Metabolic aspects of adult patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is a major cause of chronic liver disease and it encompasses a spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved in the occurrence of NAFLD and its progression are probably due to a metabolic profile expressed within the context of a genetic predisposition and is associated with a higher energy intake. The metabolic syndrome(MS) is a cluster of metabolic alterations associated with an increased risk for the development of cardiovascular diseases and diabetes. NAFLD patients have more than one feature of the MS, and now they are considered the hepatic components of the MS. Several scientific advances in understanding the association between NAFLD and MS have identified insulin resistance(IR) as the key aspect in the pathophysiology of both diseases. In the multi parallel hits theory of NAFLD pathogenesis, IR was described to be central in the predisposition of hepatocytes to be susceptible to other multiple pathogenetic factors. The recent knowledge gained from these advances can be applied clinically in the prevention and management of NAFLD and its associated metabolic changes. The present review analyses the current literature and highlights the new evidence on the metabolic aspects in the adult patients with NAFLD.

IS There A Role of 18F-FDG PET/CT for Initial Staging of Rectal Cancer？

Background： The management of the rectal cancer requires accurate initial staging. Besides routinely performed conventional imaging, during the last decade 18F-FDG PET/CT became a popular whole-body metabolic imaging for preoperative TNM classification. The purpose of the study was to evaluate the role of 18F-FDG PET/CT in the rectal cancer staging. Patients and methods： 45 patients with rectal cancer who preoperatively underwent 18F-FDG PET/CT imaging in the period from 2011 to 2014 were analyzed. All patients were referred to the surgery afterwards. Histopathologic findings were used as a standard of reference. Descriptive techniques were used for frequency analyses and sensitivity calculations. The X2 test was used for significance calculation of the contingency tables while Monte Carlo simulation and Fisher＇s exact test were used for the table fields where number of cases was smaller than demanded. Results： The average SUVmax value of the primary tumor for all T stages was 26.02 gm/mL. The average SUVmax values of the lymph nodes in N1 stage and N2 stage were 6.04 gm/mL and 6.33 gm/mL, respectively. PET/CT detected benign lesions in 17 （28.3%） patients with average SUVmax of 15.4 mg/mL. The vaginal wall infiltration was detected in 2 （4.4%） patients. Penetration of mesorectal fascia was detected in 21 （46.7%） of patients. Four patients （8.9%） had liver metastases identified by lSF-FDG PET/CT. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in T staging was 90.7%, 91.9%, and 90.5%, respectively. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in detection of metastatic lymph node was 85.8%, 89.8%, and 89%, respectively. PET/CT shows low sensitivity （77.3%） and specificity （25%） in analyzing mesorectal fascia involvement. The overall sensitivity of 18F-FDG PET/CT in M staging was 100%. Conclusions： 18F-FDG PET/CT is highly sensitive for initial T staging of rectal cancer especially in advanced disease. This imaging modality is highly accurate in detection of metastatic lymph nodes and liver metastases, but it has no role in defining ofmesorectal fascia involvement. Therefore, 18F-FDG PET/CT should be incorporated routinely in preoperative staging together with conventional imaging.

Bile acid signaling through farnesoid X and TGR5 receptors in hepatobiliary and intestinal diseases

BACKGROUND： The well-known functions of bile acids（BAs） are the emulsification and absorption of lipophilic xenobiotics. However, the emerging evidences in the past decade showed that BAs act as signaling molecules that not only autoregulate their own metabolism and enterohepatic recirculation, but also as important regulators of integrative metabolism by activating nuclear and membrane-bound G protein-coupled receptors. The present review was to get insight into the role of maintenance of BA homeostasis and BA signaling pathways in development and management of hepatobiliary and intestinal diseases.DATA SOURCES： Detailed and comprehensive search of PubM ed and Scopus databases was carried out for original and review articles.RESULTS： Disturbances in BA homeostasis contribute to the development of several hepatobiliary and intestinal disorders, such as non-alcoholic fatty liver disease, liver cirrhosis, cholesterol gallstone disease, intestinal diseases and both hepatocellular and colorectal carcinoma.CONCLUSION： Further efforts made in order to advance the understanding of sophisticated BA signaling network may be promising in developing novel therapeutic strategies related not only to hepatobiliary and gastrointestinal but also systemic diseases.