Extent of liver inflammation in predicting response to interferon alpha & Ribavirin in chronic hepatitis C patients: a cohort study

ABSTRACT: BACKGROUND: Liver inflammation due to HCV infection leads to fibrosis, which is an independent predictor of treatment response to interferon therapy in Chronic Hepatitis C (CHC) patients. This relationship has not been studied for liver inflammation on pretreatment liver biopsy and End of Treatment Response (ETR). ALT is a less invasive test than liver biopsy for measuring liver inflammation. Aim of this study was to compare ETR to Interferon alpha (recombinant Interferon) & Ribavirin in CHC patients having higher and lower grades of liver inflammation and to determine the diagnostic accuracy of pretreatment ALT for grades of liver inflammation. METHODS: A retrospective cohort of 876 naive CHC patients, who completed Interferon alpha & Ribavirin for 24 weeks, was studied for ETR. Pretreatment grade of inflammation on liver biopsy was taken as the exposure variable. It was classified as high if there was moderate or severe and low if there was minimal or mild. Multivariable logistic regression modeling was performed. Diagnostic accuracy of pretreatment ALT for liver inflammation grades was determined by computing Area Under the Receiver Operator Curve (AUROC). RESULTS: Of all patients, 672 having diagnostic liver biopsy and ETR available were analyzed. Among them, 103 had high and 569 had low grades of liver inflammation. Mean age was 36.9 (SD 9.1) years, with patients with high grades being older than those with low grades inflammation (p = 0.03). High grades of liver inflammation was associated with ETR (RR 1.17, 95% CI 1.12-1.18) adjusting for age, Total Leukocyte count (TLC) and pretreatment levels of ALT, irrespective of liver fibrosis. This relation remained significant for 'bridging fibrosis and cirrhosis' and not for 'no' or 'portal fibrosis'. AUROC of pretreatment ALT for males and females was moderately accurate for severe inflammation compared to minimal inflammation and less accurate for high grades compared to low grades. CONCLUSIONS: ETR in patients with higher grades of liver inflammation was 17% higher than those with lower grades irrespective of fibrosis and 9% higher for bridging fibrosis and cirrhosis. Pretreatment ALT was moderately accurate for severe inflammation only on liver biopsy in both males and females.     

Accessory gallbladder: a new anatomical variation arising from both left and right hepatic ducts

We present a case of accessory gallbladder demonstrating an anatomical variation not previously reported. While rare, accessory gallbladders are an important consideration if a cholecystectomy is to be performed. We also present a brief literature review of accessory gallbladders.     

Role of sentinel lymph node biopsy in patients with ductal carcinoma in situ and microinvasion

Aim: Ductal carcinoma in situ with microinvasion (DCISMI) is characterized by one or more areas of focal invasion, 1 mm or less in diameter. While pure ductal carcinoma in situ (DCIS) does not have the potential to metastasize to regional nodes, the presence of microinvasion makes lymph node metastasis possible, leading to current guidelines recommending staging of the axilla with sentinel lymph node biopsy (SLNB). However, there are few studies looking at the risk of lymphatic spread in patients with DCISMI, and indications for axillary staging in such cases is controversial. The aim of the present study was to assess the prevalence of nodal metastasis in patients with DCISMI in order to help ascertain whether SLNB can be safely avoided in DCISMI. Patients and Methods: A retrospective analysis was performed of patients undergoing surgery for DCIS over a 2‐year period (April 2006–08). Data were collected from the National Health Service Breast Screening Programme database and patient case notes. Patients having a SLNB had injection of radioisotope and blue dye. All SLNB were evaluated with serial sectioning and haematoxylin–eosin staining. Results: Over the 2‐year period, 399 screen‐detected breast cancers were treated, of which 310 (77 per cent) were invasive, 17 (4 per cent) had DCISMI and 72 (19 per cent) pure DCIS. The group with DCISMI was studied in more detail. Twelve out of the 17 patients had a wide local excision and five had a mastectomy. All 17 patients with DCISMI had a SLNB. No positive lymph nodes were found in this group. Conclusion: Our data suggest that the risk of nodal metastasis in DCISMI might be low, and question the role of SLNB in DCISMI. We highlight the lack of data on DCISMI and risk of nodal metastasis, and the need for further investigation.     

Colorectal carcinoma in first decade of life: our experience

Introduction

Though the lifetime risk of colorectal carcinoma (CRC) in general population is 5–6 %, it is uncommon in pediatric age group. Here, we are reporting our experience of CRC in the first decade of life.

Methods

From January 2010 to December 2013, seven patients with histopathologically confirmed colorectal carcinoma were treated in the Department of Pediatric Surgery, Chittagong Medical College and hospital. Age, sex, presenting symptoms, location of the primary tumor, serum CEA level, treatment modalities and outcomes were evaluated.

Results

There were four male and three female patients and age ranged from 6.5 to 10.5 years. Rectum (3 patients) and rectosigmoid (2 patients) were the most common primary sites. Serum carcinoembryonic antigen level was obtained in six patients and in only one patient the level was raised markedly (137 ng/ml). Two patients of familial adenomatous polyposis had localized disease and others presented in an advanced stage. Histopathologically, poorly differentiated adenocarcinoma was noted in five patients with one signet ring cell type and well differentiated in rest of the two patients. Only one patient was surviving at the last follow up.

Conclusion

Advanced stage at diagnosis, aggressive histologic subtype and poor survival are the hallmarks of pediatric CRC.     

Ethyl-p-methoxycinnamate isolated from kaempferia galanga inhibits inflammation by suppressing interleukin-1, tumor necrosis factor-α, and angiogenesis by blocking endothelial functions

OBJECTIVE:

The present study aimed to investigate the mechanisms underlying the anti-inflammatory and anti-angiogenic effects of ethyl-p-methoxycinnamate isolated from Kaempferia galanga.

METHODS:

The anti-inflammatory effects of ethyl-p-methoxycinnamate were assessed using the cotton pellet granuloma assay in rats, whereby the levels of interleukin-1 and tumor necrosis factor-α were measured in the animals'' blood. In addition, the levels of interleukin, tumor necrosis factor, and nitric oxide were measured in vitro using the human macrophage cell line (U937). The analgesic effects of ethyl-p-methoxycinnamate were assessed by the tail flick assay in rats. The anti-angiogenic effects were evaluated first by the rat aortic ring assay and, subsequently, by assessing the inhibitory effects of ethyl-p-methoxycinnamate on vascular endothelial growth factor, proliferation, migration, and tube formation in human umbilical vein endothelial cells.

RESULTS:

Ethyl-p-methoxycinnamate strongly inhibited granuloma tissue formation in rats. It prolonged the tail flick time in rats by more than two-fold compared with the control animals. The inhibition of interleukin and tumor necrosis factor by ethyl-p-methoxycinnamate was significant in both in vivo and in vitro models; however, only a moderate inhibition of nitric oxide was observed in macrophages. Furthermore, ethyl-p-methoxycinnamate considerably inhibited microvessel sprouting from the rat aorta. These mechanistic studies showed that ethyl-p-methoxycinnamate strongly inhibited the differentiation and migration of endothelial cells, which was further confirmed by the reduced level of vascular endothelial growth factor.

CONCLUSION:

Ethyl-p-methoxycinnamate exhibits significant anti-inflammatory potential by inhibiting pro-inflammatory cytokines and angiogenesis, thus inhibiting the main functions of endothelial cells. Thus, ethyl-p-methoxycinnamate could be a promising therapeutic agent for the treatment of inflammatory and angiogenesis-related diseases.     

Modern management of systolic anterior motion of the mitral valve

Systolic anterior motion (SAM) of the mitral valve (MV) can be a life-threatening condition. The SAM can result in severe left ventricular outflow tract obstruction and/or mitral regurgitation and is associated with an up to 20% risk of sudden death (which is substantially lower in hypertrophic cardiomyopathy (HCM)). The mechanisms of SAM are complex and depend on the functional status of the ventricle. The SAM can occur in the normal population, but is typically observed in patients with HCM or following MV repair. Echocardiography (2D, 3D and stress) has a central diagnostic role as the application of echocardiographic SAM predictors allows the incorporation of prevention techniques during surgery and post-operative SAM assessment. Cardiac magnetic resonance imaging has a special role in understanding the dynamic nature of SAM, especially in anatomically atypical hearts (including HCM). This article describes what the clinician needs to know about SAM ranging from pathophysiological mechanisms and imaging modalities to conservative (medical) and surgical approaches and their respective outcomes. A stepwise approach is advocated consisting of medical therapy, followed by aggressive volume loading and beta-adrenoceptor blockade. Surgery is the final option. The correct choice of surgical technique requires an understanding of the anatomical substrate of SAM.     

Photovoltaic and Impedance Spectroscopy Study of Screen-Printed TiO2 Based CdS Quantum Dot Sensitized Solar Cells

Cadmium sulphide (CdS) quantum dot sensitized solar cells (QDSSCs) based on screen-printed TiO₂ were assembled using a screen-printing technique. The CdS quantum dots (QDs) were grown by using the Successive Ionic Layer Adsorption and Reaction (SILAR) method. The optical properties were studied by UV-Vis absorbance spectroscopy. Photovoltaic characteristics and impedance spectroscopic measurements of CdS QDSSCs were carried out under air mass 1.5 illuminations. The experimental results of capacitance against voltage indicate a trend from positive to negative capacitance because of the injection of electrons from the Fluorine doped tin oxide (FTO) electrode into TiO₂.