Serum Biochemical Tests Research Articles

Chronic constipation in the practice of a therapist: Features of therapy for comorbidity

To evaluate the clinical efficacy of laxatives with different pharmacological effects in the combination therapy in patients with chronic constipation (CC) concurrent with obesity, hypertensive disease, and type 2 diabetes mellitus (DM). A total of 110 people (45 men, 65 women) aged 45 to 72 years with CC in the presence of concomitant diseases: grade 1 or 2 hypertensive disease + obesity + type 2 DM. The investigators determined the severity of abdominal pain syndrome and flatulence, by indicating the mean frequency of defecations per week and fecal consistency according to the Bristol stool scale; anthropometric parameters; serum biochemistry tests; and serum lipoprotein phenotyping. Quality of life was assessed by the SF-36 questionnaire. The patients were divided into 3 groups according their use of agents: 1) dietary fiber (psyllium); 2) osmotic laxatives (disaccharides); 3) osmotic laxatives (polyethylene glycol). The patients taking psyllium to treat constipation showed an increasing frequency of defecations and normalization of stool consistency. Incorporating psyllium into combination therapy was accompanied by a significant decrease in the levels of total cholesterol and low-density lipoprotein cholesterol. A similar trend was observed for serum triglycerides. The patients receiving combination therapy including other laxatives displayed no significant differences between lipid metabolic parameters at the beginning and after the end of treatment. The whole complex of properties of psyllium (Mucofalk) can be fully realized in patients with comorbidity and chronic constipation, which is accompanied not only by the normalization of bowel emptying, but also by marked positive changes in the main lipid metabolic parameters and by a reduction in overweight.

Choosing Wisely and Preoperative Hemoglobin A1c Testing

(Abstracted from Can J Anaesth, 63(12):1307–1313, 2016) To promote high-value care and improved use of health system resources, the Canadian Anesthesiologists’ Society and Choosing Wisely Canada recommended that routine preoperative testing should be avoided in surgical populations when the results would be unbeneficial or when testing might lead to complications secondary to false-positive results. These recommendations include not performing preoperative serum biochemistry tests (including blood glucose assays) in asymptomatic patients undergoing low-risk, noncardiac surgery.

TRICOBLASTOMA EM CÃO JOVEM (Canis lupus familiaris) – PRIMEIRO RELATO DE CASO NA REPÚBLICA DE MOÇAMBIQUE, ÁFRICA

Trichoblastoma is a cutaneous benign neoplasia which is derivate of primitive hair follicles and have epithelial and mesenchymal elements. The study aimed to describe a case of an unusually aggressive trichoblastoma in a male dog, Maltese breed, 7 months old and 7 kg of body weight, with history of increased and rapid growth volume in frontal head region. The neoformation was ulcerated; hard consistency and not adhered; presence of alopecia and pink color; and no pain during palpation. The blood count, serum biochemical tests, urinalysis and imaging exams revealed no changes. On the cytological examination was observed the presence of basal epithelial cells with monomorphic nuclei and basophilic cytoplasm. The treatment was surgery with total excision of the neoformation. Twenty-one months after the surgical procedure was not observed any signs of recurrence and metastasis. Even rare in dogs and with age under 6 years, it was identified a macroscopically aggressive trichoblastoma in young dog with 7 months old, with histopathological features similar to that of adult dogs, and was the first case reported in Mozambique. The total surgical excision of the trichoblastoma was the treatment for this case report.

Protective effects of a polymethoxy flavonoids-rich Citrus aurantium peel extract on liver fibrosis induced by bile duct ligation in mice.

To evaluate the possible protective effect of Citrus aurantium peel extract (CAE) against apoptosis in cholestatic liver fibrosis induced by bile duct ligation in mice. Male ICR mice were divided to 5 groups: 1) Control group (Sham-operated mice), 2) Cholestatic liver injury group induced by bile duct ligation (BDL), 3) BDL mice treated with silymarin (200mg/kg) for 4 weeks, 4) BDL mice treated with 50mg/kg CAE for 4 weeks, 5) BDL mice treated with 200mg/kg CAE for 4 weeks. Mice were sacrificed and liver fibrosis was evaluated by serum and hepatic tissue biochemistry tests and liver histopathological examination. Effects of CAE on inflammation and apoptosis gene regulation were investigated through real-time PCR. CAE effect on lipid metabolism related signaling was determined by western blot analysis. In BDL mice, administration of CAE for 4 weeks markedly attenuated liver fibrosis based on histopathological alteration. Serum and hepatic tissue biochemistry results revealed that CAE (50 and 200mg/kg) decreased the levels of alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, total bilirubin, nitric oxide, and thiobarbituric acid reactive substances. Real-time PCR and western blot analysis showed that CAE regulated inflammation, apoptosis, and lipid metabolism factors increased by BDL. Interleukin family, tumor necrosis factor α, and related apoptosis factors mRNA levels were increased by BDL treatment. However, these increases were suppressed by CAE administration. In addition, CAE effectively increased phosphorylation of AMP-activated protein kinase, nuclear factor E2-related factor 2, and related cytoprotective proteins. CAE can efficiently regulate BDL-induced liver injury with antioxidant, anti-inflammatory, and anti-apoptotic activities.

Effects of formaldehyde intoxication on liver of Swiss albino mice

Formaldehyde (FA) is a very reactive one-carbon compound, can react with lipids, proteins, and nucleic acids which are cellular components.FA induces cellular toxic effects in the liver by damaging hepatic parenchyma and impairment of functions. This study was carried out to evaluatethe serum biochemical changes and cytotoxic effects on liver in Swiss albino mice caused by FA toxicity. For this purpose, mice were divided into threeequal groups i.e. Control, oral andintraperitoneal.Oral and intraperitonealgroups were further divided into three subgroups which were subjected to exposure of FA for 30 and 10 consecutive days respectively. After exposure, blood and liver samples were collected and analyzed for biochemical and morphological studies. The serum biochemical parameters like Aspartate Transaminase (AST) and Alanine Transaminase (ALT) were increased significantly (P‹0.05) in mice after FA exposure. The anatomical results revealed gross morphological changes i.e. congestion and petechial hemorrhages on the liver. Histologically, the liver showedscattered lymphocytic infiltration, dilatation of sinusoids, necrosis and degeneration of parenchymatous cells in orally exposed mice (10 mg/kg) and diffuse lymphocytic infiltration, necrosis were seen in intraperitoneallyFA injectedmice at the rate of 7 and 10 mg/kg body weight.All these findings revealed that, FA depending on specific dose leads to an irritant toxic effects on the liver of mice. Keywords:Formaldehyde, Histomorphology, Liver, Mice, Serum biochemical test.

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial.

To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times.&nbsp.

The association of chronic kidney disease and waist circumference and waist-to-height ratio in Chinese urban adults.

This study aims to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with chronic kidney disease (CKD).A cross-sectional survey was conducted in a nationally representative sample of 123,629 Chinese urban adults who participated in health examinations between 2008 and 2009. BMI, WC, and WHtR were measured, as well as serum and urine biochemical tests. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m or urine protein positivity (proteinuria)≥1+ with dipstick testing.WHtR had the largest areas under ROC curve for CKD in men and women, followed by WC and BMI. Higher levels of BMI, WC, and WHtR were each associated with an increased odds for CKD among men. For per unit size change, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of CKD were 1.19 (95% CI, 1.13-1.25) for BMI, 1.12 (95% CI, 1.08-1.16) for WC, and 1.13 (95% CI, 1.10-1.17) for WHtR. The corresponding values were significant in multivariable models among women aged 40 years and above. Using Chinese-recommended cutoffs for BMI (≥24 kg/m), WC (≥85 cm for men, and ≥80 cm for women), and WHtR (≥0.05), WHtR was superior in the association with CKD than BMI for men, whereas WC was superior for women.Increased obesity indices were positively associated with the odds of CKD. Central obesity, defined by WC and WHtR, may be more closely correlated with CKD for Chinese urban adults.

B-Mode and pulsed Doppler sonography of kidney in healthy sheep according to age

Abstract: There is no standardization in the literature of kidney length in sheep at different ages, as there are few studies about the access with the Doppler triplex ultrasound for the renal vascularization in this species. Eighty healthy sheep of three age groups of Ile de France and White Dorper breed were used: 20 lambs, 30 yearlings and 30 adults (8 rams and 22 ewes). Renal healthiness of the animals was confirmed by serum biochemical tests of urea and creatinine, and by observation of renal architecture with conventional ultrasound, besides measurement of vital parameters. A portable ultrasound (My LabTM30 Vet Gold Esaote®, Esaote Healthcare) device was used, with a convex transducer with 3.5MHz frequency. After identification of the kidneys in two-dimensional mode, the measurement of length in the sagittal section was performed in all sheep (n=80). Then color Doppler was activated for visualization of renal and interlobar arteries of the right kidney, and the resistivity index (RI) of the yearlings (n=30) and ewes (n=22) was measured. Biochemical tests remained within normal limits and renal architecture was preserved. The values of the right and left renal length were different between the groups, increasing with age (4.34cm and 4.31cm in lambs; 6.08cm and 6.23cm in yearlings; 7.57cm and 7.37cm in adults, respectively). Median values of RI of the renal artery were statistically different (p&lt;0.05) between the groups of yearlings (0.57) and ewes (0.52). The median RI of the interlobar artery was similar in yearlings (0.58) and ewes (0.54).

Targeted photo-chemo therapy of malignancy on the chest wall while cardiopulmonary avoidance based on Fe3O4@ZnO nanocomposites.

Treatment of malignancies on the chest wall, like chest wall recurrence of tumor, advanced cutaneous neoplasm and lymphoma, is still a challenge due to the involvement of the critical structures of heart and lung by the conventional strategy. The aim of the current study was to investigate targeted photo-chemo therapy mediated by Fe3O4@ZnO nanocomposites for malignancy on the chest wall while cardiopulmonary avoidance. Fe3O4@ZnO/Dox nanocomposites, the synthesis of the core-shell Fe3O4@ZnO nanocomposites followed by loading doxorubicin (Dox), were prepared to act as multifunctional drug delivery system (DDS). The synergistic anticancer effects on tumor on the chest wall and protection performance of heart and lung were evaluated in vitro and in vivo using cell viability assay, apoptosis detection, histopathologic examination, and serum biochemistry tests. Our observations demonstrated that Fe3O4@ZnO/Dox nanocomposites, could play the role of magnetic drug targeting to deliver Dox into tumor tissues and cells to enhance its chemotherapeutic efficiency. Besides, with ultraviolet (UV) illumination, Fe3O4@ZnO showed the excellent property of photosensitizer, further attacking the cancer cells by photodynamic therapy (PDT). Thus, apoptosis was synergistically induced by the photo-chemo therapy, resulting in a distinct improvement in anticancer activity. Since UV has a limited penetration distance in tissue, causing PDT to fail in the critical structures of heart and lung, cardiopulmonary hurt could be avoided during the treatment. Therefore, targeted photo-chemo therapy mediated by Fe3O4@ZnO nanocomposites may have promise as a potent treatment option for superficial malignancies on the chest wall while cardiopulmonary avoidance.

In this issue – April 2016

In this issue – April 2016

HEMATOLOGICAL AND BIOCHEMISTRY EVALUATION IN CAPUCHIN MONKEYS FROM THE ILLEGAL CAPTIVITY

Hematological and biochemistry values can be used to detect alterations caused by pathogenic agents and to establish differences between states of health and disease. The aim of this study was to perform hemogram and serum biochemistry examination in primates from the illegal captivity, considering the sex and body mass. Fifteen capuchin monkeys (Sapajus spp.) were examined (9 males and 6 females). All subjects underwent physical exams and clinical laboratory tests. Hemograms were performed using a Sysmex XT-1800i. A leukocyte count was performed on blood smears stained with Quick Panoptic. Serum biochemistry tests were performed with commercial Kits to evaluate the following parameters: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, total protein (TP), triglycerides, cholesterol, urea nitrogen, creatinine, and lactate dehydrogenase (LDH). All variables were submitted to one-way analysis of variance (ANOVA). Comparisons of individual means were examined with the Tukey test with p < 0.05. Males were heavier than females (2.86 ± 0.99 and 1.83 ± 0.27 Kg, respectively). However, sex and body mass do not influence in blood variables. Differences observed in this study can be attributed to factors related to the anesthetic protocol, among other elements of the methodology used, and/or management/environmental variations. Laboratorial tests associated with a detailed clinical examination contributed to the better understanding of the hemogram and serum biochemistry variables. In addition, it provides more accurate and comprehensive data for clinical decision making while working with captive animals.

Prevalence of impaired fasting glucose and type 1 and 2 diabetes mellitus in a large nationwide working population in Spain

IntroductionTo report the prevalence of impaired fasting glucose (IFG), undiagnosed and diagnosed diabetes, and their association to occupational categories in a representative sample of working population in Spain. Materials and methodsA cross-sectional study of workers who attended routine medical check-ups from January 2007 to December 2007. A structured questionnaire was completed, and physical examinations and routine serum biochemical tests were performed. IFG was defined as fasting glucose levels ranging from 100 to 125mg/dl with no diagnosis of T1DM or T2DM; T1DM was defined as previous diagnosis of T1DM; and T2DM as previous diagnosis of T2DM, treatment with oral antidiabetic drugs or insulin or fasting glucose levels ≥126mg/dl, according to ADA criteria. ResultsOf the 371,997 participants (median age 35 [interquartile range 29–44] years), 72.4% were male. Raw prevalence rates (95% CI) of IFG, undiagnosed (UKDM), and previously known type 2 (KDM2) and type 1 (KDM1) diabetes were 10.4% (10.3–10.5%), 1.3% (1.2–1.3%), 1.1% (1.1–1.2%), and 0.3% (0.3–0.3%), respectively. With the exception of KDM1, prevalence of these conditions increased with age and was greater among manual/blue-collar workers (12.1%, 1.5%, 1.3% and 0.3%, respectively) as compared to non-manual/white-collar workers (7.3%, 0.8%, 0.8% and 0.3%, respectively). Age- and sex-adjusted prevalence rates of IFG, UKDM and KDM2 were 13.1%, 2.0% and 2.4%, respectively. DiscussionIn this sample of Spanish working population, impaired glycemic profiles were common. Prevalence rates of IFG and T2DM were high among blue-collar workers (except for T1DM). These data emphasize the need for earlier structured preventive schemes.

GC Gene Polymorphism and Unbound Serum Retinol-Binding Protein 4 Are Related to the Risk of Insulin Resistance in Patients With Chronic Hepatitis C: A Prospective Cross-Sectional Study.

Insulin resistance (IR) is found in chronic hepatitis C (CHC) more frequently than in other chronic liver diseases.Prospective cross-sectional study to evaluate a wide multitest panel to identify factors related with IR in CHC and their possible interactions.In 76 patients with CHC we performed a series of routine laboratory analysis as well as specifically designed serum biochemical tests [retinol, retinol-binding protein 4 (RBP4), 25-OH vitamin D, Vitamin E, lipopolysaccharide-binding protein (LBP), interleukin-6 (IL-6), and cystatin C]. The single nucleotide polymorphisms rs7041 and rs4588 GC-DBP (group-specific component-Vitamin D-binding protein), rs738409 PNPLA3 (patatin-like phospholipase domain containing 3), and rs12979860 IL28B (interleukin-28 B) genes were determined. Insulin sensitivity was established with the HOMA-IR and IR was diagnosed when HOMA-IR > 3. Fibrosis staging was assessed with liver biopsy or transient elastography.After backward logistic regression analysis, independent variables associated with IR were Gc1s/Gc1s DBP phenotype, that results from the homozygous carriage of the rs7041G/rs4588C haplotype (P = 0.033); low retinol/RBP4 ratio, reflecting a greater rate of unbound RBP4 (P = 0.005); older age (P = 0.01); high serum tryglicerides (P = 0.026); and advanced (F3-F4) fibrosis stage. The AUROC provided by the multivariate model was 0.950 (95% CI = 0.906-0.993).In addition to previously known ones, the Gc1s/Gc1s phenotype variant of DBP and the unbound fraction of plasma RBP4 may be considered as factors related with the incidence, and possibly the risk, of IR in CHC patients.

Case report: a rare right abomasal displacement in a feedlot bull calf

A Holstein male calf, less than 1 year old, was referred to the Veterinary Research and Teaching Hospital of University of Tehran (VRTH) with inappetence during the past 5 days and constipation. The first examination revealed depression and dehydration. Heart rate, respiratory rate, and rectal temperature were 107 bpm, 24 rpm, and 38.5 °C, respectively. Dehydration and hyperemia were observed in the mucus membranes. The feces were soft and scant with a foul odor. The contraction of rumen was weak, twice per minute. A clear tympanic and splashing sound was heard on the middle third of the right side in the percussion of the 13th intercostal space. To confirm the reason of tympanic sound, paracentesis was performed in the area with the most tympanic sound in right and left side of the rumen. In rectal examination, the abomasum was palpated as a sac-like organ full of gas on the right, attached to the abdominal wall in the middle of the height of the body. The distension stage of the abomasum was moderate. Additional tests like handle-induced sternum stress and chest gripping were also carried out. To differentiate from other conditions, ECG was taken using electrocardiograph (single-canal Focoda, Japan) in base-apex lead (with the paper speed 25 mm s−1 and calibration of 10 mm equal to 10 mV). The pH of paracentesis fluid of the right abdomen was 5.5 but protozoa were found in the microscopic field. Handle and gripping tests were negative. Based on the elevated PCV, severe dehydration was confirmed. Total count and differential count of the leucocytes were indicated 14,500 WBC/μl, 57 % neutrophils, and 34 % lymphocytes, respectively. Seven percent band neutrophils (immature) and neutrophil/lymphocyte ratio was 1.67:1. The number of immature neutrophils was 1015, which was more than the normal range (0–120 in each μl). Also, increased serum total protein (7.4 g/dl) and decreased serum Cl and K (85 and 2.4 mEq/l) were observed. Serum biochemical test showed hyperglycemia (170 mg/dl). In fecal culture, only Escherichia coli were isolated and there was no parasite in the floating test. Arcanobacterium pyogenes was isolated from abomasum fluid culture. In ECG, sinus tachycardia was detected due to no T-P segment. Diagnosis of abomasum right displacement was confirmed based on disease history, clinical signs, examination finding, and axillary test.

Clinical experience from Thailand: noninvasive prenatal testing as screening tests for trisomies 21, 18 and 13 in 4736 pregnancies.

The purpose of this article is to report the clinical experience and performance of massively parallel sequencing-based noninvasive prenatal testing (NIPT) as a screening method in detecting trisomy 21, 18, and 13 (T21/T18/T13) in a mixed-risk population in Thailand. In a 30-month period, 121 medical centers in Thailand offered NIPT as clinical screening tests for fetal T21, T18, and T13 in the mixed-risk population. All NIPT-positive cases were recommended to undergo invasive prenatal diagnosis. A total of 4736 participants received the NIPT test, including 2840 high-risk pregnancies, either with advanced maternal age or positive serum biochemical tests, and 1889 low-risk pregnancies without conventional indications; 99.9% (4732/4736) of the participants with a median maternal age of 35 years old received reports, and 1.3% (63/4732) were classified as test positive, including 36 T21, 19 T18, and 8 T13; 82.5% (52/63) took prenatal diagnosis, and 11.5% (6/52) false-positive cases were observed. The positive predictive values for the detection of T21, T18, and T13 were 94.4%, 79.0%, and 87.5%, respectively. With stringent protocol, our prospective large-scale multicenter nationwide study demonstrated that NIPT showed excellent performance as screening tests for the detection of fetal T21, T18, and T13 in mixed-risk pregnancies in Thailand.

Intracranial Transitional Meningioma in a Cat

Background: Meningioma is a tumor that is usually attached to the dura mater. It typically arises from the meningothelial cell of the arachnoid or pia mater. Considered an extra-axial tumor of the central nervous system which can occur on any region of the meninges. The biological behavior tends to be benign and usually is not infiltrative allowing surgical indication, conferring to the patient a better prognosis. Geriatric patients are the most affected and there is no breed predisposition. This paper describes the clinical signs, pathological findings, and immunohistochemical features of a case of transitional meningioma in a cat.Case: A 14-year-old, neutered male mongrel cat was referred to the Veterinary Clinic Hospital. The history was that the cat had anorexia and disorientation. On the day of admission, lethargy and blindness were observed. Full complete blood counts showed leukopenia and lymphopenia. The serum biochemistry tests were unspecific. Thoracic and skull radiographs and ultrasound examination revealed no abnormalities. The cat was hospitalized and the main treatment was based on antibiotics and corticosteroids. The cat tested negative for FIV and FeLV. Toxoplasma gondii serum antibodies were not detected using indirect fluorescent antibody test performed with a commercial kit. The clinical signs progressed to walking in circles, stumbling, wandering, anisocoria, and stupor. On the eleventh day the cat died during hospitalization. The cat was submitted for routine post-mortem examination revealing a rounded mass involving the right occipital cortex and the cerebellum, easily separable from the brain parenchyma. In the brainstem there were moderate diffuse congestion, perivascular edema, and moderate multifocal areas of necrosis, and hemorrhage. Histological examination revealed neoplastic cells sit in tight little whorled clusters, sometimes elongated with abundant collagen intermingled. Sections from the tumor underwent immunohistochemical evaluation for glial fibrillary acidic protein (GFAP), S100, cytokeratin, and vimentin. There was immunoexpression only of vimentin. The diagnosis of transitional meningioma was established from the pathologic features and confirmed by positive staining of vimentin antibody.Discussion: The animals affected by brain tumors present a series of poorly defined or mild neurological signs. Unfortunately, evaluation of cerebrospinal fluid is neither sensitive nor specific test for the diagnosis of meningiomas in dogs and cats. Computed tomography and magnetic resonance imaging are considered the main diagnostic tools available for ante-mortem investigation of several types of brain tumors, but they are also expensive and difficult to obtain in veterinary medicine. The neurosurgery related morbidity and mortality limits the biopsy and surgical treatment to veterinary centers with highly qualified and advanced anesthesia techniques and critical care. In Brazil, there is no report of transitional meningiomas in cats and there are a few controlled studies to better insight into the biological behavior of intracranial neoplasms, prognosis and therapeutic procedures in cats. The meningioma should be included in the differential diagnosis of patients with clinical signs of intracranial diseases. However, as the difficulty of performing imaging tests specific prevents the antemortem diagnosis, definitive diagnosis is restricted, in most cases, to necropsy and histopathology.Keywords: brain tumor, feline, intracranial tumor.

Theranostics for hepatocellular carcinoma with Fe3O4@ZnO nanocomposites.

The purpose of the current study is to investigate Fe3O4@ZnO nanocomposites as theranostic agents for hepatocellular carcinoma (HCC). Initially, the transferrin receptor antibody (TfR Ab) functionalized Fe3O4@ZnO nanocomposites, followed by loading with doxorubicin (Dox) and denoted as Fe3O4@ZnO/Dox/TfR Ab, were prepared as an all-in-one system allowing for a targeted drug delivery with simultaneous concurrent chemoradiotherapy and magnetic resonance imaging (MRI) monitoring. The diagnostic and therapeutic functionalities for HCC were evaluated in vitro and in a murine orthotopic models using cell viability assays, cell cycle tests, histopathological examinations, and serum biochemistry tests. The results demonstrated that Fe3O4@ZnO/Dox/TfR Ab could deliver Dox into the targeted HCC SMMC-7721 cells to enhance its chemotherapeutic efficiency. Besides, with the addition of short term and low dose X-ray illumination, the Fe3O4@ZnO nanocomposites showed excellent radiosensitizer properties, further attacking the cancer cells. Tumor cells were also mostly arrested at G2/M, resulting in a distinct inhibition of cell proliferation. In vivo, after the treatment, a noninvasive visualization monitoring through MRI showed that tumor growth was significantly suppressed by the targeted chemoradiotherapy mediated by Fe3O4@ZnO/Dox/TfR Ab. Therefore, Fe3O4@ZnO nanocomposites could mediate the theranostic strategy for hepatocellular carcinoma.

Elevation of Derivatives of Reactive Oxygen Metabolites Elevated in Young "Disaster Responders" in Hypertension due to Great East Japan Earthquake.

There have been very few studies on serum biomarkers associated with hypertension in disaster situations. We assessed biomarkers associated with disaster-related hypertension (DRH) due to the Great East Japan Earthquake of March 2011.We collected blood samples from members of the Japan Self Defense Forces (JSDF) (n = 77) after completing disaster relief operations. We divided them into two groups based on systolic blood pressure. We defined DRH as either systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg at the time of completing missions.In subjects with DRH, the mean blood pressure was 143.5 ± 5.0/99.5 ± 2.4 mmHg. Height and body weight measurements were slightly greater in the DRH group but the differences were not significant, and age was significantly higher in the DRH group. There were no differences in serum biochemical tests including metabolic markers, sulfur-containing amino acids, and cytokines. Among nitric oxide-related amino acids, asymmetric dimethylarginine (ADMA) was lower in the DRH group than in the normotension group (0.40 ± 0.02 versus 0.31 ± 0.02 μmol/L P = 0.04). The serum oxidative stress metabolite levels (d-ROMs; indicators of active oxygen metabolite products) were significantly higher in the DRH group (273.6 ± 6.08 versus 313.5 ± 13.7 U.CARR P = 0.016). Using multivariable regression analysis, d-ROMs levels were particularly predictive for DRH.Oxidative stress is associated with DRH in responders to the disaster of the Great East Japan Earthquake.

Brucellosis associated with kidney injury and any form of nephropathy – a review of the literature

Systemic brucellosis may be associated with acute kidney injury (AKI), haemolytic–uraemic syndrome, nephrotic syndrome or various types of nephropathy. Presentation depends on the type of renal disease the patient develops. A diagnosis of brucellosis as a cause of nephropathy would require the following: isolation of Brucella in blood culture; positive serological test for brucellosis; renal biopsy evidence of the type of nephropathy; culture of Brucella from perinephric abscess or renal abscess aspirate; culture of Brucella from nephrectomy specimen; and finding a specific type of nephropathy during histological examination. Ultrasonographic and computerized tomographic findings are not specific for brucellosis; however, the scans may show an abnormal area in the kidney from which renal biopsies can be taken for pathological examination and culturing, and if there is an abscess it can be aspirated for culture. A high index of suspicion is required to diagnose the disease. The most commonly used antibiotic regimen for the treatment for brucellosis is doxycycline 100mg twice a day for 45 days in combination with streptomycin 1g/day for 15 days. The main alternative treatment is doxycycline 100mg twice a day for 45 days in combination with rifampicin 15mg/kg/day (600–900mg) for 45 days. Experience suggests that streptomycin may be replaced by gentamicin 5mg/kg/day for 7–10 days. The optimal treatment for neonates and children under 8 years old with acute brucellosis has not yet been determined but there is some experience with trimethoprim/sulfamethoxazole (cotrimoxazole) in combination with an aminoglycoside (streptomycin, gentamicin) or rifampicin. In general, other combinations of antibiotics have also been used to treat brucellosis. In cases of kidney injury and dehydration, in addition to antibiotic treatment, rehydration and clinical monitoring is required, as is monitoring urine output, repeated urinalysis and repeated serum biochemical tests for renal function estimation to assess the patient’s progress. Most renal complications due to brucellosis resolve/improve after combined antibiotic treatment and rehydration, which is also most often associated with return of normal renal function or improvement in renal function. However, relapses can occur, and careful patient follow-up is required to further assess the patient clinically by regularly repeating urinalysis, renal function tests, liver function tests and full blood count and coagulation tests, as well as repeating blood and urine cultures and Brucella serology tests. Patients should be educated to avoid contact with and ingestion of unpasteurized dairy products. Pasteurization of all dairy products should be advised, encouraged and monitored. Veterinary surgeons in endemic areas should be informed and assist when a new diagnosis is made in order to help identify and treat or kill affected animals harbouring Brucella .

An Octogenarian With Acute Epigastric Pain: More Than Meets the Eye

Question: An 84-year-old woman with a history of dementia and gastroesophageal reflux disease presented to the emergency department with several hours of worsening chest and epigastric pain associated with nausea and vomiting. Upon arrival she was hypertensive to 218/110 mm Hg and had a low-grade fever of 37.8 C. Physical examination was remarkable for epigastric tenderness in a cachectic, elderly woman with mild cognitive impairment. Electrocardiogram and cardiac enzymes ruled out acute coronary syndrome. Further evaluation revealed leukocytosis to 16.1 10/L and markedly abnormal serum liver tests with aspartate aminotransferase of 632 U/L, alanine aminotransferase of 548 U/L, alkaline phosphatase of 309 U/L, and total of bilirubin 1.9 mg/dL. Lipase was at the upper limit of normal. A chest radiograph showed a diaphragmatic hernia without evidence of free air (Figure A). Abdominal ultrasonography showed multiple small choleliths (without signs of acute cholecystitis) and mildly dilated extrahepatic and intrahepatic bile ducts. Cross-sectional imaging was subsequently obtained (Figure B and C) and demonstrated a “double-duct sign” (Figure C), a large diaphragmatic hernia, and an additional critical finding. Based on this patient’s symptoms, serum biochemical tests, and imaging findings, what is the likely etiology of her acute clinical presentation? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.