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Background The mechanisms by which intestinal bacteria impact liver diseases remain poorly understood. The aim of this study was to develop a mouse model of small-bowel bacterial overgrowth and to determine its impact on hepatobiliary injury. Materials and methods A jejunal self-filling blind loop (SFBL) was created in C57BL/6 mice. Three weeks after surgery, the mice were euthanized, and bacterial cultures of luminal content of the loop and extraintestinal tissues were performed. Liver and jejunum were collected for histological grading of inflammation and injury. Serum liver biochemistry assays were performed. Hepatobiliary transporter mRNA expression in liver was measured by quantitative real-time polymerase chain reaction. Bile and blood were collected for measurement of total bile acids, phospholipid, and cholesterol. Mice undergoing jejunal transection and reanastomosis and laparotomy only served as control groups. Results SFBL induced a dramatic increase in intraluminal bacterial counts, mesenteric lymph node bacterial translocation, and evidence of jejunal and hepatobiliary injury. Significant reductions in hepatic expression of hepatobiliary transporters involved in biliary canalicular export and basolateral uptake were observed in SFBL mice. SFBL resulted in a significant increase in biliary total bile acid concentration, decreases in bile phospholipid and cholesterol output, and an increase in the bile acid/phospholipid ratio. Conclusions We have developed a reproducible mouse model of small-bowel bacterial overgrowth with evidence of liver inflammation, altered hepatobiliary transporter expression, and alterations in bile composition. This model may help to elucidate the mechanisms by which gut-derived bacterial factors impact the liver and contribute to the exacerbation of liver diseases and biliary injury.

The purpose of this study was to evaluate relationships between subsarcolemmal mitochondrial aggregates and electron transport chain deficiencies in skeletal muscle with the objective of establishing an association between mitochondrial accumulation and electron transport chain complex deficiency. We conducted a large-scale, retrospective study to evaluate factors associated with subsarcolemmal mitochondrial aggregates (percent) in pediatric patients who received muscle biopsies for suspected respiratory chain disorders. Patients were included if they had histochemical stains for assessment of mitochondrial pathology and had biochemical testing for muscle electron transport chain complex activities. Significant positive bivariate correlations (n = 337) were found between subsarcolemmal mitochondrial aggregate percentage and electron transport chain complexes II, IV, I + III, and II + III activities. Evaluation showed that a cutoff value of2% subsarcolemmal mitochondrial aggregates had poor overall diagnostic accuracy (mean, 32%), compared with a5% cutoff (mean, 60%). To better evaluate the effects of subsarcolemmal mitochondrial aggregates percentages, patients were stratified according to lower one-third (group 1, n = 120 plus ties) and upper one-third (group 2, n = 115 plus ties) of subsarcolemmal mitochondrial aggregates values. Although only minor clinical and pathologic differences were observed, group 1 participants had significantly lower electron transport chain complex activities than group 2 for all enzymes except complex III. Logistic regression showed over 2-fold greater odds of deficiency for electron transport chain complexes I + III (P = .01) and II + III (P = .03) for group 1 participants compared with group 2. We conclude that, contrary to the previous2.0% subsarcolemmal mitochondrial aggregates cutoff for respiratory chain disorder, patients with a low subsarcolemmal mitochondrial aggregates percentage (≤4%) are significantly more likely to have electron transport chain complex deficiency than patients with increased subsarcolemmal mitochondrial aggregates percentage (≥10%). This morphological approach for assessment of mitochondrial proliferation may assist clinicians to select further testing to rule out an electron transport chain complex deficiency in children by other methods, including direct biochemical testing of electron transport chain complex activities, measurement of muscle coenzyme Q10 content, or evaluation for a mitochondrial DNA depletion syndrome.

Glypican-3 (GPC3) is an oncofetal protein that has been demonstrated to be a useful diagnostic immunomarker for hepatocellular carcinoma and hepatoblastoma. Its expression in mesenchymal tumors of the liver, particularly undifferentiated embryonal sarcoma (UES) and mesenchymal hamartoma (MH), has not been investigated. In this study, a total of 24 UESs and 18 MHs were immunohistochemically stained for GPC3 expression. The results showed cytoplasmic staining for GPC3 in 14 (58%) UESs, of which 6 exhibited diffuse immunoreactivity and the remaining 8 showed focal positivity. The patients with GPC3-positive UES tended to be younger (mean 18 years; median 11 years) than those with GPC3-negative tumors (mean 39.4 years; median 27 years), although the difference did not reach statistical significance (P = .06). Eight MHs also exhibited GPC3 immunoreactivity (44%; 4 diffuse and 4 focal). Positive staining in all 8 cases was primarily seen in entrapped nonlesional hepatocytes with a canalicular and cytoplasmic staining pattern. In only 4 cases (22%) was GPC3 immunoreactivity also observed in the mesenchymal component. The patients with positive staining also tended to be younger (mean 2.6 years; median 1.1 years) compared with those with negative staining (mean 16.3 years; median 4.5 years), but the difference was not statistically significant (P = .15). Our data demonstrate that GPC3 is expressed in a subset of UES and MH of the liver. Caution should thus be exercised when evaluating a GPC3-expressing hepatic neoplasm, particularly on a needle biopsy when the differential diagnosis includes poorly differentiated hepatocellular carcinoma or hepatoblastoma.

Coenzyme Q10 content, pathology evaluation, and electron transport chain (ETC) enzyme analysis were determined in muscle biopsy specimens of 82 children with suspected mitochondrial myopathy. Data were stratified into three groups: "probable" ETC defects, "possible" ETC defects, and disease controls. Muscle total, oxidized, and reduced coenzyme Q10 concentrations were significantly decreased in the probable defect group. Stepwise logistic regression indicated that only total coenzyme Q10 was significantly associated with probable ETC defect. Receiver operator characteristic (ROC) analysis suggested that total muscle coenzyme Q10 was the best predictor of an ETC complex abnormality. Determination of muscle coenzyme Q10 deficiency in children with suspected mitochondrial disease may facilitate diagnosis and encourage earlier supplementation of this agent.

Metallothionein I and II are small metal binding proteins with a high affinity for zinc. They are found in the CNS and are thought to play a role in modulating the effects of free zinc. We hypothesized that MT-I,II deficient mice would have more neurological deficits both functionally and anatomically following a neonatal hypoxic-ischemic (HI) insult than wild-type mice subjected to the same insult. Forty wild-type and 40 MT-I,II deficient C57 X 129T2 F1 P10 mice were randomized to either 45 min of HI or sham HI. Beginning on P50, the mice were given a series of behavioral tests including locomotor activity, novel object recognition, Morris water maze (cued, hidden platform, reduced platform), a 2-week-delayed probe trial and an apomorphine-induced rotation test. At the conclusion of testing, the brains were removed for histological analysis including staining with NeuN and GFAP to assess neuronal loss and reactive gliosis. There were no significant differences in functional or anatomic measures between the wild-type HI mice and the MT-I,II deficient HI mice. The MT-I,II deficient mice exhibited an impaired rate of learning in the spatially oriented mazes but once learned retained the information as well as the wild-type mice. The absence of functional MT-I,II proteins does not result in significantly worse injury following 45 min of HI on P10. The MT-I,II deficient mice have baseline impairments in spatial learning but not retention.

Background and purpose: Hypoxic–ischemic injury in term neonates remains a significant cause of long-term neurological morbidity. The post-natal day 10 (P10) mouse is accepted as a model for the term human. This study was designed to assess the relationships between the duration of hypoxia–ischemia (HI) on P10 and the structural and functional neurological deficits that appear in the adult mouse as a consequence. Methods: Post-natal day 10 129T2×C57Bl/6 F1 hybrid mice were subjected to 0, 45, 60 or 75 min of hypoxia–ischemia using the Rice–Vannucci model. Beginning on P50 these mice were tested over the next 8 weeks using zero maze, locomotor activity, novel object recognition, cued, hidden and reduced Morris water mazes, delayed probe trials and response to apomorphine injection. Brain weights and histology were obtained at the end of testing. Results: The degree of structural and behavioral abnormalities in adult mice correlated with the duration of hypoxia–ischemia on P10. Useful behavioral tests for separating adult mice according to duration of hypoxia–ischemia on P10 include locomotor activity, the Morris water mazes and response to apomorphine. We found cued “learning” persisted, although latencies increased, with increasing HI time while spatial learning decayed as a function of HI time. Severe HI injury involving the ventral hippocampus resulted in excessive locomotor activity. Conclusions: After correcting for motor deficits, there is evidence for persistence of “cued” learning but not spatial learning with increasing hypoxia–ischemia time on P10 in this model system.

We studied muscle biopsies of 103 pediatric patients in whom clinical suspicion for disorder of energy metabolism was highest in 13 patients, intermediate in 8 patients, and lowest in 82 patients. Electron transport complex (ETC) enzyme activity measurements were available in 96 of 103 patients. Most children with unclassified encephalopathy before biopsy had negative or equivocal morphological and biochemical evaluation for disorder of energy metabolism (72/85). The incidence of ETC abnormality and morphological abnormality in muscle from 39 patients with clinical encephalomyopathy (groups I, II, and III) was 20% and 38%, respectively. In 21 children with high or intermediate clinical suspicion of mitochondriopathy, light microscopy was confirmative in 12, ultrastructure was confirmative in 15, and major ETC abnormality was present in only 4 (29%) of 14. In 82 children with lower clinical suspicion of mitochondriopathy, morphological criteria at both the light and electron microscopic level were absent, and major abnormality of ETC activity was uncommon, in 9 (11%) of 82. Partial reductions of ETC activity occurred in 15 (18%) of 82, but are of uncertain significance. Ragged blue fibers were more prevalent in infants with mitochondriopathy than ragged red fibers. Increase of large, but not small, subsarcolemmal mitochondrial aggregates based on succinate dehydrogenase histochemistry is a useful indicator for mitochondriopathy. Thus, a distinction should be made between small aggregates (normal) and large aggregates. Using strict criteria to define pathological mitochondria, we concluded that electron microscopy is a powerful tool in the diagnosis of mitochondriopathy mainly when clinical suspicion is high. We found no consistent difference in the frequency of mitochondrial "proliferation" as currently defined or in citrate synthase activity in any group. Better patient selection in infants and children and better methods for investigation of mitochondriopathy are needed.

Background Coenzyme Q (CoQ) has been suggested as a biomarker for tissue redox status. The aims are (1) to compare ubiquinol-9, ubiquinol-10, ubiquinone-9, ubiquinone-10, total CoQ content and CoQ redox ratio in quadriceps muscle, heart, brain and liver tissues of mdx mice with wild-type controls; and (2) to determine if ubiquinol content and CoQ redox ratio changes are associated with pathological findings in mdx mouse . Methods CoQ contents were determined in homogenized quadriceps muscle, heart, liver and brain of age-matched mdx and wild-type control mice by HPLC-EC. Light and electron microscopy studies were conducted using standard pathology methods. Results Ubiquinol-9 and ubiquinol-10 concentrations are significantly increased in quadriceps and heart muscle of mdx mouse. Increased redox ratios of coenzyme Q 9 and coenzyme Q 10 are also evident in quadriceps, heart and liver tissues in mdx mouse, but not brain. Pathological examination shows marked myofiber regeneration and evidence of mitochondrial proliferation for mdx muscle. Conclusions Evidence that changes in ubiquinol content and CoQ redox ratio are related to pathological features in mdx skeletal and heart myofibers suggests that tissue ubiquinol content and CoQ redox ratio may be useful biomarkers for evaluating muscle disorders associated with mitochondrial proliferation and defects in oxidative phosphorylation.

The aim of this study is to determine whether coenzyme Q (CoQ) muscle concentrations and redox state are associated with pathologic changes in muscle biopsy specimens. Skeletal muscle biopsies were collected (January 2002-February 2004) and underwent pathologic evaluation. Quadriceps specimens (n = 47) were stratified accordingly: Group 1, controls without evidence of pathologic abnormalities; Group 2, type I myofiber predominance; Group 3, type II myofiber atrophy; Group 4, lower motor unit disease; and Group 5, muscular dystrophy. Ubiquinol-10, ubiquinone-10, total coenzyme Q10 (CoQ10), coenzyme Q9 (CoQ9), total CoQ (CoQ9+CoQ10) concentrations were analyzed in biopsy muscle by high-performance liquid chromatography. Ubiquinone-10, total CoQ10, and total CoQ concentrations were significantly decreased in Group 5. Significant positive correlations (r congruent with 0.40) were found between muscle ubiquinone-10, total CoQ10, and total CoQ concentrations vs the percentage of myofibers having subsarcolemmal mitochondrial aggregates. CoQ redox ratio and the fraction CoQ9/total CoQ were negatively correlated with subsarcolemmal mitochondrial aggregates. A significant correlation (r = 0.328) also occurred between ubiquinol-10 concentration and citrate synthase activity. This study suggests that total CoQ concentration provides a new method for estimating mitochondrial activity in biopsy muscle; and that the muscle CoQ test is feasible and potentially useful for diagnosing CoQ deficiency states.

Objective The purpose of this study was to determine which histologic features could enable one to distinguish oral condyloma, as defined by the detection of human papillomavirus (HPV) DNA through in situ hybridization, from its mimics. Study design Thirty-two paraffin-embedded specimens from 28 patients that were clinically suggestive of oral condyloma were analyzed histologically and through in situ hybridization with a consensus HPV probe. Results HPV DNA was detected in 17/32 (53%) of the lesions; no additional positive cases were detected after polymerase chain reaction amplification. Only 5 of the 17 virus-positive cases were considered to be histopathologically unequivocal for condyloma. The histologic features significantly associated with HPV detection were nonuniform perinuclear halos, often in association with epithelial crevices (P = .02), and papillomatosis (P = .02). Each of the 17 patients who were HPV-positive had either HPV-6 or HPV-11, a finding that is similar to those for condyloma involving the penis and vulva/vagina. Conclusion Differentiation between oral condyloma and its mimics is best accomplished by using a combination of histologic, clinical, and in situ viral studies.

The objective of this study was to compare the relative bioavailability of two new products with solubilized and non-solubilized over-the-counter (OTC) coenzyme Q 10 products. Nine healthy adults were given single 180 mg doses of each coenzyme Q 10 formulation at two week intervals. A commercially-marketed, non-solubilized Q 10 powder formulation (product D) was only minimally absorbed, and was excluded from the analysis of data. ANOVA comparison of maximum plasma concentrations (C max ), time of maximum concentrations (t max ), areas under the concentration-time curves from times zero to 144 hours post dose (AUC 0-144h ), and areas under the concentration-time curves from times zero to infinity (AUC 0-∞ ) were not significantly different ( P > 0.05) between test products A (LiQ-10™) and B (Q-Nol™) and the reference product C (UbiQGel®). The upper limits of the 90% confidence intervals of the log-transformed ratios (A:C and B:C) of C max, AUC 0-144h, and AUC 0-∞ were >1.25 for both test products, but significant ( P 0-144h. The results of this study indicate that LiQ-10™ has increased bioequivalence compared to the reference product, but did not reach statistical significance. Q-Nol™ has increased bioavailability compared to the reference product ( P

Patients with Duchenne muscular dystrophy (DMD) lose ambulation by age 12. Long-term steroids have lengthened ambulation by 2-5 years. Ischial weight-bearing knee ankle foot orthoses prolong ambulation for 2-3 years. We report the outcome of the ambulatory status of a patient with DMD treated with daily steroid therapy and orthoses. This male patient was diagnosed with DMD at age of 2. He has been treated with daily steroids since age 7 years. He lost the ability to arise from the floor and walk up steps at age 14 and lost ambulation by age 16. He was fitted with orthoses at age 16 following surgical correction of his lower extremity contractures and regained independent ambulation. At age 20, he was able to stand independently in his orthoses and take steps with moderate support. We conclude that a combination of daily steroids and orthoses prolongs ambulation beyond that of the natural history DMD.

BACKGROUND: Bariatric surgery is an effective method for achieving sustainable weight loss and health benefit in the morbidly obese population. Although inflammatory bowel disease (IBD) is often associated with malnutrition and weight loss, there has been a temporal increase in the prevalence of obesity among IBD patients. We evaluate the effect of IBD on post-surgical complications and health care utilization among inpatient gastric bypass procedures for obesity. METHODS: The Nationwide Inpatient Sample (NIS) was analyzed for all hospitalizations between 1998 through 2011 with accompanying Roux-en-Y gastric bypass surgery (ICD-9-CM 44.31, 44.38, 44.39) for obesity (ICD-9-CM 278, V778, V853V854, V855.4). IBD hospitalizations were identified using ICD-9-CM 555 and 556 in any diagnosis position. Logistic and linear regression analyses were used to assess the effect of IBD on post-operative complications, inpatient mortality, post-operative length of stay, and total charges. Multivariable models were adjusted for age, sex, payer source, medical comorbidities, and hospital size. RESULTS: Of 933,930 inpatient gastric bypasses for obesity, 967 were performed on IBD patients. Most gastric bypass patients were female (81.5%) with a mean age of 43.0 years. Compared with non-IBD patients, IBD patients were more likely to require conversion from laparoscopic to open surgery (odds ratio [OR] 3.30; 95% confidence interval [CI] 1.55 7.04). IBD patients were also significantly more likely to experience post-surgical complications, including seromas (OR 12.46; 95% CI 1.72 90.39), infections (OR 2.80; 95% CI 1.15 6.83), and gastrointestinal issues (e.g., vomiting, ileus, obstruction) (OR 2.77; 95% CI 1.55 4.98). There were no differences in perforation risk (OR 0.88; 95% CI 0.22 3.54), pulmonary (OR 0.73; 95% CI 0.30 1.77) or cardiovascular complications (OR 1.22; 95% CI 0.39 3.83), or death (0.52% vs. 0.22%; OR 2.04; 95% CI 0.28 14.67). Length of stay, post-operative length of stay, and total charges were similar between non-IBD and IBD hospitalizations. CONCLUSION: IBD is associated with seromas, infections, and gastrointestinal complications after bariatric surgery. Risk of other major complications, death, and hospitalization costs were otherwise similar between IBD and non-IBD patients. The rate of conversion from laparoscopic to open surgery was significantly higher in patients with IBD. Bariatric surgery remains a viable option for treatment of obesity in this special population.