Evaluating M2BPGi as a Marker for Liver Fibrosis in Patients with Chronic Hepatitis B

BACKGROUND

The accurate evaluation of liver fibrosis is crucial for the treatment and follow up of chronic hepatitis B (CHB) patients.

AIM

We examined the efficiency of serum Mac-2 Binding Protein Glycosylation isomer (M2BPGi) in diagnosing liver fibrosis stages in CHB patients.

METHODS

A cross-sectional study was conducted on 177 adult CHB patients visiting the University Medical Center Ho Chi Minh City, Vietnam between October 2019 and December 2021. M2BPGi, ARFI, APRI, and FIB-4 were tested against FibroScan® for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The optimal M2BPGi cut-off values were identified based on the area under the receiver operating characteristic (AUROC) curve.

RESULTS

There was a strong agreement between M2BPGi and FibroScan® (r = 0.77, P < 0.001). The optimal M2BPGi cut-off index (C.O.I) for detecting significant fibrosis (F ≥ 2) was 0.79 with an AUROC of 0.77, 67.3% sensitivity, 70% specificity, 60.6% NPV, and 75.3% PPV. Compared with APRI (61%) and FIB-4 (47%), M2BPGi had the greatest sensitivity for diagnosing F ≥ 2. M2BPGi combined with APRI yielded highest diagnosis performance for F ≥ 2 with an AUROC of 0.87. The optimal cut-off index of M2BPGi for diagnosing cirrhosis (F4) was 1.3 with an AUROC of 0.91, 88% sensitivity, 87.4% specificity, 97% NPV, and 61% PPV. The AUROC of M2BPGi for diagnosing F4 was comparable to that of ARFI (0.93).

CONCLUSIONS

With cut-off values of 0.79 C.O.I and 1.3 C.O.I, M2BPGi could be an effective method for diagnosing significant fibrosis and cirrhosis in CHB patients, respectively.

Diagnostic Performance of Acoustic Radiation Force Impulse Imaging in Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study

Background  Acoustic radiation force impulse point shear wave elastography (ARFI-pSWE), measuring shear-wave velocity (SWV), has been utilized to examine the liver stiffness caused by different etiologies. However, information on its reliability in staging liver fibrosis in chronic hepatitis B (CHB) patients is scarce.

Purpose  The aim of the study is to examine the diagnostic performance of ARFI-pSWE and determine the optimal SWV cut-off values to predict significant fibrosis ( F ≥2) and cirrhosis (F4) in CHB patients.

Material and Methods  All 114 adult CHB patients visiting the University Medical Center, Ho Chi Minh City, Vietnam between February 2019 and March 2021 underwent liver stiffness measurement using ARFI-pSWE and FibroScan. SWV results were tested against FibroScan for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The area under the receiver operating characteristic (AUROC) curve was used to identify the optimal SWV cut-off values.

Results  There was a strong agreement between ARFI-pSWE and FibroScan ( r  = 0.92, p <0.001). The optimal SWV cut-off value for detecting significant fibrosis was 1.37 m/s with an AUROC of 0.975, sensitivity of 83.3%, specificity of 100%, PPV of 100%, and NPV of 81%. The optimal cut-off value for predicting cirrhosis was 1.70 m/s with an AUROC of 0.986, sensitivity of 97%, specificity of 93%, PPV of 95%, and NPV of 96%.

Conclusion  ARFI-pSWE could be an effective technique for evaluating liver fibrosis in CHB patients. SWV cut-off values of 1.37 and 1.70 m/s could be used to diagnose significant fibrosis and cirrhosis, respectively.

Bilateral diffuse lamellar keratitis following bilateral simultaneous versus sequential laser in situ keratomileusis

AIM

To determine the difference in the incidence of bilateral diffuse lamellar keratitis (DLK) in patients undergoing simultaneous versus sequential laser in situ keratomileusis (LASIK) as an indication of intrinsic risk for inflammation.

METHODS

A retrospective non-comparative case series of 1632 eyes that had undergone bilateral, simultaneous or sequential LASIK between April 1998 and February 2001 at a university based refractive centre by three surgeons. All cases that developed clinically evident DLK were identified and reviewed. In order to identify isolated cases and exclude those caused by environmental factors, when more than one patient in a given session developed DLK, the session was excluded. The main outcome measure was the incidence of unilateral and bilateral isolated, non-epidemic DLK.

RESULTS

Of 1632 eyes, 126 eyes (7.7%) of 107 patients developed at least grade 1 DLK. In six operating sessions, DLK was observed in more than one patient per session, and on this basis 13 patients were excluded. 16 of the 94 remaining patients developed DLK in both eyes (17.0%). Six of 41 patients (14.6%) in the simultaneous group, versus 10 of 53 patients (18.9%) in the sequential group developed bilateral DLK (p >0.5).

CONCLUSION

In isolated, non-epidemic bilateral DLK, a similar incidence was observed regardless of whether the surgery was simultaneous or sequential, suggesting an underlying intrinsic cause for DLK.

Collision tumor: a peripheral neuroepithelioma and a transitional-cell carcinoma occurring simultaneously in the renal pelvis

We report a unique case of a collision tumor of the kidney composed of a peripheral neuroepithelioma (PNE) and a transitional cell carcinoma (TCC) that occurred in a 67-year-old man with a long history of superficial TCC of both the bladder and bilateral upper urinary tracts. The PNE was composed of hyperchromatic, small, round cells, arranged in clusters and poorly cohesive sheets. Immunohistochemical studies revealed the small cells to be strongly positive for O13 (ie, a MIC2 gene product stain [CD99]) and vimentin. Electron microscopic examination found numerous interdigitating cell processes, multiple poorly formed cell-cell junctions, and dense-core granules. The latter were most conspicuous at the tips of the cell precesses. The PNE cells were clearly negative for cytokeratin, and they showed no transitional or intermediate features that would suggest evolution of the PNE from the adjacent TCC. The proximity of these two tumors appears to be serendipitous; thus, it can be considered a true collision tumor of the kidney.

Effects of a combination of detomidine and butorphanol on respiratory function in horses with or without chronic obstructive pulmonary disease

OBJECTIVE

To evaluate the effects of detomidine and butorphanol in combination on respiratory function in horses and to determine whether these effects are more severe in horses with pre-existing respiratory dysfunction,

DESIGN

Pulmonary function testing and arterial blood gas analyses were performed before and after administration of a combination of detomidine (10 micrograms/kg of body weight, i.v.) and butorphanol (20 micrograms/kg, i.v.).

ANIMALS

5 horses with chronic obstructive pulmonary disease and 5 horses free of respiratory disease (controls).

PROCEDURES

Flow rates were obtained from a pneumotachograph attached to a face mask, and esophageal pressure was measured with a catheter placed in the distal third of the esophagus. Respiratory rate, tidal volume (VT), minute ventilation (VE), maximal change in transpulmonary pressure, pulmonary resistance, and dynamic compliance were calculated by use of a pulmonary function computer. Arterial blood was collected from the transverse facial artery, and blood gas partial pressures were measured with an automated blood gas analyzer.

RESULTS

The combination of detomidine and butorphanol caused significant changes with time in respiratory rate, VT, VE, PaO2, and PaCO2. Changes with time in VT, VE, and maximal change in transpulmonary pressure were significantly different between groups.

CONCLUSION

The combination of detomidine and butorphanol affects respiratory function in horses, and the observed changes are affected by the presence of pre-existing respiratory dysfunction.

CLINICAL RELEVANCE

Changes in respiratory function after administration of a combination of detomidine and butorphanol are not necessarily more severe in horses with pre-existing respiratory dysfunction.