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Limosilactobacillus reuteri Strains Differentially Stimulate Immunity in Response to Human Milk Oligosaccharides in Newborn Mice
No full textProbiotic Limosilactobacillus reuteri DSM 17938 reduces autoimmunity in mouse models. Recently, a novel strain, L. reuteri DSM 32846 (BG-R46®), derived from DSM 17938 was found to have unique properties including bile acid tolerance and enhanced adenosine production. Human milk oligosaccharides (HMOs) help establish the intestinal microbiome and assist immune and neurodevelopment. The objective of the study was to explore the differential effects of each strain (with or without HMOs) with respect to innate and adaptive immunity in the intestine of mice during early development at postnatal d8 (early stage), d14 (rapid growth stage), and d21 (at weaning). C57BL/6J mice received intragastric DSM 17938 or DSM 32846 individually or in combination with HMOs, a mixture of 2`-FL and 6`-SL, daily from d7 to d20. We subsequently assessed circulating and intestinal immune cell markers at d8, d14 and d21. Both strains promoted development of intestinal macrophages, natural killer cells, and activated T and B cells. The cellular responses in the intestine of d8 mice were boosted within one day of treatment with DSM 17938, as opposed to 1–2 weeks after treatment with DSM 32846. This delay could be reversed by supplementing HMOs along with DSM 32846. Both DSM 32846 and DSM 17938 facilitated dendritic cell maturation and enhanced regulatory T cell numbers in the intestines of these newborns. However, HMOs enhanced the effects of DSM 32846, but not DSM 17938. Therefore, an early-life boost of intestinal immune cells by probiotics was observed which could be essential to protection against neonatal inflammatory conditions. This novel difference between two strains of the same species in immune modulation could provide a rationale for co-administration in an HMO-rich environment
Alcohol and Metabolic Stress Synergize to Dysregulate Mitochondrial Health and Lipid Metabolism; Evidence from a Hepatocyte Spheroid Model
No full textMetabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease frequently co-occur, manifesting as MetALD. Understanding the hepatocyte-specific effects of alcohol and metabolic stressors is critical to uncovering mechanisms of synergistic injury. This study evaluated the individual and combined effects of ethanol, sugars, and saturated/monounsaturated fats on hepatocyte lipid metabolism, oxidative stress, and mitochondrial function using a 3D human HepaRG spheroid model. HepaRG spheroids were treated with ethanol (50 mm), sugar (glucose and fructose), and fatty acids alone or in combination for 10 d. The combination of ethanol (E) and metabolic (sugar and fat, SF) stressors (ESF) synergistically increased triglyceride content and lipid droplet accumulation. ESF increased gene expression of lipid handling targets including perilipins 1 and 2, fatty acid binding protein 1, and hepatic lipase compared to controls. ESF also induced the highest rate of ROS production compared to E and SF and dysregulated antioxidant gene expression. E and SF additively impaired ATP content and ATP production linked mitochondrial respiration. Ethanol and metabolic stressors synergize to dysregulate hepatocyte lipid homeostasis and oxidative stress while additively impairing mitochondrial bioenergetics. Gene expression results suggest that lipid accumulation may be driven by altered expression of triglyceride storage and lipid handling markers rather than de novo lipogenesis. These findings highlight the importance of metabolic contributions in alcohol-induced hepatocellular dysfunction and establish HepaRG spheroids as a robust model to elucidate hepatocyte-specific responses in MetALD
The Clinical Anatomy of the Vascular System
No full textThe radial recurrent artery (RRA) (Figs. 98.1 and 98.2) branches from the radial, ulnar, or brachial artery, traveling radially and oriented transversely. In upper limbs with normal arterial axes, the most common morphology features the RRA as the largest lateral branch of the radial artery. The vessel supplies blood to the brachioradialis, brachialis, extensor carpi radialis longus, and brevis and supinator muscles (Honma et al. 2008). In this pattern, the RRA branches from the lateral aspect of the radial artery in the cubital fossa, just distal to the transepicondylar line, and ascends the arm superiorly through the branches of the radial nerve (Honma et al. 2008). It courses proximally on the surface of the supinator muscle, then deep between the brachioradialis and brachialis muscles (Gupta et al. 2012). It terminates by anastomosing with the anterior branch of the deep brachial artery, the radial collateral artery, just proximal to the distal humerus. The average diameter of the RRA at its origin is 2.67 ± 0.60 mm in males and 2.35 ± 0.49 mm in females (Hamahata et al. 2012). Standard arterial patterns have shown that the RRA branches from the radial artery from 1.3 to 6.2 cm below the transepicondylar line (Yamaguchi et al. 1997). Arterial branches of the RRA cross the posterior interosseous nerve and enter the Arcade of Frohse to form what is commonly known as the Leash of Henry
The Clinical Anatomy of the Vascular System
No full textThis multidisciplinary book provides an in-depth review of the human vascular system with emphasis on anatomy, embryology, pathology, and surgical features. Arteries, veins, and lymphatics are each assigned chapters that discuss their relevant anatomy, topography, embryology, histology, imaging, pathology, surgical significance, and complications. The comprehensive text was written and edited by leading experts in the field and is ideal for surgeons, proceduralists, anatomists, trainees, and students. Informative chapters are sectioned according to their part of the body
A guide to diagnosis and management of hypertrichosis
No full textHypertrichosis is a phenotype characterized by excessive hair growth in areas not typically prone to dense hair coverage. It may be congenital or acquired, and has significant clinical and psychosocial implications, often leading to psychological distress and social stigmatization. Diagnostic approaches emphasize the importance of thorough clinical evaluation and differentiation from hirsutism. Treatment options include topical and systemic treatments, as well as mechanical methods and laser therapies. Special considerations are given to pediatric patients regarding the psychosocial aspects of the phenotype. This review aims to provide physicians and researchers with a thorough understanding of hypertrichosis to facilitate better diagnosis, treatment, and patient support
Impact of preoperative liver disease diagnosis on postoperative outcomes in bariatric surgery
No full textBACKGROUND: Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD was added as a new variable for the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, allowing for analysis of this variable on perioperative and postoperative outcomes. OBJECTIVE: To examine the impact of preoperative LD diagnosis on 30-day outcomes following MBS and quantify intraoperative liver biopsy frequency. SETTING: MBSAQIP, 2023. METHODS: A total of 217,952 cases (24,240 with LD; 193,712 without LD) were analyzed to compare operative length, length of stay (LOS), infectious complications, serious complications, major adverse cardiovascular events (MACE), and mortality. Chi-square and Wilcoxon rank-sum tests were used, and propensity matching was performed based on age, sex, race, body mass index, and preoperative comorbidities. RESULTS: Patients with LD had a slight increase in operative length (99.6 vs. 92.0 min; P \u3c .0001) and were more likely to experience prolonged LOS (\u3e5 days: .84% vs. .67%; P \u3c .05). Rates of infectious complications (1.86% vs. 1.40%; P \u3c .0001) and serious complications (1.65% vs. 1.31%; P \u3c .01) were higher among those with LD. There were no differences in 30-day mortality (.08% vs. .11%; p = NS) or MACE (MACE: .10% vs. .07%; p = NS) between groups. Only 3.5% of cases included intraoperative liver biopsy. CONCLUSION: Patients with LD experienced higher rates of postoperative infections and serious complications, as well as prolonged LOS, than those without LD. These findings highlight the importance of preoperative LD screening in bariatric surgery patients
Increased risk of renal disease in patients with hidradenitis suppurativa: A retrospective cohort study utilizing TriNetX
No full textThe Clinical Anatomy of the Vascular System | Ch 8
No full textThe early embryologic cardinal, vitelline, and umbilical veins initially develop from capillary plexuses and ultimately drain into the sinus venosus. The anterior and posterior cardinal veins run cranially and caudally to the heart, later developing into the superior vena cava (SVC) and inferior vena cava (IVC), respectively. The posterior cardinal veins regress, and the subcardinal and supracardinal veins arise. The right supracardinal vein drains the lower abdomen, including what will ultimately become the renal and gonadal veins (Figs. 80.1 and 80.2) in gestational weeks 5–7, into the iliac anastomosis (Mozes and Gloviczki 2007; Nallikuzhy et al. 2018; Kara et al. 2012)
The Clinical Anatomy of the Vascular System | Ch 112
No full textIn 1919, Senior detailed the embryological origin of the lower limb (Senior 1919). During the 9 mm stage of embryonic development, a primitive iliac artery arises from the umbilical artery and courses caudally to supply the lower limb. This artery bifurcates into a dorsal internal iliac axis, which forms the axial artery, and a ventral external iliac artery, which becomes the femoral artery at the 12 mm stage (Rosset et al. 1995). At the 12 mm stage, the walls of the femoral artery consist only of a thin wall of endothelium, resembling the associated femoral vein (Senior 1919). During the 14 mm stage, the axial artery gives off three segments: the more proximal ischiatic artery, the intermediate deep popliteal artery, and the distalmost interosseous artery. At this stage, the deep popliteal artery lies between the popliteus muscle and the posterior margin of the tibia. Just proximal to the popliteus muscle, the deep popliteal artery gives off two branches: the superficial posterior tibial artery and the superficial posterior fibular artery (Senior 1919). These two branches will later fuse to form the superficial popliteal artery. At the 22 mm stage, the ischiatic artery involutes, and the only remaining supply to the leg is the femoral artery. Distal to the popliteus muscle, a medial communicating branch arises and connects the superficial popliteal artery to the most distal extremity of the deep popliteal artery. Subsequently, this communicating branch will become the proximal segment of the anterior tibial artery. In contrast, the portion of the superficial popliteal artery above the communicating branch will become the tibiofibular trunk (Rosset et al. 1995). Finally, at the 24.5 mm stage, the distal part of the deep popliteal artery, deep to the popliteus muscle, involutes. The popliteal artery is then made up of a small, proximal segment of the deep and superficial popliteal artery (Senior 1919)
The Clinical Anatomy of the Vascular System | Ch 102
No full textThe ulnar and the radial arteries course distally down the forearm and are responsible for all the blood supply to the hand. The palmar carpal branch of the ulnar artery passes laterally across the anterior aspect of the distal ulna and deep to the tendons of the flexor digitorum profundus. The corresponding palmar carpal branch of the radial artery stems just distal to the inferior edge of the pronator quadratus, then continues inferomedially along the anterior aspect of the distal radius, also deep to the flexor muscles. These two vessels anastomose centrally to form the palmar carpal arch, which is responsible for the vascular supply of the anterior wrist (Gray 1918)