Gangliosides of liver tumors induced by N-2-fluorenylacetamide. I. Ganglioside alterations in liver tumorigenesis and normal development.

Hyperplastic nodules and hepatocellular carcinomas were induced in livers of rats by a low-protein diet containing 0.05% of the carcinogen N-2-fluorenylacetamide. Ganglioside amounts and composition were determined for histologically different hepatocellular carcinomas and compared with those for control livers, hyperplastic nodules, and liver tissue surrounding hepatomas and nodules as well as those for livers of fetal, newborn, 1-week-old, weanling, and adult Sprague-Dawley rats. Ganglioside sialic acid levels were elevated above those of normal adult liver in all liver tissues following the carcinogen treatment regimen. Livers of fetal and newborn rats contained nearly twice the amount of ganglioside sialic acid on a protein or DNA basis as did livers of adult rats. Analyses of individual nodules and hepatomas revealed two populations of tumors in which the levels of ganglioside sialic acid were 2.3 and 3.8 times normal. Ganglioside sialic acid content was at hepatoma levels in small nodules. Individual gangliosides were evenly distributed between products of the monosialoganglioside and disialoganglioside pathways in normal liver with a ratio of [N-acetylneuraminic acid (sialic acid)] (NAN)-galactose (Gal)-N-acetylgalactosamine (GalNAc)-(NAN)-Gal-glucose (Glc)-ceramide (Cer) (GD1a) to Gal-GalNAc-(NAN)2-Gal-Glc-Cer (GD1b) of about one. In contrast, the monosialogangliosides predominated in liver tissues following administration of the carcinogen. Increased levels of specific monosialogangliosides were present in nodules, in liver of carcinogen-treated animals prior to the appearance of tumors, and in the liver tissues surrounding nodules and hepatomas. In single hepatomas, ganglioside patterns correlated with tumorigenicity. A well-differentiated hepatoma had a normal complement of most gangliosides but was deficient in trisialogangliosides. In a poorly diferentiated but well-circumscribed hepatoma, the relative levels of all higher gangliosides were reduced. The monosialoganglioside Gal-GalNAc-(NAN)-Gal-Glc-Cer (GM1) accounted for 80% of the total ganglioside in a poorly circumscribed and poorly differentiated hepatoma. The ganglioside pattern of fetal livers most closely resembled that of a poorly differentiated hepatoma. During the first week post natum, levels of all higher monosialogangliosides and disialogangliosides declined, but the decline was most pronounced for gangliosides GM1 and GD1a. The ratio of GM1 + GD1a to GD1b + NAN-Gal-GalNAc-(NAN)2-Gal-Glc-Cer or (NAN)3-Gal-Glc-Cer (GT), used as an index of the relative predominance of the monoslaloganglioside and disialoganglioside pathways, fell from 2.7 for fetal liver to 0.4 for adult liver. Pools of precursor gangliosides increased during development, transiently for GalNAc-(NAN)-Gal-Glc-Cer and for more than 3 weeks for NAN-Gal-Glc-Cer. When hyperplastic nodules and hepatocellular carcinomas were compared, a reverse pattern was observed. The ratio of GM1 + GD1a to GD1b + GT rose steadily to values of 2.7 and 11...     

Inhalant Use Among Child Welfare–Involved Adolescents

Illicit substance use, especially of inhalants, is a public health crisis during adolescence, particularly for maltreated youths. This study advances the literature by highlighting the prevalence of inhalant use among child welfare–involved adolescents. Using the National Survey of Child and Adolescent Well-Being (NSCAW) II data set, case-status factors, problem behaviors, deviant peers, delinquency, depression, and school peer engagement were inspected using logistic regression. Females, delinquency, deviant peers, problematic behaviors, and depression are positively related to inhalant use, whereas youth school peer engagement mitigates inhalant use. Attention to peer relationships and psychosocial risk factors is necessary for adolescents.     

Oliguria after prophylactic ureteric stenting in gynaecological surgery—a report of three cases and review of the literature

Ureteric injury is one of the most serious complications of gynaecological surgery. Use of prophylactic preoperative bilateral ureteric stents to reduce ureteric injury is established in colorectal surgery and becoming commonplace in complex gynaecological surgery. The safety of the procedure has been questioned due to reports of stent-induced complications including a rare but serious phenomenon of stent-induced transient obstructive oligo-anuria termed reflex anuria, a response to manipulation and irritation of the ureters. A retrospective case-note review of patients who had bilateral ureteric stents placed prior to gynaecological surgery at Salford Royal Hospital, UK, from 2007 to 2011 was performed to identify cases of oligo-anuria post-stenting, which were not related to hypovolaemia, nephrotoxic drugs or a radiologically evident obstruction. All patients had their stents removed immediately at the end of surgery before leaving the operating theatre. Three out of 439 patients (0.7 %), who had preoperative bilateral ureteric stents, developed post-operative oligo-anuria despite relatively normal radiological assessment. In these three cases outlined below, one self-resolved, and two required urgent re-stenting to relieve obstruction. Use of ureteric stents for major gynaecological surgery can expedite intraoperative identification of the ureters to help reduce accidental ureteric injury but can directly cause complications. These three cases have contributed to knowledge of the complications of ureteric stents during major gynaecological surgery. Awareness of reflux anuria as a possible root cause of post-operative acute renal failure is important for guiding appropriate and timely management to preserve renal function.     

Enteral Autonomy with Teduglutide Treatment of Intestinal Failure/Short Bowel Syndrome with Depleted Central Venous Access

Digestive Diseases and Sciences -