Sulforaphane-rich broccoli sprout extract improves hepatic abnormalities in male subjects

AIM: To evaluate effects of dietary supplementation of sulforaphane(SF)-rich broccoli sprout(BS) extract on hepatic abnormalities in Japanese male participants.METHODS: In a randomized,placebo-controlled,double blind trial,male participants with fatty liver received either BS capsules containing glucoraphanin [GR; a precursor of SF(n = 24)] or placebo(n = 28) for 2 mo. Liver function markers,serum levels of aspartate and alanine aminotransferases(AST and ALT,respectively) and γ-glutamyl transpeptidase(γ-GTP) and an oxidative stress marker,urinary levels of 8-hydroxydeoxyguanosine(8-OHd G),were measured and compared in participants before and after the trial period. In an animal model,chronic liver failure was induced in Sprague-Dawley rats by successive intraperitoneal injection with N-nitrosodimethylamine(NDMA) for 4 wk. Concomitantly,rats received AIN-76 diets supplemented with or without BS extract. Thereafter,rats were sacrificed,and their sera and livers were collected to measure serum liver function markers and hepatic levels of thiobarbituric acid reactive substances(TBARS) levels and hepatic glutathione S-transferase(GST) activity,a prototypical phase 2 antioxidant enzyme.RESULTS: Dietary supplementation with BS extract containing SF precursor GR for 2 mo significantly decreased serum levels of liver function markers,ALT [median(interquartile range),before: 54.0(34.5-79.0) vs after supplementation: 48.5(33.3-65.3) IU/L,P < 0.05] and γ-GTP [before: 51.5(40.8-91.3) vs after: 50.0(37.8-85.3) IU/L,P < 0.05],as well as the alkali phosphatase activity. Placebo showed no significant effects on the markers. The urinary level of 8-OHd G,an established oxidative stress marker,was significantly reduced in participants who had received BS capsules but not the placebo [before: 6.66(5.51-9.03) vs after: 5.49(4.89-6.66) ng/mg-creatinine,P < 0.05]. The reduction of urinary 8-OHd G was significantly correlated with decreased levels of both ALT and γ-GTP [?8-OHd G and ?ALT: Spearman r(r) 0.514 and P = 0.012,?8-OHd G and ?γ-GTP: r = 0.496 and P = 0.016]. Intake of BS extract prevented NDMA-induced chronic liver failure in rats,which was attributable to the suppression of the increase in TBARS through induction of hepatic phase 2 antioxidant enzymes including hepatic GST(86.6 ± 95.2 vs 107.8 ± 7.7 IU/g,P < 0.01).CONCLUSION: Dietary supplementation with BS extract containing the SF precursor GR is likely to be highly effective in improving liver function through reduction of oxidative stress.

Malignant peritoneal mesothelioma presenting umbilical hernia and Sister Mary Joseph's nodule

Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph's nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical her-nia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.

Relationship between response to lusutrombopag and splenic volume

AIM To assess the correlation between the efficacy of lusutrom-bopag and clinical characteristics in patients with chronic liver disease.METHODS In this retrospective, multicenter study, which conducted at four locations in Japan, 50 thrombocytopenic patients with chronic liver disease were enrolled. All patients received oral lusutrombopag(3.0 mg/d for 7 d) for chronic liver disease. We assessed the increase in platelet count after the trial drug administration. A treatment response was defined as a platelet count ≥ 5 × 104/μL and an increased platelet count ≥ 2 × 104/μL from baseline after drug administration. We evaluated the response to lusutrombopag compared to baseline clinical characteristics in patients with chronic liver disease.RESULTS The numbers of responders and non-responders were 40(80.0%) and 10(20.0%), respectively. The patients were divided into a responder and non-responder group, and we added factors that may correspond to successful treatment with lusutrombopag. Splenic volume and body weight were lower in the responder group than in the nonresponder group. White blood cell count and hemoglobin level were higher in responders compared with nonresponders. Using a logistic regression model to assess the relationship between response to lusutrombopag and clinical characteristics, multivariate analysis confirmed that splenic volume was an independent factor that predicted the response of platelet counts(P = 0.025; odds ratio = 11.2; 95% confidence interval: 1.354-103.0). Splenic volume negatively correlated to changes in platelet count(r =-0.524, P = 0.001).CONCLUSION Splenic volume influences the change in platelet counts after administration of lusutrombopag in patients with chronic liver disease.

Intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine:A case report

BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.