Raoultella planticola is a developing pathogen that can infect both humans and animals. Raoultella spp. commonly colonize the gastrointestinal and upper respiratory systems. It usually causes pneumonia, bile tract infections, and bacteremia. In this study, the anticancer activity of an isolated brown pigment of a R. planticola isolate was tested in vitro. The laboratory examination included culturing in brain-heart infusion broth, conducting biochemical tests, using the automatic VITEK2 Compact for bacterial isolate identification, performing the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay to evaluate the cytotoxic effect on both the mammary cancer cell line (AMN3) and normal rat fibroblast (REF), and utilizing an enzyme-linked immunosorbent assay to measure cytokine levels. Raoultella planticola was found in cow nasal swabs with respiratory problems. The extracted pigment had a significant cytotoxic effect (decreased cell viability) at doses of 2,067.5 μg/ml (p <0.0001 and 0.0001, respectively) and 1,033.5 μg/ml (p < 0.0001 and 0.003, respectively). However, the lowest dose (516.875 μg/ml, p > 0.43 and p > 0.18) could not inhibit the growth of malignant or healthy cells. The first and second highest pigment concentrations reduce Interleukin-1 beta and Tumor Necrosis Factor-alpha and increase Fas in the AMN3 cell supernatant (p < 0.05). In the AMN3 cell supernatant, the lowest concentration significantly increased IL-1β levels (p < 0.0472) and Fas levels (p < 0.0146), but did not affect TNF-α levels (p < 0.1274). Pigment concentrations at the first and second highest levels significantly reduced IL-1β and TNF-α levels in the REF cell supernatant (p < 0.05), whereas the lowest concentration did not. All pigment doses did not affect the Fas levels in the REF cell supernatant (p > 0.05). In a concentration-dependent manner, the extracted pigment may exert cytotoxic effects and impact cytokine secretion levels in cancerous and normal cell types.

Current situation of endoscopic biliary drainage for bile tract cancer

In the present study 32 wild elephants across different forest ranges of the Nilgiris were screened for the presence of flukes during necropsy from December 2023 to November 2024, out of which only one elephant was found to be infected with flukes. The occurrence of Fasciola jacksoni flukes in liver and Pseudodiscus collinsi flukes in the caecum and colon of a Thirty five year old, free ranging male elephant (Elephas maximus) is reported. The infected elephant harboured a total of 22 numbers of F. jacksoni in the liver and 487 numbers of P. collinsi flukes in the caecum and colon. Morphologically F. jacksoni flukes were flat with ill-defined cephalic end armed with numerous minute dermal spines at both dorsal and ventral surfaces. Oral sucker was terminal and small whereas ventral sucker was large and well forward. Intestinal caeca were branched occupying nearly the whole extent of the body internally. Body of P. collinsi flukes were tapering anteriorly and rounded posteriorly with oral pouches and wavy intestinal caeca. The testes were deeply lobed, placed side by side and ovary was single, posterior to testes. The ventral sucker was subterminal. Liver of the elephant infected with F. jacksoni was enlarged, congested, hemorrhagic and bile tracts were filled with a dark yellowish deposition with numerous immature and mature flukes present inside the liver. Though numerous P. collinsi flukes were found in the caecum and colon, no pathological lesions were appreciable. The present observations on coinfection of Fasciola jacksoni and Pseudodiscus collinsi in a free ranging wild elephant seems to be the first report of its kind and will be important to map the status of fluke infections in wild elephants and to frame control strategies.

Background: Candida species are increasingly causing infections and are considered high priority fungal pathogens. Despite this, published data describing the clinical importance of Candida growth in the bile tract is limited to case reports and small cohorts. Our goal is to characterize treatment outcomes of patients who had Candida spp isolated from bile cultures obtained via Endoscopic Retrograde Cholangiopancreatography (ERCP) to determine the value of antifungal use in these cases. Methods: We performed a single-center retrospective cohort study of patients with bile cultures positive for Candida spp collected during ERCPs from January 2010 to December 2023. Patients were identified by cross-matching databases of patients who underwent ERCP and patients with Candida-positive bile cultures. The treatment cohort included patients who received antifungals within seven days of the first ERCP with Candida growth in bile cultures (principal ERCP) compared to a control cohort who did not. Patients with candidemia or deep-seated candida infection prior to the principal ERCP or insufficient chart data were excluded. The primary outcome was a composite of death and/or development of invasive candida infection within one year of the principal ERCP date. Kaplan Meier plots and log-rank tests were used to analyze the primary outcome. Results: A total of 266 patients were included out of 285 with 8 being excluded for insufficient records and 11 being excluded for invasive candidiasis within one year prior. The included patient population was 60.2% male, 79.7% white, 7.9% black, and 12.4% other/unknown race and had a mean age of 63.6 +/- 15.8 years. The most common species of Candida identified were C albicans (65.9%), C glabrata (17.4%), and C tropicalis (7.2%) with 27 patients (9.2%) having 2 isolates in their culture. There were 52 patients (19.5%) who received antifungals—46 fluconazole and 6 micafungin. At one year the primary endpoint occurred in 23 out of 53 patients (43.3%) in the antifungal group and 93 out of 213 patients (43.6%) in the control group. The primary outcome was plotted on a Kaplan Meier curve. The hazard ratio was 1.14 (0.71 to 1.85, 95% CI; p=0.574) which did not reach statistical significance. Additionally, antifungal initiation had no statistically significant impact on rehospitalization rates (p=0.602), relapse of bacterial cholangitis (p=0.230), or recurrent Candida-positive bile cultures (p=0.441) within one year. Conclusions: This retrospective study of the use of antifungals in patients with Candida growing from bile cultures following ERCP found no benefit in starting antifungal treatment.

Gallbladder Cancer (GBC) is a highly concerning malignancy, particularly prevalent in the Asian continent, attributed to irregularities in the bile tract. As of 2022, GLOBOCAN data ranks GBC as the 22nd most common cause of cancer-related mortality globally and the 6th among gastrointestinal cancers. According to recent World Cancer Research statistics, approximately 122,491 new cases of gallbladder cancer were reported by the end of 2022, ranking it 23rd among cancers in men and 20th in women worldwide. Towards the therapy of GBC, genetic studies have provided valuable insights into the molecular mechanisms driving GBC. Mutations in TP53, KRAS, ERBB2 (HER2), CDKN2A, and PIK3CA play crucial roles in tumor initiation and progression. Additionally, epigenetic modifications and aberrant signaling pathways, including Wnt/β-catenin, Notch, and PI3K/AKT/mTOR, have been implicated in GBC pathogenesis. Exploring these genetic alterations has led to targeted therapies, such as HER2 inhibitors (trastuzumab, pertuzumab) and immune checkpoint inhibitors, offering new treatment prospects. Further, current treatment approaches, including surgical resection, chemotherapy (gemcitabine-cisplatin), and radiation therapy, offer suboptimal outcomes in advanced stages of GBC. Despite its prevalence, effective therapeutic approaches and early-stage diagnostic methods remain elusive. This review provides a comprehensive overview of GBC, including its genetic mutations, epidemiology, risk factors, prevention, diagnosis, treatment options, and challenges. This work aims to offer valuable insights into the various factors directly or indirectly associated with GBC, which may assist in preparing an effective strategy against this growing malignancy.

<h2>Abstract</h2><h3>Background</h3> Bile tract cancer (BTC) is a heterogeneous and aggressive malignancy with a poor prognosis. Surgical resection is the main potentially curative treatment, but only about 20–30 % of patients present with resectable disease. The benefit of neoadjuvant chemotherapy (NAC) in BTC remains controversial. We explored outcomes of patients with BTCs receiving NAC compared to those who underwent upfront surgical resection using a propensity score weighting approach. <h3>Methods</h3> We identified patients who underwent surgical resection for stage I-III BTC between 2019 and 2023 and were evaluated at the Johns Hopkins Liver Multidisciplinary Cancer Clinic (Liver MDC). Propensity score weighting (PSW) was used to balance groups. Groups were assessed for differences in pathological response, recurrence-free survival (RFS), and overall survival (OS). Hazard ratios (HRs) were estimated using the PSW Cox proportional hazard regression model. <h3>Results</h3> Among 56 BTC patients that fit the inclusion criteria, 34 underwent upfront surgery, and 22 received NAC. Patients receiving NAC were more likely to have higher risk disease compared to patients receiving upfront resection (77.3 % vs 23.5 %, p < 0.001), including tumor size greater than 5 cm (45.5 % vs 11.8 %, p = 0.0221), lymph node involvement on staging imaging (50.0 % vs 23.5 %, p = 0.0495), and a trend towards higher mean CA19–9 at diagnosis (258.7 vs 87.7 U/mL, p = 0.179). In the univariate analysis, the NAC group showed a trend toward shorter RFS compared to the upfront surgery group (15.1 months; 95 % CI 10.3-not available (NA) versus 23.5 months; 95 % CI 15.5-NA, HR= 2.24; 95 % CI: 0.88–5.69, p = 0.082). No significant differences were seen for OS (36.5 months; 95 % CI 26.5-NA versus 48.2 months; 95 % CI 44.5-NA, HR=1.53; 95 % CI: 0.51–4.64–5.69, p = 0.448). Following PSW multivariable Cox analyses, receipt of NAC was associated with a trend toward reduced risk of recurrence (HR 0.83; 95 % CI 0.24–2.87 p = 0.7651) and death (HR 0.66; 95 % CI 0.2–2.16 p = 0.4890), although no statistically significant differences were observed. <h3>Conclusion</h3> These findings suggest that NAC may provide benefit for patients with higher-risk BTCs, achieving outcomes comparable to upfront surgical resection. The similar pathological results between the two groups further support the potential efficacy of neoadjuvant approaches. However, prospective trials are essential to definitively establish the optimal sequencing of chemotherapy and surgery in this patient population.

593 Background: Advanced metastatic ICC, characterized by poor survival and limited therapeutic options, may benefit from the combined use of surufatinib—a selective tyrosine kinase inhibitor targeting VEGFR 1, 2, and 3, FGFR1, and CSF-1R—and ICIs, alongside locoregional treatments like TACE, DEB-TACE, and HAIC. Methods: Eligible pts who were 18 -75 years old with histologically confirmed unresectable or metastatic intrahepatic cholangiocarcinoma were enrolled. Pts received surufatinib (250mg, orally daily), ICI, and locoregional therapies until surgery, disease progression, death, intolerable toxicity, or withdrawal of consent. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), disease control rate (DCR), overall survival (OS), conversion to surgical resection rate and safety. Results: By July 31, 2024, 20 pts were enrolled and 10 pts were evaluated. Median age was 56.4 years (range: 36-69), with a majority being male (70%). 9 pts were pathologically confirmed as adenocarcinoma, 1patient was small bile tract type. Treatment included DEB-TACE (20%), TACE (30%), and HAIC (50%). 50% (5/10) pts achieved partial response (PR), 20% (2/10) pts accepted conversion surgery, 30% (3/10) pts achieved stable disease (SD), and the confirmed ORR was 50%, DCR was 80%. The median PFS (95%Cl: 6.9-NA months) had not yet matured, with no significant differences in survival benefits based on age or gender, though TACE showed potential benefits. The most common AEs of all grades were nausea (30%), dizziness (30%), and headache (10%), No grade ≥ 3 TEAEs or new safety signals occurred. Conclusions: Surufatinib plus immune checkpoint inhibitor, along with locoregional therapies showed preliminary anti-tumor activity and manageable toxicity for the 1L treatment of ICC, providing an additional treatment option for pts with ICC. Clinical trial information: NCT05236699 .

Background: Gallbladder disease, including acute cholecystitis (AC) and biliary colic, is a common condition that primarily affects women, especially during pregnancy. It is influenced by various factors, including hormonal changes, multiparity, and obesity, which contribute to gallstone formation and complications. The prevalence of gallstones varies across regions and populations, with higher rates observed among certain ethnic groups and during pregnancy. Aim: The aim of this study is to provide an updated overview of gallbladder-related emergencies, including the epidemiology, risk factors, pathophysiology, and clinical management, particularly focusing on emergency healthcare professionals, nurses, and clinical pathologists. Methods: A review of current literature and clinical data was conducted to analyze the incidence, risk factors, pathogenesis, and clinical presentation of gallbladder disease, with a particular emphasis on pregnant women. The role of hormones such as estrogen and progesterone in gallstone formation and the effects of insulin resistance were also explored. Results: Gallstones are more common in women, particularly during pregnancy, with incidence rates increasing with multiparity and obesity. Hormonal changes, especially elevated estrogen levels, contribute to gallstone formation, while insulin resistance further exacerbates the risk. The study also found that gallbladder disease in pregnancy may remain asymptomatic but can progress to acute cholecystitis, pancreatitis, or cholangitis, often requiring surgical intervention. Conclusion: Gallbladder disease remains a significant health issue, particularly in pregnant women, and requires prompt diagnosis and management. Emergency healthcare professionals, including nurses and clinical pathologists, should be aware of the risk factors and clinical manifestations to provide effective care and reduce complications. Preventive measures, including lifestyle changes and careful monitoring in high-risk populations, are essential for managing this condition

Background/AimBile tract cancer (BTC) is a malignant tumor with a poor prognosis. Recent studies have reported the heterogeneity of the genomic background and gene alterations in BTC, but its genetic heterogeneity and molecular profiles remain poorly understood. Whole-genome sequencing may enable the identification of novel actionable gene mutations involved in BTC carcinogenesis, malignant progression, and treatment resistance.Patients and MethodsWe performed whole-genome sequencing of six BTC samples to elucidate its genetic heterogeneity and identify novel actionable gene mutations. Somatic mutations, structural variations, copy number alterations, and their associations with clinical factors were analyzed.ResultsThe average number of somatic mutations detected in each case was 53,705, with SNVs accounting for most of these mutations (85.02%). None of the 331 mutations related to BTC in The Cancer Genome Atlas (TCGA) database were found in the mutations identified in our study. A higher prevalence of gene mutations was observed in samples without vascular invasion than in those with vascular invasion. Several genes with differences in mutation accumulation between groups were identified, including ADAMTS7, AHNAK2, and CAPN10.ConclusionOur study provides novel insights into the genomic landscape of BTC and highlights the potential of whole-genome sequencing analysis to identify actionable gene mutations and understand the molecular mechanisms underlying this malignancy. The high mutational burden, structural variations, and copy number alterations observed in BTC samples in this study underscore the genetic complexity and heterogeneity of this disease.

The autonomic nervous system orchestrates thefunctions of the brain and body through the sympathetic and parasympathetic pathways1. However, our understanding of the autonomic system, especially the sympathetic system, at the cellular and molecular levels is severely limited. Here we show topological representations of individual visceral organs in the major abdominal sympathetic ganglion complex. Using multi-modal transcriptomic analyses, we identified molecularly distinct sympathetic populations in the coeliac-superior mesenteric ganglia (CG-SMG). Of note, individual CG-SMG populations exhibit selective and mutually exclusive axonal projections to visceral organs, targeting either the gastrointestinal tract or secretory areas including the pancreas and bile tract. This combinatorial innervation pattern suggests functional segregation between different CG-SMG populations. Indeed, our neural perturbation experiments demonstrated that one class of neurons regulates gastrointestinal transit, and another class of neurons controls digestion and glucagon secretion independent of gut motility. These results reveal the molecularly diverse sympathetic system and suggest modular regulation of visceral organ functions by sympathetic populations.

Gardenia blue (GB), a widely used plant-derived food color is prepared by reaction of genipin, the aglycone of geniposide, with protein hydrolysate. Recent animal studies investigating GB toxicity have indicated blue coloration in the gastrointestinal tract, kidneys and mesenteric lymph nodes in rodents following dietary administration. This study investigated the uptake and disposition of [14C]GB in male and female rats and mice administered 100 or 1000 mg/kg by gavage. [14C]GB was prepared by reaction of [2–14C]genipin with soy protein hydrolysate. Following administration in rats, 14C was eliminated primarily in feces (89–97% of administered dose), exhaled volatile organic chemical (VOC) and CO2 traps contained no radioactivity, and urine contained 0.2–0.4 %. In bile-duct-cannulated rats (100 mg/kg [14C]GB), 0.25% of dose was recovered in bile, and in urine, 0.5%. The percent of the dose absorbed was 0.9%, based on radioactivity in urine, bile, and carcass minus digestive tract contents. The highest level of radioactivity in tissues was in kidney; however renal recovery was low, with only 0.02–0.04% of the dose recovered in kidney. Repeated dosing indicated that 14C accumulated in kidney, and was slowly removed following cessation of dosing, consistent with previous studies, in the absence of any functional or histopathological changes.

Background:Cholangiocarcinoma is a kind of malignant tumor that originates in the epithelium of the biliary tract. Although there are several options for second-line treatment for patients without specific genetic mutations, the overall treatment efficacy is disappointing. Second-line treatment which is composed of liposomal irinotecan plus fluorouracil and leucovorin significantly improved the treatment efficacy for advanced biliary tract cancer and extended patient survival. This study aims to evaluate the efficacy and safety of the combination of cadonilimab with liposomal irinotecan plus fluorouracil and leucovorin for advanced biliary tract cancer.Objectives:The primary objective of this study is to determine the objective response rate. The second objectives of this study are overall survival, progression-free survival, disease control rate, and adverse event incidence rate.Design:The study is a single-arm, prospective phase II clinical trial. In all, 51 patients who are diagnosed with locally advanced or metastatic bile tract cancer will be enrolled.Methods and analysis:Eligible participants will receive cadonilimab at a dosage of 6 mg/kg on day 1 of each 14-day cycle combined with intravenous liposomal irinotecan at a dosage of 70 mg/m2 for 90 min on day 1 plus leucovorin at a dosage of 400 mg/m2 for 30 min on day 1 and fluorouracil at a dosage of 2400 mg/m2 for 46 h every 2 weeks.Discussion:Previous studies have suggested that there is a synergistic effect between the two treatment modalities. However, the potential of cadonilimab in bile tract cancer has not been explored. Hence, this trial is the first to investigate its efficacy and toxicity. In addition, the trial is also willing to explore potential biomarkers in patients with locally advanced and metastatic bile tract cancer.Trial registration:This study was registered on ClinicalTrials.gov with NCT06438822.Ethics:This study protocol and amendments have been approved by the Ethics Committee of West China Hospital (2024(791)).

The autonomic nervous system orchestrates the brain and body functions through the sympathetic and parasympathetic pathways. However, our understanding of the autonomic system, especially the sympathetic system, at the cellular and molecular levels is severely limited. Here, we show unique topological representations of individual visceral organs in the major abdominal sympathetic ganglion complex. Using multi-modal transcriptomic analyses, we identified distinct sympathetic populations that are both molecularly and spatially separable in the celiac-superior mesenteric ganglia (CG-SMG). Notably, individual CG-SMG populations exhibit selective and mutually exclusive axonal projections to visceral organs, targeting either the gastrointestinal (GI) tract or secretory areas including the pancreas and bile tract. This combinatorial innervation pattern suggests functional segregation between different CG-SMG populations. Indeed, our neural perturbation experiments demonstrated that one class of neurons selectively regulates GI food transit. Another class of neurons controls digestion and glucagon secretion independent of gut motility. These results reveal the molecularly diverse sympathetic system and suggest modular regulations of visceral organ functions through distinct sympathetic populations.

The authors highlight the mechanisms of dyskinesia of the biliary tract, gallbladder, and sphincter of Oddi dysfunction (as preliminary mechanisms for the development of chronic cholecystitis and cholelithiasis) in the article. The authors focus on the role of rehabilitation measures, which they deem to be optimally effective. The importance of diet therapy and physical therapy in preventing biliary sludge is considered since it is a sign of calculous cholecystitis. The authors emphasize the usefulness of therapeutic massage, provided there is no exacerbation. It normalizes the activity of the autonomic nervous system; stimulates the tone of the gallbladder in the hypotonic form of dyskinesia and eliminates spasm in the hyperkinetic form; eliminates bile stagnation and prevents the formation of gallstones; and improves blood and lymph flow in the liver and other digestive organs. In order to develop adaptation mechanisms during remission, the authors recommend regular use of therapeutic and morning hygienic exercises, hydrokinesiotherapy, a health path, hiking and skiing, cycling, skating, swimming, rowing, sports, and outdoor games. The authors present the technique of segmental reflex and classical massage of the digestive tract, the paravertebral zones of the spinal segments C3–C4, D6–D10, the reflexogenic zone of the right half of the chest, and the areas of the solar plexus, abdomen, liver, and gall bladder. The authors emphasize the importance of physiotherapy in both preventive and therapeutic processes for gallbladder dyskinesia. Solux, UHF therapy, medicinal electrophoresis, UV irradiation, paraffin-ozokerite and mud applications are administered. The authors recommend electrical stimulation of the gallbladder's area and the right thoracic nerve for the hypokinetic form of gallbladder dyskinesia, which is characterized by atony of the walls. To improve the motor function of the gallbladder and bile ducts and the physicochemical properties of bile, the authors administer a drinking treatment with hydrocarbonate-chloride-sulfate-sodium-calcium-magnesium waters.

Summary. Background. Endoscopic retrograde cholangiopancreatography (ERCP) and associated interventions play a crucial role in the diagnosis and treatment of choledocholithiasis, correction of malignant biliary obstruction, and pathology of the major duodenal papilla. The main complications of ERCP are acute pancreatitis, bleeding, perforation, cholangitis and acute cholecystitis. Aim. To analyze the presence of complications following ERCP and endoscopic interventions, depending on the nature of the obstruction of the extrahepatic biliary tract – malignant or non-malignant. Materials and Methods. We analyzed 604 cases of extrahepatic bile duct obstruction (EHBDO) in which endoscopic techniques were utilized for treatment. Results. Among 498 patients with non-malignant obstruction, acute pancreatitis occurred in 35 (7%), bleeding in 14 (2.8%), perforation in 1 (0.2%), cholangitis in 1 (0.2%), and acute cholecystitis in 4 (0.8%). Among 106 patients with tumor obstruction, the respective figures were 2 (1.9%), 3 (2.8%), 1 (1%), and no cases of acute cholecystitis. Conclusions. The most common complication following ERCP and endoscopic interventions on the biliary tract is acute pancreatitis (6.1%). It occurs significantly more frequently in cases of non-malignant EHBDO (p=0.046). Bleeding, perforation, and acute cholecystitis were observed in 2.8%, 0.3%, and 0.7% of patients, respectively. No statistical differences were found between malignant and non-malignant obstructions in terms of these complications (p&gt;0.05). Cholangitis, occurring in 0.7% of cases, was significantly more common in patients with tumor-related EHBDO (p=0.003) and was associated with the failure of endoscopic bliary decompression.

BackgroundThe emergence of immune checkpoint inhibitors (ICIs) has enhanced survival outcomes for certain patients with advanced biliary tract carcinoma (BTC). Pinpointing those who would benefit most from immunotherapy remains elusive. We investigated the predictive value of the modified Gustave Roussy Immune Score (mGRIm-s) in BTC patients treated with ICIs.MethodsData from 110 patients at Chinese People's Liberation Army General Hospital, spanning September 2015 to April 2021, were analyzed. The median follow-up duration was 38.7 months as of December 2023. Risk factors included low albumin, high lactate dehydrogenase, and an elevated neutrophil–lymphocyte ratio. Patients were stratified into low (patients with no risk factors) and high (patients with at least one risk factor) mGRIm-s groups based on these factors.ResultsSurvival outcomes post-immunotherapy favored the low mGRIm-s group, with significantly improved progression-free survival (PFS) and overall survival (OS) (8.50 months vs. 3.70 months and 21.60 months vs. 8.00 months). COX regression confirmed an elevated risk in the high mGRIm-s group. Subgroup analysis highlighted a notable survival advantage for low mGRIm-s patients receiving first-line immunotherapy.ConclusionsThis study underscores mGRIm-s's potential in predicting immunotherapy response in BTC, paving the way for more targeted approaches.

PI3K-CCL2-CCR2-MDSCs axis: a potential pathway for tumor clostridia-promoted CD 8+ T lymphocyte infiltration in bile tract cancers

Helicobacter pylori (H. pylori), is a spiral shaped gram-negative bacterium; H. pylori infection affects 60% of the population in India. H. pylori infection is one of the reasons of gastric inflammation, which results in duodenal ulcer, peptic ulcer, and gastric ulcer and gastric cancer. Infection with H. pylori has also been linked to cholelithiasis, cholecystitis, gallbladder polyps, and bile tract cancer. However, due to a lack of literature, the relationship between H. pylori and gallbladder pathologies remains unknown. In this review, it was aim to provide an up-to-date summary of the link between H. pylori and gallbladder diseases. It was concluded that infection with H. pylori was linked to cholelithiasis, chronic cholecystitis, and gallbladder cancer. But available literature reports showed contradictory results. Therefore, panel of studies are needed to establish the link between H. pylori associated gallbladder diseases.

Introduction: They are accessory bile ducts, less than 2 mm in diameter, they are in contact with the gallbladder bed, they depend on the right hepatic lobe most frequently. Clinical case: A 41-year-old male patient without comorbidities underwent laparoscopic cholecystectomy, during which bile leak from the accessory duct was detected. Double ligation was performed. During the postsurgical period, the patient presented a good clinical evolution. No evidence of collections, fistulas or any complications. Discussion: Different case series demonstrate that injuries during laparoscopic cholecystectomy are usually recognized during the procedure or more commonly in the immediate postoperative period. In the immediate postoperative period, the presence of bile output through a drain or peritoneal signs should imply a biliary injury. Localized accumulation of bile can produce a sterile bilioma , subhepatic or interhepatophrenic abscess . Conclusions: Surveillance must be exercised before any cholecystectomy, whether open or laparoscopic, since the presence of bile leak, its clinical presentation, diagnosis, classification, complexity and adequate treatment can reduce morbidity and mortality in the patient.

PI3K-CCL2-CCR2-MDSCs axis: A potential pathway for tumor Clostridia-promoted CD 8+ T lymphocyte infiltration in bile tract cancers