Are Helicobacter Species and Enterotoxigenic Bacteroides fragilis Involved in Inflammatory Bowel Disease?

The aim of this study was to determine if either Helicobacter or enterotoxigenic Bacteroidesfragilis (ETBF) was linked to inflammatory bowel disease (IBD), using PCR. We analyzed the luminal washings and colonic biopsies of 35 patients with IBD and 37 control patients. The presence of Helicobacter was confirmed in the luminal washing of one IBD patient and three control patients and in the biopsies of two IBD patients. Ten of 28 control patients and 8 of 32 IBD patients had a positive luminal washing for the enterotoxin gene. Six of 33 control patients and 4 of 32 IBD patients had positive biopsies. The prevalence of the enterotoxin gene was higher in IBD patients with active disease compared with patients with inactive disease, although it did not achieve statistical significance. In conclusion, Helicobacter was not associated with IBD in our population of patients, although ETBF may be associated with active disease.     

Detection of non-enterotoxigenic and enterotoxigenic Bacteroides fragilis in stool samples from children in São Paulo, Brazil

Non-enterotoxigenic bacteria of the Bacteroides fragilis group and enterotoxigenic B. fragilis were identified from children with and without aqueous acute diarrhea. In this study, 170 stool samples from 96 children with and 74 without diarrhea were analyzed. Enterotoxin production and the toxin gene detection were detected by cytotoxicity assay on HT-29/C1 cells and by PCR, respectively. B. fragilis species was prevalent in both groups and enterotoxigenic B. fragilis strains were isolated from two children with diarrhea. More studies are important to evaluate the role of each bacteria of the B. fragilis group, including enterotoxigenic strains play in the diarrheal processes in children.     

Transanal total mesorectal excision: dissection tips using ‘O’s and ‘triangles’

Purpose

Transanal total mesorectal excision (taTME) requires specific technical expertise, as it is often difficult to ascertain the correct dissection plane. Consequently, one can easily enter an incorrect plane, potentially resulting in bleeding (sidewall or presacral vessels), autonomic nerve injury and urethral injury. We aim to demonstrate specific visual features, which may be encountered during surgery and can guide the surgeon to perform the dissection in the correct plane.

Method

Specific features of dissection in the correct and incorrect planes are demonstrated in the accompanying video.

Results

The ‘triangles’ created using appropriate traction can aid in performing a precise dissection in the correct plane. Recognition of features described as ‘O’s can alert surgeons that they are entering a new fascial plane and can avoid incursion into an incorrect plane.

Conclusion

Understanding and recognizing the described features which can be encountered in taTME surgery, a safe and accurate TME dissection can be facilitated.

     

The diagnostic value of Rosemont and Japanese diagnostic criteria for ‘indeterminate’, ‘suggestive’, ‘possible’ and ‘early’ chronic pancreatitis

Background

Longitudinal data are lacking to support consensus criteria for diagnosing early chronic pancreatitis.

Inducible Metronidazole Resistance in nim–Positive and nim–Negative Bacteroides fragilis Group Strains after Several Passages Metronidazole Containing Columbia Agar Plates

Abstract Background: Recent data show an emergence of resistance in the Bacteroides fragilis group against several antimicrobial agents and inducible resistance against metronidazole in nim–positive strains. The aim of the present study was to investigate inducible metronidazole resistance in nim–positive as well as in nim–negative B. fragilis group strains. Materials and Methods: Of 18 B. fragilis strains (including four nim–positive reference strains and one ATCC strain), two Bacteroides ovatus strains, and one Bacteroides thetaiotaomicron DSM strain minimum inhibitory concentration (MIC) values for metronidazole were determined by Etest^? and analyzed for nim genes (nimA to –G) by PCR. For this purpose bacterial suspensions were incubated on supplemented Columbia agar plates containing metronidazole at twice the MIC value of the specific strain and incubated under anaerobic conditions for 48 hours. After incubation, growing bacteria were harvested and thereafter incubated at four times the original MIC. This procedure was repeated with increasing antibiotic concentrations. The resulting MIC values were confirmed by Etest^?. Results: The MIC values for metronidazole of the four nim–positive reference strains ranged from 3 to 8 mg/l. The B. fragilis ATCC 25285 strain and the B. thetaiotaomicron DSM 2255 strain were nim negative with MIC values of 0.19 mg/l and 0.75 mg/l, respectively. Three clinical isolates of B. fragilis strains showed MIC values of > 256 mg/l. In all three strains, nim genes were detected by PCR. The other clinical isolates were nim negative. In these strains, MIC values ranged from 0.19 to 0.75 mg/l. After several passages on metronidazole containing agar, all B. fragilis group strains exhibited MIC values of > 256 mg/l determined by Etest^?. Conclusion: Metronidazole resistance can be selected not only in nim–positive strains but also in nim–negative strains, suggesting that mechanisms other than nim genes are involved. These findings and the emerging resistance of the B. fragilis group against several antimicrobial agents underscore the importance of susceptibility testing of anaerobes even in routine laboratories. This paper is dedicated to the founders of the Walter Marget Foundation, D. Adam and F. Daschner, in gratitude for their support of the training in infectious diseases.     

Exercise-induced ‘browning’ of adipose tissues

Global rates of obesity continue to rise and are necessarily the consequence of a long-term imbalance between energy intake and energy expenditure. This is the result of an expansion of adipose tissue due to both the hypertrophy of existing adipocytes and hyperplasia of adipocyte pre-cursors. Exercise elicits numerous physiological benefits on adipose tissue, which are likely to contribute to the associated cardiometabolic benefits. More recently it has been demonstrated that exercise, through a range of mechanisms, induces a phenotypic switch in adipose tissue from energy storing white adipocytes to thermogenic beige adipocytes. This has generated the hypothesis that the process of adipocyte ‘browning’ may partially underlie the improved cardiometabolic health in physically active populations. Interestingly, ‘browning’ also occurs in response to various stressors and could represent an adaptive response. In the context of exercise, it is not clear whether the appearance of beige adipocytes is metabolically beneficial or whether they occur as a transient adaptive process to exercise-induced stresses. The present review discusses the various mechanisms (e.g. fatty acid oxidation during exercise, decreased thermal insulation, stressors and angiogenesis) by which the exercise-induced ‘browning’ process may occur.