Serum IgG4 level for malignancy prediction in indeterminate thyroid nodules among patients with or without autoimmune thyroid disease.

The incidence of thyroid nodules (TNs) has increased nowadays, and it is critical to properly differentiate between malignant and benign nodules to prevent unneeded thyroidectomy as well as complications related to surgery. IgG4 significantly contributes to various cancer-associated processes. The present study aimed to assess the value of serum IgG4 level in predicting malignancies in indeterminate thyroid nodules (ITN) among patients with and without autoimmune thyroid disease (AITD). A total of 67 patients with indeterminate cytology thyroid nodules (Bethesda III and IV, according to Bethesda system for reporting thyroid cytopathology) were selected. Preoperative serum thyroid profile, IgG4, anti-thyroglobulin (TG) and anti-thyroid peroxidase (TPO) antibody levels were determined. After total thyroidectomy, patients were categorized based on the postoperative histopathology outcome into two groups. Group (I): confirmed benign nodules (n=55) and Group (II): confirmed malignant TNs (n=12). IgG4 levels were significantly elevated among malignant TNs patients than in benign TNs patients, with a median (IQR) of 194.5 mg/dl (183 - 214) vs. 91 mg/dl (60 - 113), respectively (P=0.001). The cut-off value for differentiation between malignant and benign TNs was >180 mg/dl with a sensitivity of 75% and specificity of 100%. There was a significant positive correlation between thyroid antibodies and IgG4 levels (P=0.001). AITD patients had significantly higher level of IgG4 compared with those without AITD 189 mg/dl (153 - 208) vs 89 mg/dl (58 - 112), respectively (P =0.001). Eighty percent (12/15) of patients with AITD had malignant TNs with IgG4 >180 mg/dl, while 20% (3/15) of patients with benign TNs showed IgG4 levels < 180 mg/dl. In conclusion, IgG4 level can be proposed as a predictor of malignant TNs.

Urinary neutrophil gelatinase-associated lipocalin in type 2 diabetes: Relation to nephropathy and retinopathy.

BACKGROUND: Diabetes mellitus is the leading cause of end stage renal disease worldwide. Early identification of diabetic nephropathy even before appearance of microalbuminuria is a challenge for early prevention of occurrence and progression of this complication. Neutrophil gelatinase-associated lipocalin is a small protein that belongs to the lipocalin protein. Urinary neutrophil gelatinase-associated lipocalin is a promising early marker in different renal problems. AIM OF THE WORK: To measure urinary neutrophil gelatinase-associated lipocalin in type 2 diabetic patients and to assess its role as an early marker for diagnosis of diabetic nephropathy and diabetic retinopathy. PATIENT AND METHODS: The current study included 60 subjects with type 2 diabetes and 20 healthy control subjects. Diabetic subjects were divided into 3 groups according to urinary albumin creatinine ratio; 20 normoalbuminuric patients, 20 micro-albuminuric patients and 20 macroalbuminuric patients. They were subjected to history taking, full clinical examination, fundus examination, anthropometric measurement, urinary neutrophil gelatinase-associated lipocalin and urinary albumin creatinine ratio. RESULTS: Urinary neutrophil gelatinase-associated lipocalin was higher in all diabetic groups than in the control group, with no difference in between diabetic groups. The difference was of great value when comparing normoalbuminuric group with control as albumin creatinine ratio was not different while the urinary neutrophil gelatinase-associated lipocalin was statistically significant (5.94 ±â€¯1.85 ng/dl vs 1.96 ±â€¯0.65, p < 0.001). No correlation was found with retinopathy. CONCLUSION: Urinary neutrophil gelatinase-associated lipocalin is a sensitive marker for early detection of diabetic nephropathy even in normoalbuminuric patients denoting early tubular damage before microalbuminuria. It is not correlated with retinopathy.

Short-Term Impact of Laparoscopic Sleeve Gastrectomy on Serum Cartonectin and Vaspin Levels in Obese Subjects.

BACKGROUND: Cartonectin is a potent anti-inflammatory adipokine that might be implicated in metabolism and energy storage. Our objective was to evaluate the influence of weight reduction following laparoscopic sleeve gastrectomy (LSG) on serum cartonectin and vaspin levels. SUBJECTS AND METHODS: Thirty-two individuals (29 female and 3 male) with morbid obesity underwent LSG. Anthropometric indices, lipid profile, fasting serum concentrations of glucose, insulin, vaspin, and cartonectin were measured prior and 3 months after LSG. Insulin sensitivity was determined using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Following LSG, circulating cartonectin level increased significantly while serum vaspin was significantly decreased. The percentage change of serum cartonectin level correlated negatively with the percentage changes in body mass index, waist circumference, and waist-hip ratio and positively with percentage changes in LDL-C, triglycerides, and HOMA-IR after adjustment for age and sex. Moreover, the changes in vaspin concentration positively correlated with the changes in insulin level and HOMA-IR after adjustment for age and sex. In a multiple stepwise linear regression model, the changes in waist circumference explained 13% variability of changes in cartonectin level while the changes in HOMA-IR and LDL-C were responsible for 31% of the variability in changes of vaspin level. CONCLUSION: LSG-induced weight loss rapidly increases serum cartonectin level and decreases the serum vaspin level in morbidly obese subjects. The changes in cartonictin level seem to be influenced by the changes of waist circumference while the changes of HOMA-IR and LDL-C might be determinant factors of the changes in vaspin level.