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Abstract Objective Colorectal cancer (CRC) is conventionally classified as right sided, left sided, and rectal cancer. Clinicopathological, molecular features and risk factors do not change abruptly along the colorectum, and variations exist even within the refined subsites, which may contribute to inconsistencies in the identification of clinically relevant CRC biomarkers. We generated a CRC metabolome map to describe the association between metabolites, diagnostic and survival heterogeneity in cancers of different subsites of the colorectum. Design Utilizing 372 patient-matched tumor and normal mucosa tissues, liquid chromatography-mass spectrometry was applied to examine metabolomic profiles along seven subsites of the colorectum: cecum (n = 63), ascending colon (n = 44), transverse colon (n = 32), descending colon (n = 28), sigmoid colon (n = 75), rectosigmoid colon (n = 38), and rectum (n = 92). Results 39 and 70 significantly altered metabolites (including bile acids, lysophosphatidylcholines and lysophosphatidylethanolamines) among tumors and normal mucosa, respectively, showed inter-subsite metabolic heterogeneity between CRC subsites. Gradual changes in metabolite abundances with significantly linear trends from cecum to rectum were observed: 23 tumor-specific metabolites, 30 normal mucosa-specific metabolites, and 15 metabolites in both tumor and normal mucosa, had concentration gradients across the colorectum, and is disease status dependent. The metabolites that showed a linear trend included bile acids, amino acids, lysophosphatidylcholines, and lysophosphatidylethanolamines. Comparison of tumors to patient-matched normal mucosa revealed metabolite changes exclusive to each subsite, thereby further highlighting differences in cancer metabolism across the 7 subsites of the colorectum. Furthermore, metabolites associated with survival were different and unique to each subsite. Finally, an interactive and publicly accessible CRC metabolome database was designed to enable access and utilization of this rich data resource ( https://colorectal-cancer-metabolome.com/yale-university ). Conclusions Gradual changes exist in metabolite abundances from the cecum to the rectum. The association between patient survival and distinct metabolites with anatomic subsite of the colorectum, reveals differences between cancers across the colorectum. These inter-subsite metabolic heterogeneities enrich the current understanding and substantiate previous studies that have challenged the conventional classification of right-sided, left-sided, and rectal cancers, by identifying specific metabolites that offer new biological insights into CRC subsite heterogeneity. The database designed in this study will enable researchers to delve into granular information on the CRC metabolome, which until now has not been available.

Enterohemorrhagic Escherichia coli (EHEC) is a major food-borne pathogen that causes human disease ranging from diarrhea to life-threatening complications. Accumulating evidence demonstrates that the Western diet enhances the susceptibility to enteric infection in mice, but the effect of diet on EHEC colonization and the role of human gut microbiota remains unknown. Our research aimed to investigate the effects of a Standard versus a Western diet on EHEC colonization in the human in vitro Mucosal ARtificial COLon (M-ARCOL) and the associated changes in the gut microbiota composition and activities. After donor selection using simplified fecal batch experiments, two M-ARCOL bioreactors were inoculated with a human fecal sample (n = 4) and were run in parallel, one receiving a Standard diet, the other a Western diet and infected with EHEC O157:H7 strain EDL933. EHEC colonization was dependent on the donor and diet in the luminal samples, but was maintained in the mucosal compartment without elimination, suggesting a favorable niche for the pathogen, and may act as a reservoir. The Western diet also impacted the bacterial short-chain fatty acid and bile acid profiles, with a possible link between high butyrate concentrations and prolonged EHEC colonization. The work demonstrates the application of a complex in vitro model to provide insights into diet, microbiota, and pathogen interactions in the human gut.

Context: Sexually transmitted infections (STIs) are a problem of increasing concern among men and women. They can affect fertility, increase maternal and neonatal morbidity, and can become a burden on both physical and emotional health. Owing to lack of awareness and partly due to the social stigma attached, couples do not come forward for screening. Antenatal testing for STIs is an effective strategy recommended to detect STIs in this subset of the population. Aims: To estimate the seroprevalence of four STIs (hepatitis B, hepatitis C virus, HIV, and syphilis) in pregnant women, to evaluate its correlation with sociodemographic characteristics and sexual behavior, and to check awareness regarding STIs. Settings and Design: It was an observational study on 500 pregnant women attending an antenatal clinic at a tertiary care hospital in rural Haryana, India. Methods and Material: Pregnant women were screened for four STIs – hepatitis B, hepatitis C virus, HIV, and syphilis. Statistical Analysis Used: The sample size was calculated considering the mean reported seroprevalence of infections in pregnant women in previous studies. The power of the study was kept 80% and the alpha error was 0.05. Results: Seroprevalence for STIs in pregnancy was 5.2% – hepatitis C virus (2.6%), hepatitis B (2.4%), and syphilis (0.4%). Conclusions: Viral STIs are more prevalent among pregnant women. Antenatal screening is an effective strategy for the detection of STIs in pregnant women.

Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3 P2 L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need of peripartum hysterectomy.