulation of farnesoid X receptor(FXR)/fibroblast growth factor 15,24.53%-55.91%),and promoted liver bile acid synthesis(up-regulation of peroxisome proliferator-activated receptor-α/cholesterol 7-alpha hydroxylase,34.65%-79.14%),thereby partly restoring liver cholesterol metabolism(regulated FXR/small heterodimer partner/sterol-regulatory element binding proteins,53.19%-95.40%).Altered bile acid metabolic profiles(increased chenodeoxycholic acid,ursodeoxycholic acid,lithocholic acid,etc.)may also improve liver cholesterol metabolism by altering gut and liver inflammation.Thus,gut microbial reshaping and altered bile acid metabolism may be key targets of Pu-erh tea for improving DSS-induced liver cholesterol metabolism disorders via the gut-gut microbe-bile acid-liver axis.
