Pharmacokinetics, tissue distribution and excretion study of trans-resveratrol-3-O-glucoside and its two metabolites in rats

BACKGROUND

Trans-resveratrol-3-O-glucoside (TRG), isolated from the Chinese traditional herbal medicine Huzhang, has been shown to have a wide range of pharmacological benefits.

PURPOSE

The aim of this study is to investigate the pharmacokinetics, tissue distribution and excretion of TRG and its metabolites, (TRN (trans-resveratrol-3-O-glucuronide) and TR (trans-resveratrol)), following a single intragastric (i.g.) administration of TRG in rats.

STUDY DESIGN

To evaluate the pharmacokinetic properties of TRG, TRN and TR, groups of rats were administrated a single i.g. dose of either 75, 150 or 300 mg/kg TRG. The absolute bioavailability of TRG was estimated from the ratios of AUC_0-∞ values for oral and intravenous administration. Tissue distributions of TRG, TRN and TR in rats were investigated following a single i.g. administration to four groups at 150 mg/kg dosage of TRG. For urinary, fecal and biliary excretion study, TRG, TRN and TR excretions were recovered from a group of rats administered a single i.g. dose of 150 mg/kg TRG.

METHODS

The levels of TRG, TRN and TR in plasma, tissues, bile, urine and feces were measured by a rapid and sensitive LC-UV method. The precision was below 10.0%, and the accuracy was within ±9.9% for TRG, TRN and TR.

RESULTS

The concentrations of TRN were markedly higher than those of TRG and TR in plasma, urine and bile. TRG, TRN and TR showed linear dynamics in dose range of 75-300 mg/kg TRG. TRG had poor absolute bioavailability in rats. The major distribution tissues of TRG, TRN, and TR in rats were in the digestive tract. TRG, TRN and TR were all eliminated from tissues quickly. TRG was mostly excreted via the renal route in the form of TRN, which accounted for 52.8% of the administered dose up to 72 h.

CONCLUSION

Following a single i.g. administration to rats TRG was easily absorbed and rapidly converted to the metabolites TR and TRN. These metabolites were found to be mainly excreted by the kidneys.

Community attitudes towards bears, bear bile use, and bear conservation in Luang Prabang, Lao PDR

BACKGROUND

Bear bile is widely believed across much of Asia to have medicinal properties. As a result, great numbers of bears have been poached from the wild and numerous bear farms have been set up to drain the animals' bile on a regular basis. Although most such farms are now illegal, they continue to exist in countries such as Lao PDR. A new bear sanctuary is under construction in Luang Prabang in the northern part of the country with the aim of providing shelter to bears rescued from these farms. Understanding the level and nature of local communities' support for this sanctuary is vital for the long-term success of conservation efforts in the area, including outreach.

METHODS

This research, drawing from both ethnozoological and conservation frameworks, comprises a household survey (n = 263) administered in five villages surrounding the sanctuary and in-depth interviews conducted with key community leaders and institutional representatives. The questionnaire assessed local socio-economic status and attitudes towards bears, bear bile use, and bear conservation in general.

RESULTS

Respondents have generally positive attitudes towards bears and bear conservation. Age, gender, ethnicity, village, and household size have significant influence on attitudes towards bear bile use, which may also be determined by the expansion of sources for the supply of the traditional medicine market in neighboring China. However, many locals lack knowledge about the current status of wild and captive bears. This may be due to inadequate outreach involving community incentives for positively influencing attitudes. We argue that local communities will need to be integrated into conservation efforts while enhancing knowledge of conservation issues through improved outreach and communication.

CONCLUSION

Positive attitudes towards bears appear prevalent in the communities surrounding the new sanctuary. Villagers are familiar with laws regarding wildlife conservation but lack a deeper understanding of the status and plight of wild bears in the country, particularly how bear farming is a threat to the species. Conservation efforts must entail culturally relevant co-educational initiatives to garner further support from local communities.

Comparative assessment of bile duct decompression methods in patients with obstructive jaundice of non-tumor genesis

OBJECTIVE

Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world's population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis.

PATIENTS AND METHODS

Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days.

RESULTS

Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier.

CONCLUSION

Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.

Perspective for evaluation of microrna in plasma and bile for differential diagnosis of obstructive biliary tract disease

OBJECTIVE

Introduction: Cholelithiasisis diagnosed in 10-25% of the adult population. The manifestation of cholelithiasis in the form of acute cholecystitis, cholangitis, jaundice etc. occurs with a probability of 2-3% or more per year depending on the risk factors. Most often, it manifests it self as acute calculous cholecystitis. Up to 20% of such patients have additional calculi in extrahepatic bile ducts requiring simultaneous surgical intervention. Currently, the algorithm for diagnosis of concomitant choledocholithiasis in acute cholecystitis is multilevel and it needs to be simplified and improved. Conventional non-invasive diagnostic techniques have low specificity and sensitivity. A new safe diagnostic test is needed for the diagnosis of choledocholithiasis in cholecystitis in order to improve the results of surgical treatment of patients. The aim of the study - to determine the prospects for diagnosis of microRNA for differential diagnosis of obstructive diseases of the biliary tract on the basis of the literature data.

PATIENTS AND METHODS

Materials and methods: The analysis of the selected international literature in the period of 1991-2018 concerning the studies of microRNA in cholestatic liver diseases was carried out. The search for literature was conducted using Google Scholar and PubMed search engines for the following keywords: microRNA, cholestasis, choledocholithiasis, acute cholecystitis, biliary obstruction in their various combinations.

RESULTS

Review: MicroRNA is a specific post-transcriptional regulator of gene expression in all organs and systems of the body. There are specific types of miRNAs for different tissues. The most studied type of liver miRNA is miR-122. The studies showed better sensitivity and specificity of the detection of miR-122 both in the plasma and in the bile for the diagnosis of pathological liver conditions compared with conventional liver tests (aminotransferase, alkaline phosphatase, gamma-glutamyltransferase). Regarding the cholestatic hepatocyte injury occurring in choledocholithiasis, the following types of miRNA were identified: 122, 21, 29, 125, 222, let-7, 98 etc. Their concentrations in plasma and bile can be used as a diagnostic test for the presence of concomitant benign cholestasis in acute cholecystitis. Moreover, these markers can be used for the differential diagnosis of cholestasis of different etiology.

CONCLUSION

Conclusions: Quantitative and qualitative characteristics of microRNA in bile and plasma can be used as an additional non-invasive method for diagnosis of cholestasis induced by choledocholithiasis in acute calculous cholecystitis. Further studyis needed to identify the most optimal algorithm for the administration of microRNA in clinical practice.

Characterization of the antibacterial activity of Bald's eyesalve against drug resistant Staphylococcus aureus and Pseudomonas aeruginosa

Bald's eyesalve is an Anglo-Saxon medicinal remedy that has been used through ancient times to treat eye sty infections and may represent a source of ancientbiotics. This study assessed the efficacy of Bald's eyesalve against several strains of Staphylococcus aureus and Pseudomonas aeruginosa, including a multi-drug resistant phenotype, and identified the principal compound conveying antibacterial activity. Bald's eyesalve formulations were produced by combining garlic, onion or leek, wine, bovine bile, and brass, with specific ingredient omissions in several formulations, followed by incubation at 4 °C for 9 days. Bald's eyesalve formulation ES-GBBr exhibited the greatest antibacterial activity against S. aureus and P. aeruginosa. Fractionation of ES-GBBr using molecular size exclusion and organic solvent partitioning isolated its antibacterial activity to the small molecule nonpolar fraction, and 1D 1H NMR revealed the identity of the antibacterial agent to be allicin. Depletion of allicin from this fraction by addition of exogenous cysteine established that all observable growth inhibition originated from allicin. Quantification of allicin demonstrated that its concentration was significantly greater in ES-GBBr compared to the ES-O formulation; however, this was not due to greater yield. The antibacterial activity of allicin against S. aureus was antagonized by other ingredients within Bald's eyesalve, whereas they were additive or synergistic against P. aeruginosa. These results suggest that neither leek nor onion is necessary for the antibacterial efficacy of Bald's eyesalve against S. aureus or P. aeruginosa, and while allicin was identified as the principal antibacterial agent present, its activity is influenced differentially in the presence of additional Bald's eyesalve ingredients when used against S. aureus compared to P. aeruginosa. Ancientbiotics may provide a source of promising antibacterials; however, identifying the source of activity and assessing distinct formulations for cooperative effects are essential to using ancient remedies, such as Bald's eyesalve, effectively against drug resistant pathogens.

[Effect of fermentation on components of bile acids in Arisaema Cum Bile and determination of three kinds of free bile acids in Arisaema Cum Bile]

The aim of this study is to analyze the compositions of main bile acids in fermented and mixed processing products of arisame cum bile from pig bile, and to establish a method for content determination of bile acids in fermented Arisaema Cum Bile. Fermented and mixed processing products were prepared from arisaematis rhizome and arisaematis rhizoma preparatum with pig bile respectively. Then the differences in bile acids compositions between such two kinds of products were compared by high performance liquid chromatography and evaporative light-scattering detector (HPLC-ELSD). With three kinds of free bile acid compositions as the indicators, HPLC-ELSD method was adopted to determine the content of bile acid compositions in fermented product,on Agilent Eclipse XDB C₁₈(4.6 mm×250 mm, 5 μm) chromatographic column, with acetonitrile and 0.1% glacial acetic acid solution (55:45) as mobile phase, at a flow rate of 1 mL·min⁻¹, column temperature of 30 °C, drift tube temperature of 90 °C, and a nitrogen flow rate of 2.2 mL·min⁻¹. The results showed that the bile acids in fermented bile Arisaema were mainly in a free form, while in mixed processing product, the compositions were mainly in a conjugated form. Three kinds of free bile acids, namely porcine cholic acid (HCA), porcine deoxycholic acid (HDCA) and chenodeoxycholic acid (CDCA) in fermented product, showed a good linear relationship in the range of quantification. The average recovery rate was 95.99%-104.3%, complying with the requirements. The results showed that the conjugated bile acids could be transformed into free bile acids during the fermentation of arisaema cum bile. This established method can effectively control the content of bile acids compositions in fermenting arisaema cum bile.

Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma

BACKGROUND

Biliary leak following severe blunt liver injuries is a complex problem becoming more frequent with improvements in non-operative management. Standard treatment requires main bile duct drainage usually performed by endoscopic sphincterotomy and stent placement. We report our experience with cholecystostomy as a first minimally invasive diagnostic and therapeutic approach.

METHODS

We performed a retrospective analysis of consecutive patients with post-traumatic biliary leak between 2006 and 2015. In the first period (2006-2010), biliary fistula was managed using perihepatic drainage and endoscopic, percutaneous or surgical main bile duct drainage. After 2010, cholecystostomy as an initial minimally invasive approach was performed.

RESULTS

Of 341 patients with blunt liver injury, 18 had a post-traumatic biliary leak. Ten patients received standard treatment and eight patients underwent cholecystostomy. The cholecystostomy (62.5%) and the standard treatment (80%) groups presented similar success rates as the first biliary drainage procedure (p = 0.41). Cholecystostomy presented no severe complications and resulted, when successful, in a bile flow rate inversion between the perihepatic drains and the gallbladder drain within a median [IQR] 4 days [1-7]. The median time for bile leak resolution was 26 days in the cholecystostomy group and 39 days in the standard treatment group (p = 0.09). No significant difference was found considering median duration of hospital stay (54 and 74 days, respectively, p = 0.37) or resuscitation stay (17.5 and 19.5 days, p = 0.59).

CONCLUSION

Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.

Comment on Tauriainen et al.: Serum, liver and bile sitosterol and sitostanol in obese patients with and without NAFLD

This short article provides a comment on the recent article by Tauriainen et al. [Bioscience Reports (2018) 38, BSR20171274 https://doi.org/10.1042/BSR20171274].

Long-term results of percutaneous cholecystostomy for definitive treatment of acute acalculous cholecystitis : a 10-year single-center experience

BACKGROUND AND STUDY AIMS

Conventional use of percutaneous cholecystostomy [PC] is bridging therapy to delayed cholecystectomy for acute cholecystitis in high-surgical risk patients. Primary aim of this report is to evaluate the long-term outcome of PC as a definitive treatment for acute acalculous cholecystitis [AAC].

PATIENTS AND METHODS

Seventy-one AAC patients who underwent PC procedure were identified. Fifty-one interventions in 47 patients who were treated only with PC and followed-up after catheter withdrawal were reviewed to evaluate the long-term efficacy of PC as a definitive treatment for AAC.

RESULTS

Technical and short-term clinical success rates were 100% and 92%, respectively. In-hospital mortality rate was 9.3%, minor complication rate was 5.3%, major complication rate was 2.7% and procedure related mortality was 0%. Median follow-up after catheter withdrawal was 8 months. Long-term primary clinical success after removal of the catheter was 87.2%. With the repeated PC in 4 of 6 recurrences, clinical success was 95.7%. Presence of bile sludge, perforation or a co-existing disease did not result in a significant difference in recurrence free survival.

CONCLUSIONS

PC was a safe and easy to perform procedure with high positive clinical response and low long-term recurrence rate. PC without subsequent cholecystectomy may be a favorable treatment for AAC with respect to high surgical risk present in most of the AAC patients.

Efficacy of fibrin-sealants in reducing biliary leakage following laparoscopic common bile duct exploration

INTRODUCTION

In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy.

METHODS

We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group.

RESULTS

Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P=.338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P=.020), which was a protective factor with an odds ratio of 10.5.

CONCLUSION

Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE.

Cholecystectomy: Safe or Not Safe to Drain?

The aim of this study was to determine whether drains influenced the size of subhepatic collections following cholecystectomy, and if these had any affect on complications.

Eighty-five patients undergoing cholecystectomy had either no drain, a narrow bore suction drain or an open corrugated drain. Subhepatic fluid collections were measured by real time ultrasound on the first and fifth postoperative days, and thereafter if necessary. The volumes of fluid drained were also measured and clinical complications recorded. The subhepatic collections were, on average, the same whether a drain was used or not. Drains produced volumes considerably in excess of any subhepatic collection measured, but they did not appear to warn of biliary leakage. More complications (28%) were seen in the drained group compared with the undrained group (10.5%), and furthermore, the complications did not seem to occur in relation to the larger collections. One patient who had had a corrugated drain correctly placed developed biliary peritonitis.

We suggest that drainage of simple cholecystectomy is unnecessary and, if an open drain is used, potentially dangerous.

[Bile-resistant Gram-negative bacteria effect of different kinds of root decoction pieces]

To investigate the microbial contamination in Chinese herbal decoction pieces with different functional types by studying the total aerobic microbial count (TAMC), and total yeast and mould count (TYMC) in 40 samples of 8 types of root decoction pieces; further evaluate the contamination load of bile-resistant Gram-negative bacteria, and identify the Gram-negative bacteria by using biochemical identification system for Gram-negative bacteria. Our results showed that the TAMC value was more than 1 000 CFU•g⁻¹ in 85% (34/40) samples, and was more than 100 CFU•g⁻¹ in 30% (12/40) samples; the contamination of bile-resistant Gram-negative bacteria was detected in 45% (18/40) of the samples. The bile-resistant Gram-negative bacteria load of seven batches of samples was N>1 000 MPN•g⁻¹. Sixteen bacterium strains including Serratia plymouthensis, Cedecea neteri, Escherichia vulneris, Klebsiella oxytoca, Enterobacter amnigenus, E. cloacae, E. sakazakii, Proteus penneri and E. gergoviae were obtained and identified. E. cloacae was the predominant bacterium that was isolated from Salviae Miltiorrhizae Radix et Rhizoma, while E. amnigenus, Yersinia pseudotuberculosis was the typical bacterium of Ophiopogonis Radix and Codonopsis Radix, respectively. All these suggested that the contamination of bile-resistant Gram-negative bacteria was severe for the root decoction pieces in Wuhan city. Microbial species have certain selection specificity for medicinal ingredients, so the type and limit of control bacteria for detection should be formulated according to the pollution type and quantity of bile-resistant Gram-negative bacteria.

[Bronchobiliary fistula. Report of a case]

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract.

Lactic acid bacteria isolated from yak milk show probiotic potential

Probiotic industries strive for new, efficient and promising probiotic strains that impart a positive impact on consumer health. Challenges are persisting in isolation, screening, and selection of the new indigenous probiotic strains. In the present research, we explored the probiotic potential of 17 lactic acid bacteria isolated from Yak milk in a series of in vitro tests. We also demonstrated their health benefits, i.e., cholesterol degradation, lactose digestion, antimicrobial activity, antioxidant, and anticancer activities. Principal component analysis revealed that more than 50% of the strains fulfilled the examined criteria, e.g., survival in acidic pH, bile concentrations, and adherent property. Approximately all the strains produced antimicrobial substances against the maximum number of tested strains including clinical strains. Most strains degraded cholesterol in comparison to the reference probiotic strain whereas strain Yc showed 1.5 times higher the degradation efficiency of the control strain. Lan4 strain exhibited remarkable anticancer activity and induced the maximum apoptosis (87%) in the Hela cells and was non-toxic to the non-cancerous HEK293 cells. Around ten strains showed positive lactose digestion. Overall, this can be concluded that selected lactic acid bacteria revealed excellent probiotic properties along with desirable health benefits. These strains need to be further investigated in details for their application in the development of novel probiotic preparations for the improvement of public health.

Bile Cast Nephropathy in Cirrhotic Patients: Effects of Chronic Hyperbilirubinemia

OBJECTIVES

The aim of this study was to determine the prevalence of bile cast nephropathy (BCN) in autopsied cirrhotic patients and to correlate BCN with clinical and laboratory data to direct attention to this underrecognized renal complication of liver failure.

METHODS

We assessed 114 autopsy cases of cirrhosis for the presence of renal intratubular bile casts using Hall stain for bile. Presence of bile casts was correlated with etiology of cirrhosis, clinical and laboratory data, and histologic findings.

RESULTS

Bile casts were identified in 55% of cases. The most common etiology of cirrhosis was hepatitis C virus (HCV) infection (52%), and serum creatinine ( P  = .02) and serum urea nitrogen ( P  = .01) were significantly higher in the Hall-positive group. Conjugated bilirubin was below 20 mg/dL in 90%, and levels below 10 mg/dL were noted in 80% of cases.

CONCLUSIONS

To our knowledge, this is the largest study of BCN in human subjects and a first report describing the association of BCN with HCV-related cirrhosis. We demonstrated that in the face of protracted chronic hyperbilirubinemia, bile casts are formed at much lower bilirubin levels than previously thought. Furthermore, we proposed an algorithm to assist in better identification of bile casts.

Dexamethasone Effect on the Expression of Transforming Growth Factor-β1/Smads Signaling Pathway in Benign Biliary Stricture Fibroblasts in Rodent

OBJECTIVE

To investigate the effects of dexamethasone on transforming growth factor (TGF)-β1/Smads signaling pathway in benign biliary stricture (BBS) fibroblasts.

STUDY DESIGN

An experimental study.

PLACE AND DURATION OF STUDY

Guizhou Medical University, Guiyang, Guizhou, China, from January to August 2016.

METHODOLOGY

Fibroblasts derived from rabbit BBS model were cultured and identified, then treated by different concentration of dexamethasone (0.02, 0.1 and 0.5 mg/ml). Dexamethasone-treated cells and non-treated control groups were incubated respectively for 48 hours. Cell proliferation was assessed using cell counting kit-8. Relative mRNA expression of TGF-β1, Smad4 and Smad7 were assessed by quantitative RT-PCR. Protein expression of TGF-β1 and Smad4 were investigated by Western blotting.

RESULTS

Treatment with dexamethasone significantly inhibited the proliferation of BBS fibroblasts, significantly attenuated both the mRNA and protein expression of TGF-β1 and Smad4, and significantly up-regulated the mRNA expression of Smad7 in BBS fibroblasts (all p<0.05, 0.1-0.5 mg/ml), and exhibited in a dose-dependent manner.

CONCLUSION

TGF-β1/Smads signaling pathway may play an important role in BBS progression; dexamethasone significantly altered the expression of TGF-β1/Smads signaling pathway and significantly inhibited cell proliferation in rabbit BBS fibroblasts. Therefore, dexamethasone may be a therapeutic option for the prevention of BBS.

Preventive Measures for Postoperative Bile Leakage After Central Hepatectomy: A Multicenter, Prospective, Observational Study of 101 Patients

BACKGROUND

There are no conclusive measures for preventing postoperative bile leakage (POBL).

METHODS

First, 310 patients who underwent hepatectomy were analyzed retrospectively to clarify risk factors for POBL. Then, focusing on operations at high risk of POBL, patients who underwent central hepatectomy were recruited prospectively among 18 institutions, to evaluate various preventive measures for avoiding POBL. The primary endpoint was the frequency of POBL.

RESULTS

The retrospective analysis revealed central hepatectomy and repeated hepatectomy to be independent risk factors for POBL. One hundred and one patients undergoing central hepatectomy were enrolled in the prospective study. POBL developed in 13 patients (12.9 %). Intraoperative bile leakage was recognized in 42 of the 101 patients (41.6 %), and 10 of the 42 patients developed POBL (23.8 %). Primary closure of the site of bile leakage and/or biliary drainage tube placement was preferable for preventing POBL in the patients with intraoperative bile leakage. Although 59 patients (58.4 %) did not show intraoperative bile leakage, three patients (5.1 %) developed POBL. In the group without intraoperative bile leakage, treatment with fibrin glue with a polyglycolic acid (PGA) sheet or collagen sheet coated with a fibrinogen and thrombin layer (CSFT) had good results.

CONCLUSIONS

Primary closure of the site of bile leakage and/or placement of biliary drainage tubes may be recommended in cases involving intraoperative bile leakage. Treatment with fibrin glue with a PGA sheet and/or CSFT might have preventive effects in patients without intraoperative bile leakage.

Timing of percutaneous cholecystostomy tube removal: systematic review

INTRODUCTION

Percutaneous cholecystostomy (PC) is an effective procedure to treat moderate or severe acute cholecystitis (AC) in high-risk patients. The ideal timing of the drainage removal is argued. The aim of this study is to analyze our experience and perform a systematic review about the ideal timing of a percutaneous cholecystostomy (PC) tube removal.

EVIDENCE ACQUISITION

A web-based literature search was performed and studies reporting the length of the catheter maintenance were analyzed. A regression analysis between the timing of tube removal and morbidity, mortality and disease recurrence was performed. Patients who underwent PC as definitive treatment of moderate or severe acute cholecystitis at our institution between 2011 to 2015 were analyzed. Clinical and technical success, morbidity, mortality and recurrence rates were retrospectively retrieved from a perspective database.

EVIDENCE SYNTHESIS

The systematic review yield to analyze 50 studies. None of them focused exclusively on outcome measures in relation to PC tube duration. The timing of the drain removal varied from 2 to 193 days. Regression analyses showed no correlation between length of tube maintenance and the considered outcomes. We studied 35 patients. The median age was 78 (range 52-94) and 88.5% had an ASA score ≥3. P-POSSUM estimated morbidity was 68.7% (range 34.3-99.0) and mortality was 15.8% (range 1.9-80.2). Clinical success was 97.1%. Procedure-related morbidity was 34.3%: 2 abscess, 1 bleeding, 1 biloma and 8 tube dislodgment. Biliary leakage was not observed. The observed 30-day overall mortality was 11.4%. The median follow-up was 16 months. Recurrence rate was 12.1%.

CONCLUSIONS

PC is an effective procedure in high-risk patients with moderate or severe AC. At the moment there is no evidence whether the duration of PC tube may affect outcome.

Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 hepatectomy patients registered in the National Clinical Database of Japan

To construct a robust morbidity risk-prediction model based on a Japanese nationwide web-based database of patients who underwent liver surgery.Although liver resection has become safer, patient mortality and morbidity still occur. This study investigated postoperative morbidity risks in patients who underwent hepatectomy in Japan at institutions registered in the National Clinical Database.This analysis involved 14,970 patients who underwent hepatectomy of more than 1 section, except for left lateral sectionectomy, during 2011 and 2012 at 1192 hospitals in Japan. Patients were randomized into 2 subsets, with 80% of patients analyzed for model development and the remaining 20% for model validation.Rates of 90-day inhospital mortality and overall morbidity were 3.7% and 25.7%, respectively. Rates of surgical site infection and bile leakage were 9.0% and 8.0%, respectively, but these morbidities showed little association with mortality. Rates of nonsurgical complications, including postoperative transfusion over 5 units, unexpected intubation, renal failure, cardiac events, septic shock, and postoperative pneumonia, ranged from 0.2% to 2.6%. These complications were highly associated with mortality, suggesting they were life-threatening. Risk models for morbidity yielded high C-indices for transfusion of over 5 units (0.758), unplanned intubation (0.755), renal failure (0.80), cardiac events (0.779), septic shock (0.783), pneumonia (0.768), and bile leakage (0.676).Preoperative parameters/comorbidities can accurately predict life-threatening complications after hepatectomy. These models allow early identification of patients at risk of mortality and may be useful in deciding on surgical interventions and in improving surgical quality.

Global and hepatocyte-specific ablation of Bmal1 induces hyperlipidaemia and enhances atherosclerosis

Circadian rhythms controlled by clock genes affect plasma lipids. Here we show that global ablation of Bmal1 in Apoe-/- and Ldlr-/- mice and its liver-specific ablation in Apoe-/- (L-Bmal1-/-Apoe-/-) mice increases, whereas overexpression of BMAL1 in L-Bmal1-/-Apoe-/- and Apoe-/-mice decreases hyperlipidaemia and atherosclerosis. Bmal1 deficiency augments hepatic lipoprotein secretion and diminishes cholesterol excretion to the bile. Further, Bmal1 deficiency reduces expression of Shp and Gata4. Reductions in Shp increase Mtp expression and lipoprotein production, whereas reductions in Gata4 diminish Abcg5/Abcg8 expression and biliary cholesterol excretion. Forced SHP expression normalizes lipoprotein secretion with no effect on biliary cholesterol excretion, while forced GATA4 expression increases cholesterol excretion to the bile and reduces plasma lipids in L-Bmal1-/-Apoe-/- and Apoe-/- mice. Thus, our data indicate that Bmal1 modulates lipoprotein production and biliary cholesterol excretion by regulating the expression of Mtp and Abcg5/Abcg8 via Shp and Gata4.

[Analysis of lignans and their metabolites derived from Schisandra chinensis and vinegar Schisandra chinensis in rats’ plasma, bile, urine and faeces based on UHPLC-QTOF/MS]

UHPLC-QTOF/MS technique was used to study the differences of lignans and their metabolites derived from Schisandra chinensis and vinegar Schisandra chinensis in rat plasma, bile, urine and faeces by the data processing techniques such as the dynamic background subtract(DBS), mass defect filtering(MDF) and enhance peak list (EPL) in analysis. In order to enhance accuracy for Schisandra chinensis hepatoprotective effect, we established rat acute alcoholic liver injury model in this experiment, and studied the prototype components and metabolisms of Schisandra lignans in vivo under pathological condition. The main ingredients of alcohol extract are lignans, including deoxyschizandrin, schisandrin B, schizandrin C, schizandrol, schizandrol B,schisantherin, schisantherin B, schisanhenol, gomisin G, gomisin J. The metabolic transformation of lignans in rats was mainly induced by methylation, hydroxyl, oxidation, and so on. Finally, we identified 6 kinds of prototype components and their 20 potential metabolites in Schisandra chinensis group and vinegar Schisandra chinensis group.

A case report of motesanib-induced biliary sludge formation causing obstructive cholangitis with acute pancreatitis treated by endoscopic sphincterotomy

BACKGROUND

Gallbladder toxicity was reported in most motesanib studies with varying frequency and at variable times after initiation of treatment.

METHOD AND RESULTS

A 44-year-old man was admitted due to severe epigastric pain. The patient was diagnosed with non-small cell lung cancer 9 months ago and received 6 cycles of chemotherapy with motesanib, paclitaxel, and carboplatin. Ultrasonography showed a large amount of sludge within gallbladder. Computed tomography scan demonstrated diffuse dilatation of biliary tree with distended gallbladder without evidence of stone and mild pancreatic swelling. Endoscopic retrograde cholangiopancreatography showed yellowish viscous mucoid plug impacting ampullary orifice and dilated bile duct with amorphous filling defect at distal half of common duct. Endoscopic sphincterotomy was performed to prevent biliary obstruction and recurrent pancreatitis after removal of mucoid material.

CONCLUSION

To the best of our knowledge, this is the first report of obstructive cholangitis and acute pancreatitis associated with sludge formation during motesanib therapy. Endoscopic sphincterotomy appears to be useful to treat and prevent biliary obstruction caused by motesanib-induced biliary sludge.

A rare case of Mirizzi syndrome due to pure calcium carbonate stones (Limy Bile)

We report the first case of Mirizzi syndrome in a patient who presented with biliary obstruction caused by pure calcium carbonate stones. A 61 years old male with history of portal vein thrombosis presented with rash, nausea and jaundice. An ultrasound of biliary tree showed gallstones with dilatation of hepatic duct and intrahepatic biliary tree. There was suspicion of a stone in proximal CBD. CT scan showed an opaque gallbladder with dense radio-opaque material in its lumen. An ERCP was then performed revealing external common hepatic duct obstruction at the neck of the gallbladder. A plastic biliary stent was placed across the obstruction, followed by a cholecystectomy. Resected gallbladder specimen revealed thick whitish paste like material, and formed stones filling the gallbladder lumen. Laboratory testing showed this material to be composed of 100% calcium carbonate crystals.

ATP-dependent transport of a novel thromboxane A2 receptor antagonist, [2-(4-chlorophenylsulfonylaminomethyl)indan-5-yl]acetate (Z-335) and its xenobiotic taurine conjugate (Z-335-Tau) by rat bile canalicular membrane vesicles

PURPOSE

The characteristics of bile canalicular transport processes for xenobiotic taurine conjugates have not yet been clarified. To elucidate the biliary excretion characteristics of xenobiotic taurine conjugates, we investigated the transport of a novel thromboxane A2 receptor antagonist, Z-335, and its taurine conjugate (Z-335-Tau) across the bile canalicular membrane.

METHODS

We examined the uptake of Z-335 and Z-335-Tau by isolated bile canalicular membrane vesicles (CMVs) from Sprague Dawley and Eisai-hyperbilirubinemic rats (EHBRs) which EHBRs have a hereditary defect of canalicular multidrug resistance-associated protein 2 (Mrp2) function. Also, the in vitro and in vivo kinetics of Z-335-Tau uptake and excretion were compared.

RESULTS

Z-335 uptake by CMVs from normal rats exhibited marked ATP-dependence, whereas ATP-dependent uptake of Z-335 into CMVs from EHBRs was not observed. In contrast, Z-335-Tau uptake into CMVs from both normal rats and EHBRs was ATP dependent. The initial uptake velocity was concentration-dependent, with an in vitro Michaelis constant for initial uptake of 189 microM, which was similar to the in vivo value.

CONCLUSIONS

The biliary excretion of Z-335 involves Mrp2, whereas that of Z-335-Tau involves active transport systems that remain intact in EHBRs and show marked ATP dependence, which ATP-dependent transport is involved in the biliary excretion of Z-335-Tau in vivo.

Biliary leakage from gallbladder bed after cholecystectomy: Luschka duct or hepaticocholecystic duct?

Anatomic variations in the biliary tract are common and can cause difficulties when a cholecystectomy is performed. One of the most common ones are hepaticocholecystic ducts and Luschka ducts, connecting the gallbladder or its bed to the bile ducts but distinction between these two types of ducts can be difficult. We do discuss here the differences between these anatomical variations, their origin and their clinical implications. These aberrant ducts may go unnoticed and may require further complementary procedures in case of postoperative biliary leakage. In addition to a careful surgical procedure and an examination of the cystic bed in the end of the intervention, an intraoperative cholangiography should be performed as often as possible.

The clinical risk factors associated with postoperative bile leakage after hepatectomy: a meta-analysis

INTRODUCTION

The occurrence of bile leakage (BL) is one of the major contributors to the morbidity after hepatectomy. However, the clinical risk factors associated with postoperative BL remains controversial. This study aims to further assess the risk factors for BL.

EVIDENCE ACQUISITION

We comprehensively searched the electronic databases of PubMed, EMBASE, Web of Science and the Cochrane Library for studies published before October 10th, 2015. Cohort studies, case-control studies, and randomized controlled trials that examined clinical risk factors for BL were included.

EVIDENCE SYNTHESIS

Eighteen retrospective studies including a total of 9270 patients were identified. From the pooled analysis, twelve factors were found to be significantly associated to the increased rate of BL, including previous liver or biliary surgery, anatomic resection, major hepatectomy, right anterior sectionectomy, left trisectionectomy, central bisectionectomy, blood transfusion, operative time, bile duct reconstruction, segment 1 involved, segment 2 involved, segment 5 involved. By contrast, hepatic fibrosis/cirrhosis, left lateral sectionectomy were found to be correlated to decreased incidence of BL.

CONCLUSIONS

Our meta-analysis reveals that previous liver or biliary surgery, anatomic resection, major hepatectomy, right anterior sectionectomy, left trisectionectomy, central bisectionectomy, blood transfusion, operative time, bile duct reconstruction, resection of segments 1, 2 and 5 involved had significant positive correlation with increased risk of BL, on the contrary, hepatic fibrosis/cirrhosis, left lateral sectionectomy had the opposite effect.

[Correlation between integrated pharmacokinetics and pharmacodynamics of bile processed Rhizoma Coptidis in febrile rats]

This study was designed to validate the correlation between integrated pharmacokinetic and therapeutic effects of alkaloids using bile processed Rhizoma Coptidis (BRC). Rats were divided into three groups: normal, disease model, model+BRC. Rats were induced to have an excessive heat syndrome. Rectal temperatures were collected at 0, 3, 6 and 9 h after single oral administration of the drugs. The plasma concentrations of three alkaloids were quantified at different times by UPLC-MS/MS after the administration of BRC. An approach of self-defined weighting coefficiency was created to the holistic pharmacokinetic profiles of alkaloids in BRC. The classified and integrated synthetic concentrations were obtained, and then the pharmacokinetic parameters of alkaloids were calculated from non-compartmental model analysis. The potential relationship between the integrated mean concentration of alkaloids and the antifebrile efficacy was investigated. The holistic t(max) of alkaloids was 1.11 h, the antifebrile effect of BRC at 3 h was improved over the model group. Double peaking appeared in the integrated blood concentration-time curve, the second t(max) of alkaloids was 4.82 h. The antifebrile effects of BRC at 3-6 h were significant, and the antifebrile effects at 6-9 h was decreased significantly. Dynamic variation of alkaloids of BRC in the body exhibited the similarity to the pattern of its antifebrile effect.

[Bile leakage after liver resection: A retrospective cohort study]

INTRODUCTION

Many previous reports have focused on bile leakage after liver resection. Despite the improvements in surgical techniques and perioperative care the incidence of this complication rather keeps increasing. A number of predictive factors have been analyzed. There is still no consensus regarding their influence on the formation of bile leakage. The objective of our analysis was to evaluate the incidence of bile leakage, its impact on mortality and duration of hospitalization at our department. At the same time, we conducted an analysis of known predictive factors.

METHOD

The authors present a retrospective review of the set of 146 patients who underwent liver resection at the Department of Surgery of the 2nd Faculty of Medicine of the Charles University and Central Military Hospital Prague, performed between 20102013. We used the current ISGLS (International Study Group of Liver Surgery) classification to evaluate the bile leakage. The severity of this complication was determined according to the Clavien-Dindo classification system. Statistical significance of the predictive factors was determined using Fishers exact test and Students t-test.

RESULTS

The incidence of bile leakage was 21%. According to ISGLS classification the A, B, and C rates were 6.5%, 61.2%, and 32.3%, respectively. The severity of bile leakage according to the Clavien-Dindo classification system - I-II, IIIa, IIIb, IV and V rates were 19.3%, 42%, 9.7%, 9.7%, and 19.3%, respectively. We determined the following predictive factors as statistically significant: surgery for malignancy (p<0.001), major hepatic resection (p=0.001), operative time (p<0.001), high intraoperative blood loss (p=0.02), construction of HJA (p=0.005), portal venous embolization/two-stage surgery (p=0.009) and ASA score (p=0.02). Bile leakage significantly prolonged hospitalization time (p<0.001). In the group of patients with bile leakage the perioperative mortality was 23 times higher (p<0.001) than in the group with no leakage.

CONCLUSION

Bile leakage is one of the most serious complications of liver surgery. Most of the risk factors are not easily controllable and there is no clear consensus on their influence. Intraoperative leak tests could probably reduce the incidence of bile leakage. In the future, further studies will be required to improve the perioperative management and techniques to prevent such serious complications. Multidisciplinary approach is essential in the treatment.

Prevention of Postoperative Bile Leak in Partial Cystectomy for Hydatid Liver Disease: Tricks of the Trade

BACKGROUND

The presence of postoperative bile leak is the major outcome measure for the assessment of operative success in partial cystectomy for hydatid liver disease. However, the optimal operative strategy to reduce the postoperative bile leak rate is yet to be defined.

METHODS

Medical records of patients who underwent partial cystectomy for hydatid liver disease between January 2013 and January 2015 were reviewed in this retrospective analysis. All patients were managed with a specific operative protocol. The primary outcome measure was the rate of persistent postoperative bile leak. The secondary outcome measures were the morbidity and mortality rate, and the length of hospital stay.

RESULTS

Twenty-eight patients were included in the study. Only one patient (3.6 %) developed persistent postoperative bile leak. The overall morbidity and mortality rate was 17.8 and 0 %, respectively. The median length of hospital stay was 5 days.

CONCLUSION

Aggressive preventative surgical measures have led to low persistent bile leak rates with low morbidity and mortality.

[Anti-atherosclerotic Effects of Bear Bile Powder in Shexiang Tongxin Dripping Pill: a Mechanism Study]

OBJECTIVE : To study the anti-atherosclerotic mechanism of bear bile powder (BBP) in Shexiang Tongxin Dripping Pill (STDP) , and to provide scientific evidence for treating atherosclerosis (AS) by its therapeutic characteristics of cool resuscitation.

METHODS

AS model was duplicated using ApoE-/- gene knocked mice fed with high-fat diet. Thirty ApoE-/- deficient male mice were divided into four groups according to body weight using random digit table, i.e., the model group (A, n =9), the STDP group (B, n=E7), the STDP without BBP group (C, n =7), and the BBP group (D, n =9). Besides, another 9 C57BL/6J male mice of the same age were recruited as a normal control group (E). All mice in Group B, C, and D were respectively administered with corresponding drugs (30, 30, and 0. 33 mg/kg) by gastrogavage. Equal volume of normal saline was administered to mice in Group A and E. All medication lasted for 8 successive weeks. Serum levels of inflammatory cytokines such as interleukin 2 (IL-2), interleukin 6 (IL-6), tumor necrosis factor a (TNF-α), interferon y (IFNγ), and oxidized low-density lipoprotein (ox-LDL) were measured by ELISA. Serum levels of malondialdehyde (MDA), activities of glutathione (GSH) and superoxide dismutase (SOD) were determined using biochemical assay. Contents of reactive oxygen species (ROS) in the aortic root was detected by dihydroethidum (DHE) fluorescent probe. Expression levels of microRNAs (such as miR-20, miR-21, miR-126, and miR-155) were detected by real-time PCR.

RESULTS

The fluorescence intensity of the aorta was obviously enhanced in Group A. But it was obviously attenuated in Group B, C, and D, and the attenuation was the most in Group B. Compared with Group E, serum levels of IL-2, IL-6, TNF-α, IFN-γ, oxLDL, and MDA all increased (P <0. 01), GSH contents and SOD activities decreased (P <0. 01), expression levels of miR-126, miR-21, and miR-155 in aorta increased (P <0. 01), and the expression level of miR-20 decreased in Group A (P<0. 01). Compared with Group A, serum levels of IL-2, IL-6, TNF-α, IFN-γ, oxLDL, and MDA were all down-regulated (P <0. 01), GSH contents and SOD activities were up-regulated (P <0. 01), expression levels of miR-126, miR-21, and miR-155 in aorta were down-regulated in Group B, C, and D (P <0. 01). The expression level of miR20 was up-regulated in Group B and D (P <0. 01). Compared with Group B, serum levels of IL-2, IL-6, TNF-α, IFN-γ increased (P <0.01); GSH contents and SOD activities decreased, levels of MDA and oxLDL increased (P <0. 01) in Group C and D. Expression levels of miR-20 and miR-155 were down-regulated in Group C and D (P <0. 01).

CONCLUSIONS

STDP played roles in significantly regulating inflammatory factors and oxidative stress factors. Its mechanism might be possibly associated with regulating expressions of miR-126, miR-21, miR-155, and miR-20 in aorta. BBP played significant roles in STDP.

Acute celiac trunk thrombosis revealed by biliary peritonitis

Acute thrombosis of the celiac trunk is a very uncommon condition, which is a life-threatening emergency. The clinical presentation is highly variable depending on the extent of the ischemic territory. We report a case of biliary peritonitis related to an acute thrombosis of the celiac trunk. This case highlights the role of abdominal computed tomography in the diagnosis of acute upper abdominal pain.

[Gallbladder Stone Types in Patients with Cholelithiasis and Clonorchis sinensis Infection in the Endemic Area of Clonorchiasis]

OBJECTIVE

To investigate the relationship between Clonorchis sinensis infection and the gallbladder stone type in patients with cholelithiasis in the endemic area of clonorchiasis.

METHODS

Gallbladder stones were collected from 598 patients with cholelithiasis through minimally invasive gallbladder-preserving cholelithotomy in the Sixth People's Hospital of Nansha District from May 2009 to October 2012. The stone samples were analyzed for composition by Fourier transform infrared spectroscopy to identify their types. The Clonorchis sinensis eggs were detected in the stones by microscopic examination, and the detection rates of eggs were calculated for different stone types. Then the clinical characteristics and biochemical indicators were compared among patients with different types of stones, as well as between Clonorchis sinensis egg-positive and -negative patients with the calcium-carbonate type of stones. Some calcium-carbonate stones positive for Clonorchis sinensis eggs were randomly selected for further scanning electron microscopy (SEM) examination.

RESULTS

Of the stones from 598 patients, 234 (39.1%) were cholesterol type, 133 (22.2%) bile pigment type, 112(18.7%) calcium-carbonate type, 86 (14.4%) mixed types and 33(5.5%) were others. The detection rate of Clonorchis sinensis eggs in these types was 6% (15/234), 44% (59/133), 60% (67/112), 36% (31/ 86) and 30% (10/33), respectively, being highest in calcium-carbonate stones while lowest in cholesterol stones. The Co2-combining power of the plasma was higher in patients with calcium-carbonate and mixed stones than in those with cholesterol stones (P < 0.05), and the CO2-combining power of the bile and biliary pH were both higher in patients with calcium-carbonate types than in those with other types (P < 0.05). In addition, in patients with calcium-carbonate stones, the CO2-combining powers of the plasma and the bile, as well as biliary pH were all higher in the egg-positives than in the egg-negatives. Further, both light microscopy and SEM revealed adherence of the Clonorchis sinensis eggs to calcium-carbonate crystals.

CONCLUSION

The infection rate of Clonorchis sinensis is higher in patients with calcium-carbonate gallbladder stones than in those with other types of stones.

Use of an autologous liver round ligament flap zeros postoperative bile leak after curative resection of hilar cholangiocarcinoma

BACKGROUND

Postoperative bile leak is a major surgical morbidity after curative resection with hepaticojejunostomy for hilar cholangiocarcinoma, especially in Bismuth-Corlette types III and IV. This retrospective study assessed the effectiveness and safety of an autologous hepatic round ligament flap (AHRLF) for reducing bile leak after hilar hepaticojejunostomy.

METHODS

Nine type III and IV hilar cholangiocarcinoma patients were consecutively hospitalized for elective perihilar partial hepatectomy with hilar hepaticojejunostomy using an AHRLF between October 2009 and September 2013. The AHRLF was harvested to reinforce the perihilar hepaticojejunostomy. Main outcome measures included operative time, blood loss, postoperative recovery times, morbidity, bile leak, R0 resection rate, and overall survival.

RESULTS

All patients underwent uneventful R0 resection with hilar hepaticojejunostomy. No patient experienced postoperative bile leak.

CONCLUSIONS

The AHRLF was associated with lack of bile leak after curative perihilar hepatectomy with hepaticojejunostomy for hilar cholangiocarcinoma, without compromising oncologic safety, and is recommended in selected patients.

[Bile lake post Kasai hepatoportoenterostomy in biliary atresia]

In this case report we describe a boy with extrahepatic biliary atresia who underwent a Kasai hepatoportoenterostomy at six weeks of age. Beginning several weeks post-op, he had recurrent cholangitis inadequately controlled by various antibiotic prophylaxis regimens. Imaging revealed the development of several bile lakes in the liver hilum. Due to the recurrent nature of his cholangitis, and some evidence of acutely impaired biliary drainage, he underwent a refashioning of his portoenterostomy with resultant improved drainage. However, shortly thereafter, the patient developed ongoing fever and anemia. Culture of the bile lake aspirate grew multiresistant Klebsiella and a 6 week course of parenteral meropenume controlled his fever and his anemia improved. Following treatment cessation his fever and anemia returned. A biliary drain was inserted into his larger bile lake and following another course of parenteral antibiotics he has remained free of clinically detected cholangitis despite ongoing contamination of drained bile fluid. The development of bile lakes after Kasai hepatoportoenterostomy is not an uncommon finding. This have been associated with worse prognosis including increased incidence of cholangitis. Often, conservative treatment with prophylactic antibiotics suffices, however, in rare cases, more aggressive intervention may be considered including percutaneous bile drainage or surgical management. The benefit of these management strategies must be balanced with the potential gain regarding quality of life and delaying transplant, on an individual basis.

[CLINICAL EFFICACY AND SAFETY OF LITHOLYTIC THERAPY WITH LIVODEXA IN PATIENTS WITH CHRONIC CHOLECYSTITIS AND BILIARY SLUDGE]

The authors present their own experience litholytic therapy of 68 patients with chronic cholecystitis and biliary sludge using the Livodexa (Sun Pharmaceutical Industries Ltd, India) at 12 and 24-week course of treatment. In a prospective 24-week investigation was estimated decrease in biliary sludge in the gallbladder as an integral indicator of the effective ness of litholytic therapy and decline of adverse event during treatment, as an indicator of the safety of treatment.

Enhancement of the immune response and protection against Vibrio parahaemolyticus by indigenous probiotic Bacillus strains in mud crab (Scylla paramamosain)

In a previous study, bacterial communities of the intestine in three populations of crabs (wild crabs, pond-raised healthy crabs and diseased crabs) were probed by culture-independent methods. In this study, we examined the intestinal communities of the crabs by bacterial cultivation with a variety of media. A total of 135 bacterial strains were isolated from three populations of mud crabs. The strains were screened for antagonistic activity against Vibrio parahaemolyticus using an agar spot assay. Antagonistic strains were then identified by 16S rRNA gene sequence analysis. Three strains (Bacillus subtilis DCU, Bacillus pumilus BP, Bacillus cereus HL7) with the strongest antagonistic activity were further evaluated for their probiotic characteristics. The results showed that two (BP and DCU) of them were able to survive low pH and high bile concentrations, showed good adherence characteristics and a broad spectrum of antibiotic resistance. The probiotic effects were then tested by feeding juvenile mud crabs (Scylla paramamosain) with foods supplemented with 10(5) CFU/g of BP or DCU for 30 days before being subjected to an immersion challenge with V. parahaemolyticus for 48 h. The treated crabs showed significantly higher expression levels of immune related genes (CAT, proPO and SOD) and activities of respiratory burst than that in controlled groups. Crabs treated with BP and DCU supplemented diets exhibited survival rates of 76.67% and 78.33%, respectively, whereas survival rate was 54.88% in crabs not treated with the probiotics. The data showed that indigenous mud-associated microbiota, such as DCU and BP, have potential application in controlling pathogenic Vibriosis in mud crab aquaculture.

[Effect of bile acids on surface tension of bronchoalveolar lavage fluid in rabbits]

OBJECTIVE

To observe changes in surface tension of bronchoalveolar lavage fluids (BALF) in rabbits with hyperbilirubinemia and the influence of bile diluents and 5 different bile acids on BALF surface tension to provide better insight into the regulatory role of bile acids on respiratory function.

METHODS

Bronchoalveolar lavage with 0.9% normal saline was carried out in 30 male New Zealand rabbits and the surface tensions of BALF were measured. The changes in BALF surface tension was measured in rabbits with hyperbilirubinemia. Different concentrations of bile diluents, normal saline, or water solutions of 5 bile acids were added into the collected BALF to test their influence on the surface tension of BALF.

RESULTS

The BALF from rabbits with hyperbilirubinemia showed a significantly increased surface tension (P<0.05). The bile diluents (1:15, 1:10, and 1:5) added into the BALF increased the surface tension of the BALF by 21.15%, 26.09%, and 19.64%, respectively. Among the water solutions of the 5 bile acids, UDCA produced no significant influence on the surface tension of BALF while CDCA, CA, LCA, and DCA increased the surface tension by 16.10%, 21.66%, 14.21%, and 13.05%, respectively.

CONCLUSION

The surface tension of BALF increases significantly during hyperbilirubinemia. Bile diluents as well as the free bile acids CDCA, CA, LCA and DCA, but not UDCA, can increase the surface tension of BALF, suggesting that these bile acids may emulsify pulmonary alveolar surfactants to increase the alveolar surface tension.