High Globulin Research Articles

A low albumin to globulin ratio with a high serum globulin level is a prognostic marker for poor survival in cervical cancer patients treated with radiation based therapy.

We investigated whether the pretreatment albumin to globulin ratio, serum albumin level, and serum globulin level can be used to predict survival among cervical cancer patients treated with radiation based therapy and assessed globulin fractions. We retrospectively enrolled 128 patients with cervical cancer treated with radiation based therapy at our institution between 2010 and 2015. The associations of the pretreatment albumin to globulin ratio, and serum albumin and globulin levels with overall survival were assessed. Additionally, the associations of the globulin fractions with the serum globulin levels and overall survival were evaluated. Median follow-up duration was 30 months (IQR 16-44 months). A low albumin to globulin ratio (< 1.53) was found to be an independent prognostic factor for overall survival (HR= 3.07; 95% CI, 1.03 to 13.3; P=0.044). On evaluating serum globulin and albumin separately, a high serum globulin level was significantly associated with overall survival (cut-off value 2.9 g/dL; HR=3.74; 95% CI 1.08 to 23.6; P=0.036) whereas a low serum albumin level was not associated with overall survival (cut-off value 3.6 g/dL; HR=1.77; 95% CI 0.57 to 4.54; P=0.29). Electrophoresis data of the serum proteins revealed that the γ-globulin fraction was most strongly correlated with the globulin levels (P<0.001). Furthermore, a high γ-globulin level (≥1.28 g/dL) was significantly associated with poor overall survival (log rank test, P=0.034). A pretreatment low albumin to globulin ratio, which might be attributable to a high serum globulin level, can be used to predict poor prognosis in cervical cancer patients treated with radiation based therapy.

Amelioration of Decline in Immune Function in Athletes after High-Intensity Training by Bovine Colostrum

Long-term high-intensity training can cause a decline in immune function in athletes. In this study, we have explored whether bovine colostrum could improve the immune function in athletes undergoing intensive training. Thirty professional athletes were randomly divided into control group and bovine colostrum group; both groups received one month of intensive training. The control group received usual colostrum-free diet and the bovine colostrum group was fed bovine colostrum-rich milk every day. The venous blood was collected from both groups before and after the treatment period. The results showed that the lymphocyte population increased significantly in the bovine colostrum group compared to the control group (P &lt; 0.05). There was no significant change in CD4+ and CD8+ in the two groups (P &lt; 0.05), but the CD3+ and CD4+/CD8+ of the bovine colostrum group were significantly higher than those of the control group. There were significant differences in albumin, globulin and albumin/globulin ratio in the control group (P &lt; 0.05), but not in the bovine colostrum group after training. The bovine colostrum group had lower serum albumin and albumin/globulin (P &lt; 0.05) and higher globulin (P &lt; 0.05) compared to the control group. There was no significant difference in immunologic indexes before and after training in both groups (P &gt; 0.05). The decline in the markers of immune function after high-intensity training was ameliorated by the intake of bovine colostrum.

A Case Report of Refractory Immune Thrombocytopenia (ITP) Following Reduced Intensity Conditioning (RIC) Hematopoietic Cell Transplantation (HCT) for Myelodysplastic Syndrome (MDS) Successfully Treated with Off-Label Use of Daratumumab

Background:A source of treatment refractoriness in immune cytopenias appears to be residual CD138/38 positive lymphocyte populations (Audia S et al, Blood 118:4394-400,2011; Mahevas M et al, J Clin Invest 123:432-442, 2013). Persistence of recipient's plasma cells can lead to prolonged refractory thrombocytopenia following RIC-HCT. (Fasano RM et al, Br J Haematol 166(3):425-34, 2014). Daratumumab was effective in the treatment of a child with refractory autoimmune hemolytic anemia after HCT (Tolbert et al, Blood 128:4819, 2016).Case Report:The patient is a 60-year-old man with intermediate-high risk MDS who underwent RIC-HCT with total lymphoid irradiation and antithymocyte globulin with peripheral blood graft from a fully matched unrelated male donor. The patient had mild thrombocytopenia prior to HCT consistent with MDS and had not received platelet transfusions. He had not received any prior therapy for MDS. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil. Cytomegalovirus (CMV) serologic testing for exposure was negative for the recipient and positive for the donor. Both the patient and the donor had evidence for prior exposure to Epstein-Barr virus (EBV). He achieved engraftment on day +12. His peripheral blood chimerism on day + 30 showed full donor origin (WB 98%,CD3 96%,CD15 95%, CD19 98%, CD56 95%) and has been maintained to date. Acute skin GVHD responded to corticosteroids. While on corticosteroid therapy, he developed an abrupt decline in platelet count from 156,000/mcl on day +152 to 9, 000/mcl on Day + 166 without evidence for recurrent or active GVHD. While this was initially attributed to simultaneous EBV and CMV reactivations, severe thrombocytopenia persisted after viral clearance. An extensive work up for other etiologies of thrombocytopenia was negative. Repeated bone marrow biopsies were normal, including adequate megakaryocytosis and no MDS recurrence. Platelet associated antibody testing and platelet antigen genotyping were not conclusive for autoimmune versus alloimmune etiology. Testing for platelet HLA antibodies showed calculated Panel Reactive Antibody of 31% and unsatisfactory corrected count increment after transfusion of HLA compatible platelets units. The patient experienced prolonged severe thrombocytopenia for over 26 weeks with platelet count less than 5000/mcl for 22 weeks and only above 10,000 /mcl on 6 occasions. Potentially responsible medications were discontinued serially, but testing for drug inducted ITP was not conducted. Therapy included high dose corticosteroids, high dose immune globulin, rituximab, plasma exchange, splenectomy, romiplostim 10 mcg/kg/week, eltrombopag 100 mg to 150 mg daily for over 24 weeks, and low dose danazol. Fostamatinib was not available. Prednisone dose was tapered over many weeks to 5 mg daily. The patient experienced recurrent life-threatening and vision-threatening bleeding. Cumulative transfusions following Day + 166 were 133 single donor platelet units and 42 red cell units. All products were from CMV negative donors. Eltrombopag and danazol were deemed ineffective and tapered to discontinuation. CD38 positive cells were present in spleen and marrow by immunohistochemistry. Daratumumab 1300 mg was infused weekly x 4. Four weeks after the last dose of daratumumab, his platelet count increased to 91,000/mcl. Platelet count normalized to 150,000/mcl in week 5 or HCT Day + 383. Hypogammaglobulinemia has been the only detectable toxicity. Testing to determine autoimmune versus alloimmune origin is ongoing.Conclusion: Clinical trials of daratumumab for the treatment of severe refractory ITP are indicated. DisclosuresNo relevant conflicts of interest to declare.

The Possible Effects of High Vessel Traffic on the Physiological Parameters of the Critically Endangered Yangtze Finless Porpoise (Neophocaena asiaeorientalis ssp. asiaeorientalis).

Background: Poyang is the largest freshwater lake in China, where the acoustic environment and space for the critically endangered Yangtze finless porpoises (YFPs) has been altered by heavy vessel traffic and dredging activities. The density of vessel and the rate of dredging increases annually, especially in the area with the highest density of YFPs. The heavy vessel traffic can cause an increase in the physical activities and direct physical injuries to the YFPs. Furthermore, noise is a potent stressor to all cetaceans irrespective of age and can compromise all their physiological functions. The objective of this study was to examine the possible effects of heavy vessel traffic and dredging on the biochemistry, hematology, adrenal, thyroid, and reproductive hormones of two different YFP populations. One population was living in Poyang Lake and the second living in the Tian-E-Zhou Oxbow which is a semi-natural resserve.Results: The results showed statistically significantly higher levels of serum cortisol, fT3, fT4, and lowered testosterone in both adult and juvenile YFPs living in Poyang Lake vs. adult YFPs living in the Tian-E-Zhou Oxbow. The serum biochemical parameters (Aspartate Amino Transferase, Alkaline Phosphatase, High Density Lipoprotein cholesterol ratio, Globulin, Uric acid, Glucose, K+, and Amylase) and the hematology parameters (Red Blood Cells, Hematocrit, Mean Corpuscular Volume, White Blood Cells, and Eosinophils) were statistically significantly higher in the adult Poyang Lake YFPs vs. adult Tian-E-Zhou Oxbow YFPs. On the other hand, adult males of the Tian-E-Zhou Oxbow also showed significantly higher levels of the serum biochemical parameters (Total Cholesterol, Light Density Lipoprotein cholesterol, Direct Bilirubin, Albumin, Lactate Dehydrogenase, CO2, and Na+) and the blood parameters (Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration). In Poyang Lake YFPs, various parameters showed significantly positive (fT4, amylase, neutrophil, Ca+2) or negative (total protein, lymphocyte) correlations with cortisol levels.Conclusions: The hyperactivity of adrenal glands in response to heavy vessel traffic and dredging resulted in significantly elevated cortisol levels in Poyang Lake YFPs. The higher cortisol level could possibly have affected various hormonal, hematological, and biochemical parameters, and ultimately the YFPs physiology.

GVHD After Orthotopic Liver Transplant: Successful Treatment With High Dose Steroids and Anti Thymocyte Globulin (ATG)

Introduction: Graft versus host disease (GVHD) is an uncommon complication after orthotopic liver transplantation (OLT) with an incidence of 0.1-2%, but an 80-100% mortality rate. We present two cases of GVHD that resolved with high dose systemic steroids and anti thymocyte globulin (ATG). Case 1: A 66 year old male with HCV cirrhosis complicated by hepatocellular carcinoma underwent OLT. 4 weeks later, he presented with a generalized erythematous maculopapular eruption. Biopsy demonstrated evidence of vacuolar type interface dermatitis with follicular involvement consistent with GVHD. Labs showed mild pancytopenia without any evidence of viral infections. Peripheral blood chimerism was negative for donor cells. He received intravenous (IV) methylprednisolone and three doses of ATG with subsequent resolution of symptoms. The patient was followed up to two years without any recurrence. Case 2: A 53 year old male with HBV cirrhosis who underwent orthotopic liver transplant presented five weeks later with fever and generalized maculopapular rash and oral ulcers. Skin biopsy showed interface dermatitis with follicular involvement consistent with GVHD. peripheral blood chimerism study did not show any donor cells. The patient received high dose IV methylprednisolone and ATG. The patient subsequently improved and had complete resolution of cutaneous findings without any recurrence on follow up. Discussion: Graft-versus-host disease after OLT usually presents 2 to 8 weeks postoperatively with bone marrow aplasia, skin rash and diarrhea. Detection of donor lymphocytes in skin and a nonspecific lichenoid reaction pattern with basal vacuolar changes, dyskeratosis and epidermal apoptotic cells may be seen. Although published literature describes the role of corticosteroids in management, treatment beyond steroids has been heterogeneous and has included antimetabolites, alkylating agents, anti-T cell antibodies, anti-B cell antibodies, intravenous immunoglobulin, cytokine inhibitors, immunostimulants and cellular therapy, including T cell infusions and hematopoietic stem cell transplantation. Despite aggressive treatment, reported mortality rate exceeds 80%. Conclusion: GVHD is a rare clinical entity but carries a high mortality. Reducing the risk factors for development of GVHD, identifying the disease promptly, preventing infection, and starting treatment as early as possible as seen in our cases may improve the dismal outcome associated with this disease.2444_A Figure 1. Papular rash seen on lower extremity2444_B Figure 2. Vacuolar type interface dermatitis with follicular involvement

Effect of albumin-globulin score and albumin to globulin ratio on survival in patients with heart failure: a retrospective cohort study in China

ObjectiveTo investigate the combined effect of albumin (ALB) and globulin (GLB) on the overall survival (OS) of patients with heart failure (HF).DesignRetrospective cohort study.SettingA hospital.Participants404 patients first diagnosed with HF.MeasurementsSerum...

Albumin/globulin ratio is negatively correlated with PD-1 and CD25 mRNA levels in breast cancer patients

BackgroundPrevious studies have demonstrated the prognostic value of globulin (GLB), albumin (ALB), the ALB/GLB ratio (AGR), body mass index (BMI), hemoglobin (Hb), and prognostic nutritional index (PNI) in breast cancer. The underlying mechanism has been investigated by examining the impact of nutritional parameters on T cells, natural killer cells, and dendritic cells, but little is known about their effect on checkpoint molecules.MethodsHere, we investigated the correlation of mRNA expression of programmed cell death protein 1 (PD-1), cluster of differentiation 28 (CD28), cytotoxic T-lymphocyte antigen-4 (CTLA-4), and cluster of differentiation 25 (CD25) with AGR, ALB, GLB, total protein, pre-ALB, Hb, BMI, and PNI in the peripheral blood of breast cancer patients. One hundred and three patients and 21 age- and sex-matched healthy controls were enrolled. Quantitative real-time PCR was used to test relative mRNA expression.ResultsThe results indicated that the mRNA levels of PD-1 and CD25 were 5.2- and 3.3-fold higher in patients with low AGR than in those with high AGR (P < 0.05). The mRNA levels of PD-1 were 3.5-fold higher in patients with high GLB than in those with low GLB (P < 0.05). In addition, breast cancer patients had higher expression levels of PD-1, CD28, CTLA-4, and CD25 mRNA in their peripheral blood compared with healthy volunteers (P < 0.05).ConclusionThese results suggest that AGR is negatively correlated with PD-1 and CD25 mRNA levels, while GLB is positively associated with PD-1 mRNA levels. Nutritional status in breast cancer patients may influence the PD-1 pathway and have implications for the optimization of cancer therapy.

Low BMI is correlated with increased TGF-β and IL-10 mRNA levels in the peripheral blood of breast cancer patients.

Transforming growth factor-β (TGF-β), interleukin-10 (IL-10), and forkhead box P3 (Foxp3) have important roles in breast cancer development. Previous studies confirmed a correlation between these immune molecules and tumor characteristics, but their association with nutritional status in breast cancer is largely unknown. We aimed to investigate the association between body mass index (BMI), hemoglobin, total protein, albumin, globulin (GLB), albumin/GLB ratio (AGR), pre-albumin, prognostic nutritional index, and TGF-β, IL-10, and Foxp3 mRNA expression in patients with breast cancer. Quantitative real-time PCR was used to detect the mRNA expression of TGF-β, IL-10, and Foxp3 in the peripheral blood of 107 patients with breast cancer and 21 healthy controls. We found that TGF-β mRNA levels were 2.6-fold, 3.2-fold, and 2.3-fold higher in patients with low BMI (<23), low AGR, and high GLB, respectively, than in their counterparts (P < 0.05). In addition, IL-10 mRNA expression levels in patients with normal BMI (<23) were 2.8-fold and 3.5-fold higher than in those who were overweight (23≤ BMI <25) and obese (BMI ≥ 25), respectively (P < 0.05). In addition, TGF-β, IL-10, and Foxp3 mRNA levels were significantly higher in patients with breast cancer than in healthy controls (P < 0.05). In summary, our results suggest that nutritional status, especially BMI, may strongly affect systematic immune function in patients with breast cancer. © 2018 IUBMB Life, 70(3):237-245, 2018.

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study.

Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation. From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS. Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care. Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals.

Fibrinogen promotes malignant biological tumor behavior involving epithelial-mesenchymal transition via the p-AKT/p-mTOR pathway in esophageal squamous cell carcinoma.

Hyperfibrinogenemia is associated with unfavorable prognosis and advanced tumor behavior in various malignancies, including esophageal squamous cell carcinoma (ESCC). However, its biological function in ESCC is unknown. The present study was designed to further validate the prognostic value of preoperative plasma hyperfibrinogenemia and evaluate the biological role of fibrinogen, as well as the underlying mechanism in ESCC. Data from 452 cases with newly diagnosed ESCC followed by curative surgery between 2006 and 2010 were retrospectively evaluated. The Clauss method was utilized to measure the preoperative plasma fibrinogen level. Correlations between the fibrinogen level and clinicopathologic characteristics and survival analysis were performed. The effects of fibrinogen on malignant behaviors, including tumor cell viability, colony formation, migration, and invasion, were also investigated. The optimal cut-off value for plasma fibrinogen level was defined as 4.0g/L according to recommendations. Thus, the proportion of hyperfibrinogenemia was 24.8% (112/452). Preoperative plasma hyperfibrinogenemia was significantly associated with advanced tumor length, deep tumor invasion, advanced tumor-node-metastasis stage, alcohol consumption, a higher white blood cell count, a higher platelet count, and high globulin levels. Univariate survival analysis revealed that compared to those with normal plasma fibrinogen levels, patients with hyperfibrinogenemia tended to have poorer disease-free survival (DFS) [hazard ratio (HR), 1.692; 95% confidence interval (CI), 1.304-2.196; P<0.001] and overall survival (OS) (HR 1.864; 95% CI 1.424-2.440; P<0.001). In the multivariate Cox regression models, these factors remained independent predictors for impaired DFS (HR 1.491; 95% CI 1.138-1.955; P=0.004) and OS (HR 1.648; 95% CI 1.246-2.180; P<0.001) after adjusting for other confounding variables. In addition, fibrinogen could significantly promote cell migration and invasion but not proliferation. Moreover, it could also induce epithelial-mesenchymal transition (EMT) and increase the levels of p-PTEN, p-AKT, and p-mTOR in ESCC cell lines. Preoperative plasma hyperfibrinogenemia might serve as an independent predictor of unfavorable survival in ESCC. Furthermore, fibrinogen may promote cell motility by inducing EMT via the p-AKT/p-mTOR pathway.

Sa1856 - Is High Globulin Fraction a Biomarker of Severity in Inflammatory Bowel Disease (IBD)? Analysis of a 6-Year, Prospective Natural History Registry

Sa1856 - Is High Globulin Fraction a Biomarker of Severity in Inflammatory Bowel Disease (IBD)? Analysis of a 6-Year, Prospective Natural History Registry

Trade-offs between reproduction and health in free-ranging African striped mice.

Energy is limited and must be allocated among competing life-history traits. Reproduction is considered one of the most energetically demanding life-history stages. Therefore, the amount of energy an individual invests in reproduction might carry fitness costs through reduced energy allocation to other activities such as health maintenance. We investigated whether reproduction impacts health in the seasonally breeding African striped mouse (Rhabdomys pumilio). We measured health in individuals that reproduced (breeders) and individuals that did not reproduce (their adult offspring) and tested whether: (1) breeders' health before reproduction was similar to that of their offspring (representing a baseline); (2) breeders' health deteriorated after reproduction; (3) breeders' health after reproduction was worse than that of their offspring. We collected blood samples from 12 breeding females and 11 breeding males both at the onset and at the end of the breeding season and from 12 adult daughters and 11 adult sons that did not reproduce at the end of the breeding season. Health was assessed using serum biochemistry analysis with VetScan Abaxis. Breeders differed considerably in their health before and after reproduction, particularly in parameters associated with digestion (lower amylase in males), metabolism (lower albumin, alkaline phosphatase, creatinine and glucose), osmoregulation (lower potassium and phosphorous in females) and immunity (higher globulin and altered alanine aminotransferase). Our results suggest that with the onset of breeding striped mice shifted their energy allocation from maintaining health to reproduction, indicating that investment into reproduction carries significant health costs.

Extraction, Fractionation and Characterization of Cotton (Gossypium herbaceum L.) Seed Proteins

Protein fractions (water-soluble/albumin, salt-soluble/globulin, alkali-soluble/glutelin, and alcohol-soluble/prolamin) were extracted from fifteen cotton (Gossypium herbaceum L.) genotypes defatted seed using water, 0.5 M sodium chloride solution, alkali/pH 11.0, and 70% ethanol, sequentially. The main protein fraction was water soluble albumin (40.6 to 56.29%) followed by globulin (21.69 to 42.78%), glutelin (4.8 to 34.7%) and prolamin (0.81 to 2.47%) among the genotypes. Genotype Gv Hv 715 contained high albumin, Bagasara ghed selection contained high glutelin whereas A.D.C-1 contained high globulin and prolamin. The molecular size of the albumin and glutelin fractions was 20 to 55 kDa whereas globulin was 20 to 125 kDa. No prolamin was detected on gel. Cotton seed protein fractions with unique protein profiles could impart characterization of different cotton genotypes.

Hematologic and Biochemical Values of Wild Red-Tailed Amazon Parrot (Amazona brasiliensis) Nestlings With Abnormal Clinical Examination in Rasa Island, Brazil

The red-tailed Amazon parrot (Amazona brasiliensis) is an endangered psittacine species, but little information is available about abnormal clinical findings and hematologic and biochemical values of this species, which are important for monitoring the health of this population. To determine hematologic and biochemical values for wild red-tailed parrot nestlings exhibiting abnormal clinical findings, 31 nestlings from the Rasa Island (Paraná State, Southern Brazil) were physically restrained for clinical examination and blood sample collection. On physical examination, 26 birds had mild abnormalities and 5 had severe disorders. Parrots were divided into 5 groups according to the following clinical findings: presence of ectoparasites (group 1), respiratory disorders (group 2), chronic skin lesions caused by fly larvae (group 3), beak disorders (group 4), and severe clinical signs (group 5). Abnormal hematologic and biochemical findings in the nestlings were high total protein in group 3; low values for hemoglobin and mean corpuscular hemoglobin concentration in group 4; low glucose concentration, high mean absolute heterophil count, and high heterophil : lymphocyte ratio in group 5; high concentrations of total plasma protein in groups 3 and 4; and high globulin concentration in groups 3 and 5. In general, the population assessed was in good condition. These results provide a guide to the expected clinical findings associated with hematologic and biochemical concentrations in a population of free-living parrots with abnormal clinical examination findings. The data support the conservation planning and health monitoring of the endangered red-tailed Amazon parrot.

Clinical analysis of HIV/AIDS patients with drug eruption in Yunnan, China.

Drug eruption is the most common clinical presentation in patients with HIV/AIDS. The systemic clinical and risk factors associated with drug eruption remain unknown. A retrospective analysis in HIV/AIDS patients with drug eruption was carried out with demographic data, epidemiological data, clinical characteristics, laboratory data and follow-up data. The risk factors correlated with prognosis were assessed by case control analysis. A total of 134 out of 1817 HIV/AIDS patients (7.4%) presented drug eruptions. The major class of sensitizing drug was HAART drugs (47.7%), followed by antibiotics (47.0%). Nevirapine (39.6%) was the most common sensitizing drug in the HAART regimens. The patients received HAART or had allergic history were prone to develop drug eruption. The alanine aminotransferase, albumin, globulin, creatinine, blood urea nitrogen (BUN), lymphocytes, red blood cells (RBC) and eosinophils of the drug eruption patients were significantly different the control patients. The allergic history, opportunistic infection, viral load, CD4 cell count, high globulin and low albumin were the risk factors correlated with death in HIV/AIDS patients with drug eruption. It is proposed that patients with higher viral loads, higher globulin levels and lower white blood cells (WBC) should be given special attention for the prevention of complications and death.

The pathophysiology of survival in harsh environments.

An individual's ability to survive harsh conditions might depend on its available energy, and also on its health, which is expected to decline as conditions deteriorate. Yet, we know little about how health and energy expenditure are shaped by harsh environmental conditions in free-living vertebrates. Here, we studied how African striped mice (Rhabdomys pumilio) that survived summer droughts differed in their energy expenditure and health from non-survivors. Specifically, we tested whether: (1) survivors' and non-survivors' health and energy expenditure differed before environmental conditions declined; (2) non-survivors were in poorer health and had greater energy expenditure than survivors when conditions were harshest; (3) non-survivors' health deteriorated more than that of survivors as conditions deteriorated; and (4) survivors recovered once conditions improved. Survivors and non-survivors' health was assessed using VetsScan ABAXIS, while energy expenditure was measured as resting metabolic rate (RMR). Before conditions declined, non-survivors had lower energy stores and higher globulin levels than survivors. As conditions became harsher, survivors' and non-survivors' health deteriorated but only non-survivors showed signs of permanent pathology (increased glucose and decreased globulin). Once conditions improved, survivors' health improved but was not fully restored (increased alanine aminotransferase and decreased globulin). Furthermore, while survivors and non-survivors had similar RMR before conditions became harsh; their levels diverged considerably when conditions deteriorated, with survivors having a decreased RMR and non-survivors having an increased RMR. Our results show that an individual's health before facing an environmental challenge and the way it regulates its RMR influences its ability to maintain homeostasis when conditions become more taxing.

The prognostic role of preoperative serum albumin/globulin ratio in patients with bladder urothelial carcinoma undergoing radical cystectomy

ObjectiveTo date, only a few studies have demonstrated the prognostic value of pretreatment serum albumin in bladder urothelial carcinoma (BUC). The aim of this study was to evaluate the association between the pretreatment albumin/globulin ratio (AGR) and the survival of patients with BUC treated with radical cystectomy (RC). Materials and methodsData from 296 patients with BUC who underwent RC between June 2000 and June 2013 were analyzed. The AGR was calculated as follows: albumin/(total protein−albumin). The AGR was divided into 2 groups for receiver operating characteristics curve analysis. Survival was estimated using Kaplan-Meier analysis and compared using the log rank test. Cox proportional hazards models were used for univariate and multivariate survival analyses. ResultsPatients in the high AGR group (AGR≥1.60) had a lower 5-year recurrence-free mortality rate compared with those in the low AGR group (AGR<1.60) (87.0% vs. 48.0%, P<0.001). The median cancer-specific survival (CSS) time was 71.1 months for low AGR patients and 156.0 months for the high AGR patients (P<0.001). After adjusting for confounding variables, the AGR remained an independent predictor of recurrence-free survival (RFS) (hazard rate = 0.356; 95% CI: 0.170–0.748; P = 0.006) and CSS (hazard rate = 0.280; 95% CI: 0.115–0.683; P = 0.005). Moreover, in the subset of 167 patients with normal serum albumin (albumin of≥40.0g/l), serum AGR continues to be an independent predictor of RFS (P = 0.012) and CSS (P = 0.008). ConclusionsHigh AGR is a strong independent predictor of long-term RFS and CSS in patients with BUC undergoing RC. Additionally, among patients with normal albumin (≥40g/l) levels, patients with higher globulin, but lower AGR have worse survival. The pretreatment AGR is an easily accessible and cheap to use for predicting mortality in patients with BUC treated by RC.

Hematological and Serum Biochemical Abnormalities Associated with a Suspected Case of Genital Squamous Cell Carcinoma in a Gray Nigerian Mare

An 18-year-old gray mare (a crossbred Nigerian horse) was observed to have a proliferative tissue growth with multiple necrotic areas, which was suspected to be a genital squamous cell carcinoma. The mucous membrane of the eyes and gingiva of the mare were pale, and the animal was dull and insensitive, had an abnormal posture and gait, with conspicuous protruding proliferative tissue mass around the vagina and vulva. Blood samples for hematology analysis and serum biochemistry were collected from the jugular vein and determinations followed standard procedures. Hematological examination revealed that the mare had macrocytic anaemia, leukocytosis, neutrophilia, monocytosis, higher than normal erythrocyte sedimentation rate. Serum biochemical assays showed that serum activities of aspartate aminotransferase and alanine aminotransferase were slightly lower than normal. High serum alkaline phosphatase activity was recorded, with high serum total protein level that was mainly due to high serum globulin level. The mare also had a lower than normal total cholesterol. High serum creatinine level was observed. These hematological and serum biochemical findings are commonly associated with genital squamous cell carcinomas in animals and humans.

Low preoperative albumin-globulin score predicts favorable survival in esophageal squamous cell carcinoma.

This study retrospectively investigated the prognostic significance of the preoperative albumin-globulin score (AGS) and albumin/globulin ratio (AGR) in esophageal squamous cell carcinoma (ESCC). A cohort of 458 newly diagnosed ESCC patients who underwent radical esophagectomy in Sun Yat-sen University Cancer Center (Guangzhou, China) between January 2006 and December 2010 were selected into this study. The optimal cut-off value was identified to be 45.6 g/L, 26.9 g/L and 1.30 for albumin (ALB), globulin (GLB) and AGR in terms of survival, respectively. Patients with low ALB levels (< 45.6 g/L) and high GLB levels (≥ 26.9 g/L) were assigned an AGS of 2, those with only one of the two abnormalities were assigned an AGS of 1, and those with neither of the two abnormalities were assigned an AGS of 0. Univariate survival analysis showed that low AGS (0) was significantly associated with favorable disease free survival (DFS) [hazard ratio (HR), 0.635; 95% confidence interval (CI), 0.441–0.914; P = 0.015] and overall survival (OS) (HR, 0.578; 95% CI, 0.387–0.862; P = 0.007), and it remained an independent predictor for OS (HR, 0.630; 95% CI, 0.418–0.952; P = 0.028), but not for DFS (HR, 0.697; 95% CI, 0.479–1.061; P = 0.060) in multivariate models. High AGR (≥ 1.30) was also correlated with favorable DFS (HR, 0.626; 95% CI, 0.430–0.910; P = 0.014) and OS (HR, 0.622; 95% CI, 0.422–0.916; P = 0.016) in univariate analysis, but it failed to be an independent prognostic indicator for DFS (HR, 0.730; 95% CI, 0.494–1.078; P = 0.114) or OS (HR, 0.759; 95% CI, 0.507–1.137; P = 0.181) by multivariate analysis. Low preoperative AGS could serve as a valuable and convenient biochemical marker to predict favorable long-term survival in ESCC patients.

An elevated pretreatment serum globulin level predicts a poor prognosis of nasopharyngeal carcinoma

To investigate the value of serum globulin levels before treatment in predicting the prognosis of patients with nasopharyngeal carcinoma (NPC). A total of 127 patients with non-disseminated NPC were recruited between January, 2009 and December, 2013 at Nanfang Hospital. The pretreatment serum globulin levels were analyzed with the receiver-operating characteristic (ROC) curve analysis to select the cut-off point for low and high pretreatment serum globulin levels. Kaplan-Meier and multivariable analyses were used to evaluate the predictive value of serum globulin levels. The ROC curve analysis determined 30.05 g/L as the optimal cut-off value for pretreatment serum globulin level, which was significantly associated with gender (P=0.024) and N stage (P=0.016). Kaplan-Meier analysis showed that a high pretreatment serum globulin level (>30.05 g/L) significantly predicted poor progression-free survival (P=0.019), overall survival (P=0.034) and distant metastasis-free survival (P=0.049); multivariate analysis identified pretreatment serum globulin level as an independent prognostic factor for progression-free survival (HR=2.344, P=0.031). Pretreatment serum globulin level may serve as a valuable marker to predict the prognosis of patients with NPC.