Cystic tumors of the liver: on the problems of diagnostic criteria

We report on three cases of cystic neoplasms of the liver with mucinous epithelium. Case 1 showed a low-grade cystic neoplasm with ovarian-like stroma (OS). Case 2 showed a low-grade cystic neoplasm without OS, and case 3 showed a high-grade cystic neoplasm without OS. In all three cases, bile duct communication (BDC) was absent. Currently, pancreatic mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm of the pancreas (IPMN) are clearly distinguishable. However, MCN of the liver and intraductal papillary neoplasm of the bile duct (IPN-B) are not as easily distinguished. According to the latest WHO classification (2010), these conditions are classed as typical MCN of the liver, MCNs of the liver without OS, or IPN-Bs without BDC. The clinicopathological differences between MCN without OS and IPN-B without BDC are controversial. We present three cases describing these presentations and discuss the difficulties related to the diagnostic criteria used to distinguish between MCN of the liver and IPN-B.     

The influence of urinary flow rate in children on excretion of markers used for assessment of renal damage: albumin, gamma-glutamyl transpeptidase, N-acetyl-beta-D -glucosaminidase, and alpha1-microglobulin

The aim of the present study was to examine the influence of urinary flow rate on markers of renal function in children. A sub-study of the New England Children’s Amalgam Trial collected 82 pairs of urine samples from children aged 10–16 years: a timed overnight collection and a spot daytime sample collected the following day. These samples were analyzed for albumin, γ-glutamyl transpeptidase (γ-GT), N-acetyl-β-D-glucosaminidase (NAG), alpha1-microglobulin (A1M), and creatinine concentration. Regression analysis was used to model the effect of urinary flow rate in the timed overnight samples. A paired t-test compared concentrations and creatinine-corrected renal markers between overnight and daytime samples. Albumin, γ-GT, NAG, and A1M excretion rates increased significantly with urinary flow rate. Their corresponding creatinine-corrected markers did not vary significantly with urinary flow rate, but the creatinine-corrected excretions of albumin, γ-GT, and NAG were significantly higher in daytime samples than in overnight samples, with the same (non-significant) trend for A1M. The influence of urinary flow rate on creatinine-corrected markers of renal function was markedly less than its influence on excretion rates. Therefore, the use of creatinine-corrected markers seems to be a good choice in practice, with the caveat that daytime and overnight samples are not comparable. This study was supported by a cooperative agreement (U01 DE11886) between the New England Research Institutes and the National Institute of Dental and Craniofacial Research, National Institutes of Health.     

Effect of gamma-glutamyl transpeptidase inhibitors on the transport of glutamate into neuronal and glial primary cultures

Inhibitors of gamma-glutamyl transpeptidase (mixture of serine and borate--13 mM, kainic acid--5 mM and 6-diazo-5-oxo-L-norleucine--2 mM) significantly suppressed glutamate uptake into cultured neurones and glial cells. The simultaneous application of any of these inhibitors with ouabain resulted in a further decline in glutamate uptake. It can be speculated that gamma-glutamyl transpeptidase significantly contributes to glutamate transport into nerve cells in the early period of brain development until the Na(+)-K(+)-gradient is fully constituted.     

Serum CathepsinD in pregnancy: Relation with metabolic and inflammatory markers and effects of fish oils and probiotics

Background and aimsElevated circulating levels of CathepsinD (CatD) have been linked to metabolic deviations including liver inflammation. We investigated 1) whether supplementation with probiotics and/or fish oil affects CatD and 2) whether the CatD concentration would associate with gestational diabetes (GDM), low-grade inflammation, lipid metabolism, body fat % and dietary composition.Methods and resultsOverweight/obese pregnant women (n = 438) were randomized into fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo groups. Fish oil contained 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid and probiotics were Lacticaseibacillus rhamnosus HN001 (formerly Lactobacillus rhamnosus HN001) and Bifidobacterium animalis ssp. lactis 420, 10¹⁰ colony-forming units each). Serum CatD levels were analysed by ELISA, GlycA and lipid metabolites by NMR, high sensitive C-reactive protein (hsCRP) by immunoassay, and intakes of energy yielding nutrients and n-3 and n-6 fatty acids from food diaries at both early and late pregnancy. GDM was diagnosed by OGTT. CatD concentrations did not differ between the intervention groups or by GDM status. Multivariable linear models revealed that body fat % and GlycA affected CatD differently in healthy women and those with GDM.ConclusionThe serum CatD concentration of pregnant women was not modified by this dietary intervention. Serum CatD was influenced by two parameters, body fat and low grade inflammation, which were dependent on the woman's GDM status.Clinical trial reg. noNCT01922791, clinicaltrials.gov (secondary analysis).     

Cysteinyl leukotriene metabolism of human eosinophils in allergic disease

Eosinophils are multifaceted immune cells with diverse functions that enhance allergic inflammation. Cysteinyl leukotrienes (cys-LTs), mainly synthesized in eosinophils, are a class of inflammatory lipid mediators produced via multiple enzymatic reactions from arachidonic acid. Multiple clinical studies have reported dysregulated fatty acid metabolism in severe asthma and aspirin-exacerbated respiratory diseases. Therefore, understanding the mechanism responsible for this metabolic abnormality has attracted a lot of attention. In eosinophils, various stimuli (including cytokines, chemokines, and pathogen-derived factors) prime and/or induce leukotriene generation and secretion. Cell–cell interactions with component cells (endothelial cells, epithelial cells, fibroblasts) also enhance this machinery to augment allergic responses. Nasal polyp-derived eosinophils from patients with eosinophilic rhinosinusitis present a characteristic fatty acid metabolism with selectively higher production of leukotriene D₄. Interestingly, type 2 cytokines and microbiome components might be responsible for this metabolic change with altered enzyme expression. Here, we review the regulation of fatty acid metabolism, especially cys-LT metabolism, in human eosinophils toward allergic inflammatory status.     

Diagnostic accuracy of apparent diffusion coefficient values combined with γ-glutamyl transpeptidase-to-platelet ratio parameters for predicting hepatitis B-related fibrosis

ObjectivesThe accuracy of non-invasive liver fibrosis diagnosis based on the apparent diffusion coefficient (ADC) value combined with the γ-glutamyl transpeptidase-to-platelet ratio (GPR) model to predict the stage of hepatitis B-related fibrosis has not been reported. This study aimed to evaluate the diagnostic efficacy of ADC value combined with GPR for liver fibrosis grading.MethodsThe data of 180 patients with chronic hepatitis B (CHB) diagnosed by liver biopsy were analyzed. The ADC value, GPR, and their combination were assessed in different cirrhosis stages using receiver operating characteristic curve analysis to evaluate their value in diagnosing liver fibrosis.ResultsWe observed that liver fibrosis stages were inversely associated with ADC values (r=?0.691, P<0.001), and positively associated with GPR (r=0.502, P<0.001). The area under the curve for diagnostic efficacy of ADC values, GPR, and their combination for F≥2 liver fibrosis was 0.831, 0.749, and 0.858, respectively, and for F≥3 was 0.872, 0.771, and 0.903, respectively. The diagnostic cutoffs of the combination for each stage were -7.07, -12.21 and -37.75, respectively.ConclusionsThe combined diagnostic tool of ADC and GPR may improve the accuracy of hepatitis B-related liver fibrosis diagnosis, especially for F≥3.     

Documentation of Alcohol Use in Hospital Records of Newly Diagnosed Cancer Patients: A Population-Based Study

Alcohol use has been associated with increased risk and poorer prognosis of various types of cancer, but the extent of actual screening for alcohol use in hospitalized cancer patients has received limited attention. In a random sample of 618 Connecticut patients diagnosed in 2002 with invasive cancer at age 20 + years, ascertained from a population-based registry, some information on usual frequency of drinking was found in hospital records for 478 (77.3%), but 143 (57.2%) of the 250 current drinkers were poorly described (e.g., “social,” “occasional”). Alcohol use disorders were rarely mentioned. Gamma glutamyl transpeptidase was found for only 21 (3.4%). Mean corpuscular volume (MCV) was found for 434 (70.2%) and was associated with heavier drinking, independent of other predictors of MCV. Better screening is needed for all hospitalized cancer patients, to plan for interventions and conduct follow-up studies of prognosis.     

镉作业工人尿γ－GT同功酶变化的研究

调查５８名镉（Ｃｄ）作业工人尿中γ－ＧＴ同功酶的变化。结果发现，所有Ｃｄ作业工人尿中γ－ＧＴ，γ－ＧＴⅠ，γ－ＧＴⅡ均超出正常值上限。无肾损伤组的工人尿γ－ＧＴ，７·ＧＴⅠ，γ－ＧＴⅡ明显地高于对照组，而γ－ＧＴⅠ／γ－ＧＴⅡ值无明显变化；重度肾损伤组，尿γ－ＧＴ，γ－ＧＴⅠ水平高于无肾损伤和进度肾损伤组，而尿γ－ＧＴⅠ／γ－ＧＴⅡ则呈下降趋势。结果提示，尿γ－ＧＴ可能作为Ｃｄ接触者健康监测的一个敏感指标；尿γ－ＧＴⅠ／γ－ＧＴⅡ值的变化似与Ｃｄ作业工人肾损伤程度有关。