Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients

OBJECTIVES: It is currently recommend to perform a liver biopsy for patients with chronically elevated liver function tests (LFT) of unknown etiology (marker negative). The necessity and benefits of these recommendations are unknown. The aims of this study were to determine the prevalence of marker-negative LFT in patients referred for evaluation of chronically elevated LFT; to determine the prevalence of diseases that may be associated with marker-negative abnormal LFT; and to assess whether a liver biopsy alters the management of such patients. METHODS: We conducted a prospective observational study of 1124 adults referred for evaluation of chronically elevated LFT. Patients who consented to a liver biopsy were eligible. Marker-negative abnormal LFT was defined as the absence of accepted serum markers for infectious, metabolic, autoimmune, or hereditary liver disease, the absence of a history of alcohol or hepatotoxic drug use, and the absence of signs of chronic liver disease. RESULTS: Eighty-one of 1124 eligible patients were marker-negative. Liver biopsies in the 81 marker-negative patients revealed: normal histology (eight), steatosis (41), steatohepatitis (26), fibrosis (four), and cirrhosis (two). All 73 abnormal liver biopsies had some degree of steatosis. There were no significant associations between histological findings and the presence of obesity (p = 0.13), hyperlipidemia (p = 0.4), or diabetes (p = 0.9). There were no significant associations when classifying patients by gender or by symptoms. CONCLUSION: In the setting of marker-negative elevated LFT, the most likely histological diagnosis is fatty metamorphosis of the liver with occasional associated fibrosis.     

Minimally invasive, longitudinal monitoring of biomaterial-associated inflammation by fluorescence imaging

Implant-associated inflammation is a major cause for the reduced performance/lifetime and failure of numerous medical devices. Therefore, the ability to non-invasively and quantitatively monitor implant-associated inflammation is critically important. Here we show that implant-associated inflammation can be imaged via fluorescence imaging using near-infrared hydrocyanine dyes delivered either locally or intravenously in living mice. This imaging strategy allowed quantitative longitudinal monitoring of inflammation by detecting reactive oxygen species (ROS) released by inflammatory cells in response to implanted poly(ethylene terephthalate) (PET) disks or injected poly (lactic-co-glycolic acid) (PLGA) microparticles, and exhibited a strong correlation to conventional analysis of inflammation. Furthermore, modulation of inflammatory responses via controlled release of the anti-inflammatory agent dexamethasone was detected using this sensitive imaging approach. Thus, hydrocyanine-based fluorescence imaging of ROS could serve as a surrogate measure for monitoring implant-associated inflammation as well as evaluating the efficacy of therapeutic approaches to modulate host responses to implanted medical devices.     

Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education

Objectives: To assess the level of melanoma awareness and risk perception among ethnic minorities and to identify ways to enhance the relevance of melanoma educational materials for ethnic minorities. Methods: Twelve focus groups composed of participants from a single ethnicity [African‐American (n=40), Hispanic (n=40), and Asian (n=40)], participated in a 2 h discussion on melanoma and skin cancer and commented on an educational brochure by the American Cancer Society and reacted to photographs of melanoma on ethnic skin. Participants also evaluated the ability to sunburn and tan and the skin cancer risk of images of celebrities before and after the discussion. Additionally, participants assessed the skin tone of celebrities as very fair, fair, olive, light brown, dark brown, and very dark. The audiotape recordings of the 12 focus groups were transcribed and analyzed with the Non‐numerical Unstructured Data Indexing Searching and Theorizing software for common themes. Results: The common themes were (1) lack of relevance of skin cancer to ethnic people, (2) understanding of skin cancer risk terminology is based on personal experience and what is acquired from the media, and (3) sources of health information for ethnic minorities are fragmented and physicians are not the primary source of information. Celebrity images representing the six skin tones were selected. Conclusions: Relevance of melanoma education to ethnic people may be improved by using ‘melanoma skin cancer’, photographs of early melanoma in people with dark skin, and providing guidance on how to inspect hands and feet for suspicious moles. Copyright © 2010 John Wiley & Sons, Ltd.     

Use of the monoclonal antibody MOC-31 as an immunomarker for detecting metastatic adenocarcinoma in effusion cytology

BACKGROUND:

MOC‐31 is an established immunologic marker with which to detect adenocarcinomas. The objective of the current study was to evaluate the use of MOC‐31 in the diagnosis of metastatic adenocarcinoma in effusion specimens.

METHODS:

The authors evaluated cytologic specimens of effusions/washings in which MOC‐31 immunostaining was performed on unstained cell block sections or Papanicolaou‐stained cytospin preparations. Membranous staining with or without cytoplasmic staining was considered to be positive. The immunostaining results were correlated with the cytologic diagnoses and clinical follow‐up data.

RESULTS:

A total of 215 effusions and washings were identified (cell blocks in 162 cases, cytospin preparations in 53 cases, and both in 2 cases in which MOC‐31 immunostaining was performed). A total of 94 (44%) of the 215 cases were found to be positive for malignancy, including 87 metastatic adenocarcinomas. Specimens were positive for MOC‐31 in 76 (87%; 55 cell blocks and 21 cytospin preparations) of 87 cases of metastatic adenocarcinoma. Eleven cases of metastatic adenocarcinoma were found to be negative for MOC‐31 (4 cases from lung tumors, 2 from stomach tumors, 2 from colon tumors, 2 from breast tumors, and 1 from a renal tumor). Minimal and/or focal cytoplasmic staining for MOC‐31 was noted in 13% of cases of reactive mesothelial cells/mesothelioma. The sensitivity of MOC‐31 for metastatic adenocarcinoma was 89%, the specificity was 100%, the negative predictive value was 92%, and the positive predictive value was 100%.

CONCLUSIONS:

MOC‐31 alone was found to be highly sensitive for distinguishing reactive mesothelial cells/mesothelioma from metastatic adenocarcinoma in effusion specimens. Interpreting membranous MOC‐31 staining as positive can help prevent confusion between reactive mesothelial cells/mesothelioma and metastatic adenocarcinoma. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society     

Effect of drying processes and curing time of chitosan-lysine semi-IPN beads on chlorpheniramine maleate delivery

Beads of semi-interpenetrating polymer network (semi-IPN) have been synthesized from chitosan and lysine with varying amounts of glutaraldehyde solution used as a cross-linker. The cross-linked beads are dried by different drying processes such as air-drying, oven-drying and freeze-drying. These semi-IPNs are characterized under a scanning electron microscope (SEM). Swelling studies of these beads are carried out in different pH (2.0 and 7.4) solutions. The effect of concentration of cross-linking agent and curing period on the swelling as well as on the drug release is analysed. The results indicate that the size of matrix depend on the curing time of beads, concentration of glutaraldehyde and technique of drying. The freeze-dried beads exhibit a relatively higher percentage of swelling in the range of 66-89% as compared to oven-dried beads (53-74%) and air-dried beads (39-61%). The drug loaded beads which are cured for different time intervals followed by drying are tested for in-vitro release of chlorpheniramine maleate (CPM) drug. The rate of drug release from freeze-dried beads is much faster than that from the oven-dried and air-dried beads.     

Simplifying paediatric immunization with a fully liquid DTP–HepB–Hib combination vaccine: Evidence from a comparative time-motion study in India

An observational time-motion study investigated logistic, programmatic and safety-related advantages and limits in the delivery of a fully liquid DTP–HepB–Hib combination vaccine versus a lyophilized combination vaccine requiring reconstitution. The study was conducted in 2006, observing 312 child vaccinations in a tertiary hospital setting in Kolkata, India. The time for vaccination was on average 46 s (35.12%) lower with the fully liquid vaccine (p < 0.05). In addition, the fully liquid combination was easier and potentially safer to handle and as well tolerated as the lyophilized formulation. Fully liquid combination vaccines have the potential to simplify immunization schedules, contribute to better resource management and improve efficiency of immunization programs.