Clinical utility of urinary liver-type fatty acid binding protein measured by latex-enhanced turbidimetric immunoassay in chronic kidney disease.

BACKGROUND: Urinary liver-type fatty acid binding protein (L-FABP) measured by enzyme-linked immunosorbent assay method (ELISA) was approved as a clinical biomarker of tubular damage by the Japanese Ministry of Health, Labor and Welfare (MHLW) in 2011. We evaluated a new latex-enhanced immunoturbidimetric assay (LTIA) to evaluate the clinical utility of urinary L-FABP measured by LTIA versus an ELISA assay. METHODS: LTIA with anti-human L-FABP mouse monoclonal antibodies was performed using an automated clinical chemistry analyzer. Five positive samples with low, medium and high L-FABP concentrations were analyzed to determine the within-run precision. In patients with chronic kidney disease (CKD) (n=91), urinary L-FABP levels were measured by ELISA and LTIA. RESULTS: Measurement of urinary L-FABP revealed urinary L-FABP levels within 30 min. The within-run coefficient of variation was 10.0% for 1.4 ng/mL, 4.4% for 2.5 ng/mL, 3.2% for 9.8 ng/mL, 1.5% for 50.1 ng/mL, and 1.2% for 102.7 ng/mL. Concentrations of urinary L-FABP measured by LTIA were significantly correlated with those measured by ELISA (ρ=0.932). Proportional systematic error was almost within limits of agreement (LOA). Urinary L-FABP levels measured by LTIA were significantly correlated with urinary albumin (ρ=0.634), urinary NAG (ρ=0.688) and eGFR (ρ=-0.561). CONCLUSIONS: Measurement of urinary L-FABP by LITA was simple, speedy, and similar in quality to ELISA results. Therefore, this method was approved as external body diagnosing medicines by the Japanese MHLW in 2014. Urinary L-FABP is expected to be widely used in various pathophysiological conditions by measuring urinary L-FABP using LTIA.

[Successful treatment of locally advanced squamous cell carcinoma of the esophagus by combination chemotherapy with 5-fluorouracil plus nedaplatin following tracheal stent tube placement-a case report].

The patient was a 68-year-old man who complained of hoarseness and dyspnea. Upper gastrointestinal endoscopy revealed a type 3 tumor located in the middle thoracic esophagus at 30 cm from the incisor tooth that involved one-fourth of the circumference of the esophagus. Histopathological examination revealed moderately differentiated squamous cell carcinoma. Chest computed tomography( CT) revealed severe tracheal stenosis due to compression by a metastatic lymph node along the left recurrent laryngeal nerve. The patient was diagnosed as having cT4( 106recL-trachea), N2( 101L, 106recL, 106recR), M0, Stage IVa unresectable esophageal carcinoma. After insertion of a tracheal stent tube( spiral Z stent: diameter, 18 mm; length, 80 mm) to improve dyspnea, combination chemotherapy with 5-fluorouracil( 5-FU) plus nedaplatin was administered. Subsequent CT and endoscopy showed that the main tumor and the metastatic lymph node had significantly reduced in size and that complete response (CR) had been achieved. Thirty months after the initial treatment, the patient showed no sign of disease recurrence, after completion of 19 cycles of chemotherapy. The patient did not experience any severe adverse events. We report a case of a patient with locally advanced squamous cell carcinoma of the esophagus successfully treated with 5-FU/nedaplatin combination chemotherapy following tracheal stent tube placement.

Internal filtration in dialyzers with different membrane permeabilities.

Over the last decade, hemodialysis with enhanced internal filtration (IF) has been investigated as an alternative to conventional dialysis. Several factors affect IF, including the geometry and permeability of hollow-fiber dialyzers. Although various studies have been performed, the association between IF and membrane permeability has not been fully examined because of the difficulty in measuring IF. Therefore, in this study, we set up an experimental circuit and attempted to directly measure IF as well as membrane permeability in five dialyzers. In the circuit, we placed two dialyzers of the same type in series, and a special sampling port between them, thereby making it possible to determine IF by measuring the extent to which blood was concentrated between the two dialyzers. We showed that a significant amount of IF occurred in this tandem-dialyzer circuit, ranging from 23.5 to 100 ml/min, which increased linearly with increasing membrane permeability. We also showed that membrane permeability was reduced in the first dialyzer to a greater extent than in the second one after four hours of circulation, suggesting that filtration caused substantial membrane fouling. In this study we practically demonstrated that membrane permeability is highly relevant to the phenomenon of IF.

[A case of anastomotic recurrence of gastric cancer who underwent esophagojejunostomy, treated with S-1 monotherapy leading to complete response (CR)].

A 67-year-old male with an anastomotic recurrence of gastric cancer who underwent esophagojejunostomy, was treated with S-1 monotherapy leading to a complete response (CR). The patient was diagnosed with gastric cardia cancer and underwent a total gastrectomy with lymph node dissection. Two years and 2 months after surgery, the patient was administered S-1 100 mg/day (4-week administration and 2-week rest) because anastomotic recurrence was confirmed. The patient was unable to take anything by mouth, but this chemotherapy could be orally administered after one course. After six courses, tumor tissue completely disappeared and he had a CR. Administration of S-1 was continued for eight courses and then discontinued. There was no relapse for two years after discontinuation.