[Gilbert's syndrome: hyperbilirubinemia enemy or friend].

Gilbert's syndrome is a kind of benign inherited disease of bilirubin binding disorder, mainly due to the homozygous polymorphism A(TA)7TAA in the promoter of the gene for uridine diphosphate -glucuronosyltransferase 1A1 (UGT1A1), which is a TA insertion into the promoter, designated as UGT1A1*28, with UGT activity reduction to 30% of the normal value. Therefore, circulating fat-soluble unconjugated bilirubin cannot be converted into water-soluble conjugated bilirubin, leading to unconjugated hyperbilirubinemia. Bilirubin has a strong affinity for erythrocyte phospholipids, which interferes with membrane composition and dynamics, resulting in increased erythrocytes fragility, easy rupture, and gradual shortening of survival time. However, there are no obvious sign of hemolysis or abnormal iron metabolism, erythrocytes and bone marrow morphology. A small amount of chronic hemolysis stimulates extramedullary (normal bone marrow morphology) hematopoiesis, ensuing compensatory increase in circulating erythrocytes and hemoglobin. Hyperbilirubinemia may also weaken gastrointestinal motility, increase passive diffusion and absorption across the intestinal mucosal epithelium by 1.5 to 2 times, thereby aggravating or worsening hyperbilirubinemia mainly with unconjugated bilirubin circulation, which indicates that there is a causal relationship between the circulating bilirubin concentration and rapid erythrocytes turnover and hemolysis rate in patients with Gilbert's syndrome. Interestingly, bilirubin also has significant antioxidant and anti-mutagenic activities, and the potential health benefits of mild hyperbilirubinemia in Gilbert's syndrome include reduced prevalence of cardiovascular disease, type 2 diabetes mellitus (and related risk factors), certain cancers, and cardiovascular-related and all-cause mortality. Exogenous bilirubin and biliverdin supplements in intestinal epithelial cells can be absorbed and may increase circulating concentration of these antioxidant compounds. With this information, we hope to raise awareness of the potentially harmful and beneficial effects of benign hyperbilirubinemia, and explore and develop beneficial medical interventions.

Simvastatin induces apoptosis of nasopharyngeal carcinoma cells through NF-κB signaling pathway.

OBJECTIVE: The aim of this study was to investigate the mechanism of simvastatin-induced apoptosis in nasopharyngeal carcinoma (NPC) cells. MATERIALS AND METHODS: CNE1 and HK1 cell lines were treated with different concentrations of simvastatin for different time course. Subsequently, Cell Counting Kit-8 (CCK-8), colony formation assay, and flow cytometry were conducted to evaluate cell activity, colony formation ability, as well as cell cycle of NPC cells, respectively. The mRNA expressions of p21, Bim, and cyclin D1 were examined by qPCR. Meanwhile, the protein expression levels of apoptosis-related proteins (including caspase-3, Bax, Bcl-2) were detected by Western blot. Caspase-3 activity was determined to estimate cell apoptosis. An NPC xenotransplantation model was constructed to further determine the role of simvastatin in vivo. In addition, NF-κB activity was assessed through Luciferase reporter gene assay and Western blot. RESULTS: Simvastatin treatment lead to significantly reduced viability of NPC cells and the number of cell colonies dose-dependently and time-dependently. Meanwhile, simvastatin treatment caused cell cycle arrest in G0/G1 phase, remarkably downregulated expression of cyclin D1, and upregulated expressions of p21 and Bim. In addition, simvastatin induced apoptosis of NPC cells and enhanced the Luciferase activity of caspase-3. Western blot results indicated that simvastatin promoted the protein level of Bax and caspase-3, whereas suppressed the protein expression of Bcl-2. In vivo experiments showed that simvastatin was able to suppress the growth of NPC cells. Further studies demonstrated that simvastatin remarkably attenuated the Luciferase activity of pNF-κB-Luc, thereby specifically inhibiting the NF-κB signaling pathway. CONCLUSIONS: Simvastatin inhibits proliferation and promotes apoptosis of NPC cells by inhibiting the NF-κB pathway.

[Diagnosis and treatment strategies for fatty liver when obesity coexists with alcohol consumption].

Non-alcoholic fatty liver disease and alcohol (ethanol)-related liver disease is a global epidemic of chronic liver disease and the main cause of fatty liver. Non-alcoholic fatty liver patients sometimes ingest different types of alcohol. Therefore, when obesity coexist with alcohol consumption, it is more difficult to diagnose the cause of fatty liver. The amount of alcohol consumption and alcohol drinking pattern and chronic liver injury, type 2 diabetes mellitus, cardiovascular disease and other metabolic-related diseases may have J-type correlation; that is to say, a light to moderate amount of alcohol consumption may bring certain benefits to the above diseases, but excessive alcohol consumption may promote the development of obesity, aggravate liver disease, metabolic abnormalities, and increase the risk of tumors. Screening for metabolic-related disease risk should be considered in addition to the assessment of changing liver lesions when obesity coexists with alcohol consumption. Changing bad living habits, losing weight and abstaining from alcohol are still the basis of treating fatty liver and metabolic disorders. Carefully selecting patients and communicating with them about the risk and benefit of drugs are important indicators of drug therapy. Patients with end-stage liver disease can be considered for liver transplantation and postoperative lifestyle improvement should be emphasized.

Ossifying inverted papilloma and ossifying polyp of the sinonasal tract: comparison of CT and MRI features.

AIM: To investigate the key imaging points in distinguishing ossifying inverted papilloma (IP) from polyps. MATERIALS AND METHODS: The native computed tomography (CT), conventional and enhanced MRI manifestations of 20 ossifying IPs and eight polyps, which were confirmed histopathologically, were retrospectively evaluated by two doctors majoring in head and neck imaging. RESULTS: A significant difference was detected between the two entities for the involved sites (p<0.05). Although two lesions had similar CT findings, the MRI features differed significantly (p<0.05). Twenty ossifying IPs demonstrated heterogeneously isointense with moderate gadolinium enhancement, and a convoluted "cerebriform" configuration. Seven ossifying polyps revealed low T1 and high T2 signal, with marginal enhancement, and one showed isointense with moderate enhancement. The ossification appeared as oval or striped bone-like high attenuation, which consisted of peripheral hyperattenuating cortical bone and central fat-like attenuation of the medullary cavity. The corresponding MRI findings of the ossifying regions were peripherally low signal and centrally high signal on both T1- and T2-weighted images. The occurrence of two key MRI features of cystic appearance and the "cerebriform" sign were significantly different between two entities (p<0.05). CONCLUSIONS: CT can better detect intralesional ossification, but MRI is the optimal imaging technique for discriminating between two disease entities.

Osteomalacia and Fanconi's syndrome caused by long-term low-dose adefovir dipivoxil.

WHAT IS KNOWN AND OBJECTIVE: Adefovir dipivoxil (ADV) is recommended for patients infected with lamivudine-refractory hepatitis B virus (HBV). We report a case of low-dose ADV-induced hypophosphatemic osteomalacia that initially presented as diffuse musculoskeletal pain. CASE SUMMARY: A 59-year-old Chinese man reported an 18-month history of severe chest wall pain and multiple bone pain during the previous 4 months with no antecedent trauma. There was no clinical evidence of an infectious, inflammatory or malignant process. Medical history showed that the patient had a history of chronic hepatitis B infection, and receiving lamivudine at a daily dose of 100 mg for 70 months. Lamivudine was changed to adefovir (10 mg/day) for the past 42 months. His serum inorganic phosphorus concentration was significantly low (0·4 mmol/l; 0·81-1·5 mmol/L), and the result of a urine routine test was abnormal. Combined with unbearable bone pain, spontaneous fractures, changes in laboratory markers and the result of ECT and other radiographic findings, the diagnosis of Fanconi's syndrome with osteomalacia was established. Dramatic clinical, laboratory and imaging improvement was observed after ADV discontinuation. WHATS IS NEW AND CONCLUSION: This case indicates that Fanconi's syndrome with osteomalacia can be acquired by a chronic hepatitis B patient taking ADV at a conventional dosage of 10 mg/day. Therefore, patients with HBV treated with long-term ADV should be regularly monitored for renal function, serum calcium and serum phosphate. Urine testing for ion concentration should also be undertaken.

Comparison of different primers for rapid detection of Vibrio parahaemolyticus using the polymerase chain reaction.

AIMS: The aim of this study was to compare different primers for rapid and effective detection of Vibrio parahaemolyticus by polymerase chain reaction (PCR). METHODS AND RESULTS: A total of four pairs of primers, three previously published and one based on a newly developed V. parahaemolyticus metalloprotease (vpm) gene, have been assayed for PCR detection of V. parahaemolyticus. They have been tested for specificity and sensitivity on a total of 101 strains including reference and environment isolates belonging to V. parahaemolyticus and other species in Vibrio. Of the four sets of primers tested, the one designed on the basis of the metalloprotease gene (675 bp) gave optimal results with bacterial strains examined as they only amplified the specific fragment in strains that had been genetically and biochemically assessed as V. parahaemolyticus and the limit of detection was 4 pg of purified target DNA. CONCLUSIONS: The primers designed on the metalloprotease gene gave optimal results for specific, sensitive and rapid detection of V. parahaemolyticus by PCR. SIGNIFICANCE AND IMPACT OF THE STUDY: PCR amplification with the optimal primer set VPM1/VPM2 could facilitate the rapid diagnosis and surveillance of potentially pathogenic strains of V. parahaemolyticus and reduce food-borne illness.