Myelin histology:a key tool in nervous system research

The myelin sheath is a lipoprotein-rich,multilayered structure capable of increasing conduction velocity in central and peripheral myelinated nerve fibers.Due to the complex structure and composition of myelin,various histological techniques have been developed over the centuries to evaluate myelin under normal,pathological or experimental conditions.Today,methods to assess myelin integrity or content are key tools in both clinical diagnosis and neuroscience research.In this review,we provide an updated summary of the composition and structure of the myelin sheath and discuss some histological procedures,from tissue fixation and processing techniques to the most used and practical myelin histological staining methods.Considering the lipoprotein nature of myelin,the main features and technical details of the different available methods that can be used to evaluate the lipid or protein components of myelin are described,as well as the precise ultrastructural techniques.

Retrospective analysis of discordant results between histology and other clinical diagnostic tests on helicobacter pylori infection

BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.

Comparative histology,transcriptome,and metabolite profi ling unravel the browning mechanisms of calli derived from ginkgo(Ginkgo biloba L.)

Gingko biloba accumulates high levels of secondary metabolites of pharmaceutical value.Ginkgo calli develop a typical browning that reduces its regenerative capacity and thus its usefulness.To elucidate the browning mechanism,histological,transcriptomic,and metabolic alterations were compared between green and browning calli derived from immature ginkgo embryos.Histological observations revealed that browning calli had a more loosely arranged cell structure and accumulated more tannins than in green calli.Integrated metabolic and transcriptomic analyses showed that phenylpropanoid metabolism was specifi-cally activated in the browning calli,and 428 diff erentially expressed genes and 63 diff erentially abundant metabolites,including 12 fl avonoid compounds,were identifi ed in the browning calli compared to the green calli.Moreover,the expression of fl avonol synthase(FLS)and UDP-glucuronosyl-transferase(UGT)genes involved in the fl avonoid pathway was more than tenfold higher in browning calli than in green calli,thus promoting biosynthesis of fl avonol,which serves as a substrate to form glycosylated fl avonoids.Flavonoid glycosides constituted the major coloring component of the browning calli and may act in response to multiple stress conditions to delay cell death caused by browning.Our results revealed the cellular and biochemical changes in browning callus cells that accompanied changes in expression of browning-related genes,providing a scientifi c basis for improving ginkgo tissue culturability.

The morphology and histology of a juvenile Sinokannemeyeria from the Middle Triassic Ermaying Formation of Shanxi, North China

Kannemeyeriiformes were dominated tetrapods in the Middle Triassic terrestrial faunae of China.Although abundant materials of Sinokannemeyeria have been collected, their postcranial morphology information is not well studied, especially the juveniles. This paper presents a description of an articulated Sinokannemeyeria skeleton from the Middle Triassic Ermaying Formation and reports the histological microstructure of its femur. This specimen represents a late-stage juvenile based on the histological information. For the first time, this specimen offers insights into the postcrania information of juvenile Sinokannemeyeria.

Online and Offline Integrated Teaching of Histology and Embryology Based on Concept of "Golden Course"

Taking construction of the online and offline integrated first-class undergraduate curriculum teaching modes of Histology and Embryology in Guangxi as an opportunity,under the guidance of student-centered teaching concept,efforts were made to innovate online and offline integrated teaching mode to overcome the shortcomings and dilemma of traditional Histology and Embryology teaching,with attention paid to the competence education in students including schematic knowledge,professional techniques,analytical thinking,and ideological and political theories,which would be of great significance for the cultivation of high-quality professionals specialized in traditional Chinese medicine.

Metastatic pattern in esophageal and gastric cancer:Influenced by site and histology

BACKGROUND Detailed information on metastatic patterns in of patients with esophageal and gastric cancer is limited.Early recognition of metastases is important to avoid futile locoregional treatments.Furthermore,knowledge on metastatic patterns is necessary for further development of personalized treatment modalities.AIM To gain insight into the metastatic pattern of gastroesophageal cancer.METHODS A nationwide retrospective autopsy study of 3876 patients with adenocarcinoma(AC)or squamous cell carcinoma(SCC)of the esophagus or stomach between 1990 and 2017 was performed.Only patient with metastases were included for analysis.The metastatic pattern was analyzed according to the primary tumor location and histological subtype.RESULTS Metastatic disease was found in 268 esophageal and 331 gastric cancer patients.In esophageal cancer,the most common metastatic locations were liver(56%),distant lymph nodes(53%)and lung(50%).Esophageal AC showed more frequently metastases to the peritoneum and bone compared with esophageal SCC.In gastric cancer,the most common metastatic locations were distant lymph nodes(56%),liver(53%)and peritoneum(51%).Intestinal-type AC of the stomach showed metastases to the liver more frequently,whereas metastases to the bone,female reproductive organs and colorectum were observed more frequently in diffuse-type gastric AC.CONCLUSION This study showed differences in metastatic patterns of patients with esophageal and gastric cancer according to the primary tumor location and histological subtype.

Serum adipokines might predict liver histology findings in non-alcoholic fatty liver disease

AIM: To assess significance of serum adipokines to determine the histological severity of non-alcoholic fatty liver disease.METHODS: Patients with persistent elevation in serum aminotransferase levels and well-defined characteristics of fatty liver at ultrasound were enrolled. Individuals with a history of alcohol consumption, hepatotoxic medication, viral hepatitis or known liver disease were excluded. Liver biopsy was performed to confirm nonalcoholic liver disease(NAFLD). The degrees of liver steatosis, lobular inflammation and fibrosis were determined based on the non-alcoholic fatty liver activity score(NAS) by a single expert pathologist. Patients with a NAS of five or higher were considered to have steatohepatitis. Those with a NAS of two or lower were defined as simple fatty liver. Binary logistic regression was used to determine the independent association of adipokines with histological findings. Receiver operating characteristic(ROC) analysis was employed to determine cut-off values of serum adipokines to discriminate the grades of liver steatosis,lobular inflammation and fibrosis. RESULTS: Fifty-four participants aged 37.02 ± 9.82 were enrolled in the study. Higher serum levels of visfatin, IL-8, TNF-α levels were associated independently with steatosis grade of more than 33% [β = 1.08(95%CI: 1.03-1.14), 1.04(95%CI: 1.008-1.07), 1.04(95%CI: 1.004-1.08), P < 0.05]. Elevated serum IL-6 and IL-8 levels were associated independently with advanced lobular inflammation [β = 1.4(95%CI: 1.09-1.8), 1.07(95%CI: 1.003-1.15), P < 0.05]. Similarly, higher TNF-α, resistin, and hepcidin levels were associated independently with advanced fibrosis stage [β = 1.06(95%CI: 1.002-1.12), 19.86(95%CI: 2.79-141.19), 560.72(95%CI: 5.98-5255.33), P < 0.05]. Serum IL-8 and TNF-α values were associated independently with the NAS score, considering a NAS score of 5 as the reference value [β = 1.05(95%CI: 1.01-1.1), 1.13(95%CI: 1.04-1.22), P < 0.05]. CONCLUSION: Certain adipokines may determine the severity of NAFLD histology accurately.

Ultrasound detection of abdominal lymphadenomegaly in subjects with hepatitis C virus infection and persistently normal transaminases:a predictive index of liver histology severity

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Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease

AIM: To study the effect of regular aerobic exercise on insulin resistance, serum aminotransferase and liver histology in nonalcoholic fatty liver disease (NAFLD) patients. METHODS: Sixty (mean age 40.0 ± 8.5 years, 75% male) NAFLD patients were included in the study. After baseline anthropometric measurement i.e., body mass index (BMI), waist circumference (WC); all patients were advised regular aerobic exercise for 30 min/d, for at least 5 d/wk and trained to achieve around 70% of his maximal heart rate. In addition, moderately energy restricted diet was advised to patients with high BMI (> 25 kg/m 2 ). Monthly follow up was done by measuring BMI, WC, aspartate aminotransferase, and alanine aminotransferase (ALT). Insulin resistance was calculated using homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) model, at baseline and after 6mo. Insulin resistance was arbitrarily considered altered when it was ≥ 2. Liver biopsy was done in a section of patients at baseline and after 6 mo. RESULTS: Seventy percent (42/60) patients were overweight or obese; 95% (57/60) had central obesity (WC > 90 cm in men, > 80 cm in women). In the 45 exercise compliant patients insulin resistance decreased from 6.4 ± 6.1 to 1.3 ± 1.0, BMI from 26.7 ± 3.3 kg/m 2 to 25.0 ± 3.3 kg/m 2 , WC from 95.7 ± 8.9 cm to 90.8 ± 7.3 cm and ALT from 84.8 ± 43.5 U/L to 41.3 ± 18.2 U/L (P < 0.01). In 15 exercise noncompliant patient's insulin resistance, BMI, WC and ALT did not show significant change at 6 mo follow up. Six of 8 patients in compliant group on repeat liver biopsy showed significant change in steatosis and necroinflammation. Nonalcoholic steatohepatitis scores improved form 5.3 ± 1.5 to 3.35 ± 1.5. The decline in insulin resistance correlated with decline in ALT (P = 0.01, r s = 0.90) and liver histology (P = 0.03, r s = 0.73). CONCLUSION: Life style modification improves insulin resistance resulting in improvement in ALT and liver histology in NAFLD patients.

Pediatric nonalcoholic fatty liver disease:Overview with emphasis on histology

Nonalcoholic fatty liver disease(NAFLD) is a disease in which excessive fat accumulates in the liver of a patient without a history of alcohol abuse.This disease includes simple steatosis and nonalcoholic steatohepatitis(NASH).NAFLD/NASH is recognized as a hepatic manifestation of metabolic syndrome.In recent years,pediatric NAFLD has increased in line with the increased prevalence of pediatric obesity.The estimated prevalence of pediatric NAFLD is 2.6%-9.6%,and it is associated with sex,age,and ethnicity.With regard to the pathogenesis of NAFLD,the "two-hit" hypothesis is widely accepted and oxidative stress is thought to play an important role in the second hit.Although clinical symptoms,laboratory data,and imaging findings are important,liver biopsy is regarded as the gold standard for the diagnosis of NAFLD/NASH.In addition,liver biopsy is essential for assessing the degree of necro-inflammatory change and fibrosis in NASH.Two different types of steatohepatitis(type 1 and type 2 NASH) have been reported,with type 2 NASH being present in as many as 51% of pediatric NAFLD patients.However,we and others have observed that type 1 and 2 patterns commonly overlap.Although pharmacotherapy has been studied in clinical trials,lifestyle modification by diet and exercise remains the mainstay of treatment for NAFLD/NASH.

Normal liver stiffness: a study in living donors with normal liver histology

AIM: To define the normal range of liver stiffness(LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology. METHODS: LS was measured using Fibroscan in 50(16 women, 34 men) healthy potential donors(mean age 28.4 ± 5.9 years) who were being evaluated for liver donation for their relatives at the National Liver Institute, Menoufeya University, Egypt. All potential donors had normal liver tests and were negative for hepatitis B or C virus infection. Abdominal ultrasounds showed normal findings. None of the subjects had diabetes, hypertension, renal impairment, heart disease, or body mass index > 30 kg/m2. All subjects had normal liver histology upon liver biopsy. They all donated the right lobe of their liver with successful outcomes.RESULTS: The mean LS was 4.3 ± 1.2 k Pa(range: 1.8-7.1 k Pa). The 5th and 95 th percentiles of normal LS were 2.6 k Pa and 6.8 k Pa, respectively, with a median of 4 k Pa; the interquartile range was 0.6 ± 0.4. LS measurements were not significantly different between men and women(4.4 ± 1.1 k Pa vs 3.9 ± 1.3 k Pa) and did not correlate with age. However, stiffness values were significantly lower in subjects with a body mass index < 26 kg/m2 compared to those with an index ≥ 26 kg/m2(4.0 ± 1.1 k Pa vs 4.6 ± 1.2 k Pa; P <0.05). There were no differences in hospital stay or postoperative bilirubin, albumin,alanine and aspartate transaminases, or creatinine levels(at discharge) between donors with livers stiffness ≤ 4 k Pa and those with stiffness > 4 k Pa. CONCLUSION: Healthy donors with normal liver histology have a median LS of 4 k Pa. Stiffness values are elevated relative to increase in body mass index.

Sex-based differences in histology,staging,and prognosis among 2983 gastric cancer surgery patients

BACKGROUND Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer(GC).AIM To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC.METHODS A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included.Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.RESULTS Among the 2983 patients, 2005(67.2%) and 978(32.8%) were males and females, respectively.The average age of the female group(59.36 years) was significantly younger than that of the male group(61.66 years;P < 0.001).Cancer of the gastric body(P < 0.001) and diffuse-type histology(P < 0.001) were more common in females than in males.This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group.Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age.The overall survival rate was significantly higher in females(P < 0.001).However, this difference disappeared for GC-specific survival(P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer(stage Ⅲ or above) in females(P = 0.045).The risk factors for GC-related mortality were older age, upper location of GC, and diffuse-or mixed-type histology.In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females.CONCLUSION Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.

Real-time histology with the endocytoscope

Endoscopic Imaging has progressed tremendously over the last few decades. Novel imaging technologies such as high-resolution and high-magnification white light endoscopy, narrow band imaging, optimal band imaging, auto? ourescence imaging and optical coherence tomography not only aid the endoscopist in detecting malignant or pre-malignant lesions but also assist in predicting histology. Recently, the introduction of Endocytoscopy (EC) and Confocal Endomicroscopy has taken us into a new realm of diagnostic endoscopy. With the ability to magnify up to 1000 ×, cellular structures can be visualized in real-time. This advance in technology could potentially lead to a paradigm shift negating the need to obtain biopsies. EC is, however, still in the early stages of development and further research needs to be carried out before it can be accepted as standard practice. This review will focus on the diagnostic utility of the Endocytoscope.

Histology and Ultrastructure of Incompatible Combination Between Puccinia striiformis and Wheat Cultivars with Low Reaction Type Resistance

The incompatible combinations between races of Puccinia striiformis and wheat cultivars with low reaction type resistance were examined by means of fluorescent microscopy, differential interference contrast microscopy and electron microscopy. The incompatible combinations consisted of wheat cultivar Niuzhute plus CY28, Hybrid46 plus CY29 and Tianxuan882 plus CY29, while the compatible combination was wheat cultivar Huixianhong plus CY28. The observation revealed a striking difference in the fungal development and the host responses between susceptible and resistant wheat cultivars following infection by the pathogen. The main histological manifestation of the pathogen development in the resistant wheat cultivars include inhibition of hyphal growth, delay of hyphal branching and colony formation, decrease of formation of haustorial mother cells and haustoria, and occurrence of host cell necrosis. The observation by electron microscopy demonstrated that a series of abnormal changes occurred in intercellular hyphae, haustorial mother cells and haustoria during pathogen development in the resistant wheat cultivars. The cytoplasm became more electron-dense and vacuoles in the cytoplasm increased in number and size. The cell walls of hyphae, haustorial mother cells were thickened irregularly. The organelles were disorderly distributed in the cytoplasm and the haustorial mother cells and haustoria lost their physiological function. In the final stage of the pathogen development, the intercellular hyphae, haustorial mother cells and haustoria became necrotic and collapsed. The structural defense reactions such as formation of cell wall apposition, collar and encasement of haustorium were essentially more pronounced in the infected wheat leaves of the resistant cultivars than in the susceptible one. In addition, the relationship between the host resistance expression and the histological and cytological features occurred in the incompatible combination was discussed in this paper.

From histology to micro-CT:Measuring and modeling resorption cavities and their relation to bone competence

The process of bone remodelling plays an essential role in the emergence and maintenance of bone geometry and its internal structure.Osteoclasts are one of the three main bone cell types that play a crucial role in the bone remodelling cycle.At the microstructural level,osteoclasts create bone deficits by eroding resorption cavities.Understanding how these cavities impair the mechanical quality of the bone is not only relevant in quantifying the impact of resorption cavities in healthy bone and normal aging,but maybe even more so in quantifying their role in metabolic bone diseases.Meta-bolic bone diseases and their treatment are both known to affect the bone remodelling cycle;hence,the bone mechanical competence can and will be affected.How-ever,the current knowledge of the precise dimensions of these cavities and their effect on bone competence is rather limited.This is not surprising considering the difficulties in deriving three-dimensional(3D)properties from two-dimensional(2D)histological sections.The measurement difficulties are reflected in the evalua-tion of how resorption cavities affect bone competence.Although detailed 3D models are generally being used to quantify the mechanical impact of the cavities,the representation of the cavities themselves has basicallybeen limited to simplified shapes and averaged cavityproperties.Qualitatively,these models indicate that cav-ity size and location are important,and that the effectof cavities is larger than can be expected from simplebone loss.In summary,the dimensions of osteoclastresorption cavities were until recently estimated from2D measures;hence,a careful interpretation of resorp-tion cavity dimensions is necessary.More effort needsto go into correctly quantifying resorption cavities usingmodern 3D imaging techniques like micro-computedtomography(micro-CT)and synchrotron radiation CT.Osteoclast resorption cavities affect bone competence.The structure-function relationships have been ana-lysed using computational models that,on one hand,provide rather detailed information on trabecular bonestructure,but on the other incorporate rather crudeassumptions on cavity dimensions.The use of high-resolution representations and parametric descriptionscould be potential routes to improve the quantitativefidelity of these models.

Morphology and Histology of Lattice-like Ossified Epaxial Tendons in Psittacosaurus(Dinosauria:Ceratopsia)

Epaxial tendons play an important role in the study of the musculoskeletal system and locomotory style of dinosaurs. Although the ossified epaxial tendon lattice is fairly well known in Iguanodontoidea, only recently has knowledge of this complex been extended to ceratopsians. This study concerns the gross morphology and microstructure of the tendon lattice in Psittacosaurus, a basal ceratopsian. As in the neoceratopsian Chasmosaurus, the ossified tendons of Psittacosaurus form a three -layered, lattice-like structure. The microstructure of the tendons in large psittacosaur individuals retains an early stage of ossification, as in juvenile birds and nestling hadrosaurs, suggesting a slow developmental rate of ossification of the tendons in psittacosaur ontogeny. Comparative study indicates that a lattice-like arrangement of three-layered epaxial tendons is widely distributed in Cerapoda. This pattern also extends to Ankylosauria, implying a similar pattern of the epaxial muscles through the ornithischian clade. In addition, comparison with crocodiles implies that the different morphology of ossified tendons in dinosaurs may be associated with adaptive aspects of their paleobiology, not simply a side effect of skeletal ossification. In contrast to the short tendons in quadrupedal Chasmosaurus and Protoceratops, the elongated tendons in Psittacosaurus may be related to the bipedal locomotion characteristic of this taxon.

Effect of Chitosan Supplemented Diet on Survival, Growth, Feed Utilization, Body Composition &Histology of Sea Bass (Dicentrarchus labrax)

The effect of chitosan incorporated into feed formulation on the growth, feed utilization, body composition and histological response of sea bass (Dicentrarchus labrax) was investigated. Final fish weight, feed conversion ratio (FCR), specific growth rate (SGR), protein efficiency ratio (PER), protein productive value (PPV), and energy utilization (EU) of sea bass feed chitosan supplemented diet and the control diet were determined at the end of experiment. Data presents mean ± SD from triplicate determination (n = 3) for 75 days feeding trial. Different concentrations (0.5, 1.0, 2.0, 3.0 & 4.0) and control without chitosan incorporated with total fish feed in the form of dry diets were fed for 75 days. Average final weight (FW) was significantly higher at diet 3 (1 g?kg?1 chitosan) and the lowest in control fish group, specific growth rate (SGR) was significant at diet 3. Also, protein efficiency ratio (PER), protein productive value (PPV), and energy utilization (EU) showed the same trend. The chemical body composition, crude protein, dry matter, crude fat and ash were significant (P ≤ 0.01) different compared to control groups. The present investigation suggested that the chitosan incorporated into diets of sea bass fish certainly enhanced the non specific responses and reduced mortality and also improved the growth performance of fish.

The Effect of Gankang Suppository on Duck Hepatitis B Virus, Serum Biochemistry and Liver Histology in Ducklings

To examine the effect of Gankang Suppository on duck hepatitis B virus （DHBV）, the serum biochemistry and hepatic histology in an animal model of DHBV infection, a model of DHBV infection was established by infecting 1-day-old Yingtaogu ducklings with DHBV-positive serum. The successful model was confirmed by PCR assay and 48 ducklings infected with DHBV were randomly divided into 3 groups： a Gankang Suppository treatment group, an acyclovir （ACV） group and a DHBV model group （control）, with each group having 16 animals. All the animals were given the medicines for 4 weeks in a row. The serum of the animals was taken 14 and 28 days after the medica- tion and 7 days after drug discontinuation. Real-time PCR was performed to detect the copy numbers of DHBV DNA in the serum. ALT and AST were dynamically monitored. The ducklings were sacrificed on the 7th day after the discontinuation of the treatment and livers were harvested and examined for inflammation and degeneration of liver cells by using HE staining. The results showed that on day 14, 28 after the treatment and day 7 after the withdrawal, the logarithmic values （log） of DHBV DNA copy numbers in ducklings of Gankang Suppository treatment group were significantly lower than that before the treatment （P=0.0092, P=0.0070, P=0.0080, respectively）. Compared with DHBV model control group, the ALT level was significantly decreased （P=0.0020, P=0.0019, respectively） on day 28 after the treatment and on day 7 after the withdrawal. The AST level was also reduced on day 14 after the treatment （P=0.0298）. Compared with the ACV control group, the level of ALT was lower on day 7 after the withdrawal （P=0.0016）. Histologically, the hepatocyte swelling, vacuolous degeneration and acidophilic degeneration in Gankang Suppository treatment group were alleviated 7 days after the withdrawal as compared with model control group （P=0.0282, P=0.0084, P=0.0195, respectively）. It is concluded that Gankang Suppository can effectively suppress DHBV replication, reduce the levels of serum ALT and AST and improve hepatic histology.

A Study of Prevalence of Diabetes and Prediabetes in Patients of Non-Alcoholic Fatty Liver Disease and the Impact of Diabetes on Liver Histology in Coastal Eastern India

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic. The aim of the study was to determine the prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to compare anthropometry, biochemical and metabolic parameters and hepatic histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods: 515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100 healthy controls were subjected to detailed anthropometric measurements and biochemical assays including blood sugars, LFT, lipid profile and HOMA. Diabetes and prediabetes were defined according to WHO criteria. Patients were categorized and compared according to the presence or absence of diabetes. Liver biopsy was performed in 240 NAFLD patients and the liver histology was also compared between the two groups. Statistical analysis was performed on SPSS 16. Results: 124 out of the 515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-diabetics, while only 3 out of 100 controls had impaired glucose tolerance. Diabetic patients were older. NAFLD patients with diabetes had significantly higher waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ± 10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p < 0.001] were significantly higher in NAFLD-diabetes group. Hypertension [35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients. Histopathology in the diabetic patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in non-diabetic patients. IR alone had a linear correlation with necroinflammatory activity. Conclusion: The prevalence of diabetes and prediabetes is six times more in NAFLD patients than in healthy controls. NAFLD patients with diabetes have higher metabolic risk factors such as large waistline, hypertension, high triglyceride levels and increased insulin resistance. Diabetes or pre diabetes patients per se do not have histologically severe disease, rather insulin resistance play an important role in increasing the severity of the disease.

Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing

BACKGROUND Endoscopic ultrasound-guided fine needle biopsy(EUS-FNB)has emerged as a safe,efficacious alternative to fine needle aspiration(FNA)for tissue acquisition.EUS-FNB is reported to have higher diagnostic yield while preserving specimen tissue architecture.However,data on the optimal method of EUS-FNB specimen processing is limited.AIM To evaluate EUS-FNB with specimen processing as histology vs EUS-FNA cytology with regards to diagnostic yield and specimen adequacy.METHODS All EUS-FNA and EUS-FNB performed at our institution from July 1,2016,to January 31,2018,were retrospectively analyzed.We collected data on demographics,EUS findings,pathology,clinical outcomes,and procedural complications in two periods,July 2016 through March 2017,and April 2017 through January 2018,with predominant use of FNB in the second data collection time period.FNA specimens were processed as cytology with cell block technique and reviewed by a cytopathologist;FNB specimens were fixed in formalin,processed for histopathologic analysis and immunohistochemical staining,and reviewed by an anatomic pathologist.Final diagnosis was based on surgical pathology when available,repeat biopsy or imaging,and length of clinical follow up.RESULTS One hundred six EUS-FNA and EUS-FNB procedures were performed.FNA alone was performed in 17 patients;in 56 patients,FNB alone was done;and in 33 patients,both FNA and FNB were performed.For all indications,diagnostic yield was 47.1%(8/17)in FNA alone cases,85.7%(48/56)in FNB alone cases,and 84.8%(28/33)in cases where both FNA and FNB were performed(P=0.0039).Specimens were adequate for pathologic evaluation in 52.9%(9/17)of FNA alone cases,in 89.3%(50/56)of FNB alone cases,and 84.8%(28/33)in cases where FNA with FNB were performed(P=0.0049).Tissue could not be aspirated for cytology in 10.0%(5/50)of cases where FNA was done,while in 3.4%(3/89)of FNB cases,tissue could not be obtained for histology.In patients who underwent FNA with FNB,there was a statistically significant difference in both specimen adequacy(P=0.0455)and diagnostic yield(P=0.0455)between the FNA and FNB specimens(processed correspondingly as cytology or histology).CONCLUSION EUS-FNB has a higher diagnostic yield and specimen adequacy than EUS-FNA.In our experience,specimen processing as histology may have contributed to the overall increased diagnostic yield of EUS-FNB.