Clinical and Experimental Evaluation of Diagnostic Significance of Alpha-Fetoprotein and Osteopontin at the Early Stage of Hepatocellular Cancer

Immuno-Kachiks formula immunomodulates and ameliorates hepatic damage induced by monosodium glutamate in rats

The immune system plays a vital role in controlling liver fibrosis and enhancing the pathogenesis of liver inflammation. Monosodium glutamate is a common flavor-enhancement food additive. This study evaluated the immunomodulatory and hepato-curative effects of the Immuno-Kachiks polyherbal formulation against monosodium glutamate-induced immune suppression and hepatic damage in rats. Monosodium glutamate was given orally at a 2000 mg/kg dose to male Wistar rats for three months to induce liver damage and immune suppression. After three months of successful induction, three groups were separately administered orally with Immuno-Kachiks formula at 400, 800, and 1500 mg/kg/day for 28 days. At the end of the treatment period, liver and blood samples were collected for histological and biochemical analysis. The lymphocyte count remained significantly low while the neutrophil count and the neutrophil-to-lymphocyte ratio increased significantly, despite the cessation of monosodium glutamate ingestion for 28 days. The Immuno-Kachiks formula (IKF) significantly increased the lymphocyte count, reduced the neutrophil-to-lymphocyte ratio, and normalized the neutrophil count. Neither monosodium glutamate nor the IKF significantly caused alpha-fetoprotein levels to rise or fall below normal. High doses (800 and 1500 mg/kg) of the Immuno-Kachiks formula significantly raised serum levels of aspartate aminotransferase, alkaline phosphatase, and total bilirubin. 1500 mg/kg of the IKF caused mild liver inflammation. The IKF restored the liver morphologic alterations observed in monosodium glutamate-induced liver damage in rats. The results suggest that the Immuno-Kachiks herbal formulation is a potential curative agent for early-stage liver damage and could restore suppressed adaptive immunity.

Review of Statistical and Methodological Issues in the Forensic Prediction of Malingering from Validity Tests: Part I: Statistical Issues

Forensic neuropsychological examinations with determination of malingering have tremendous social, legal, and economic consequences. Thousands of studies have been published aimed at developing and validating methods to diagnose malingering in forensic settings, based largely on approximately 50 validity tests, including embedded and stand-alone performance validity tests. This is the first part of a two-part review. Part I explores three statistical issues related to the validation of validity tests as predictors of malingering, including (a) the need to report a complete set of classification accuracy statistics, (b) how to detect and handle collinearity among validity tests, and (c) how to assess the classification accuracy of algorithms for aggregating information from multiple validity tests. In the Part II companion paper, three closely related research methodological issues will be examined. Statistical issues are explored through conceptual analysis, statistical simulations, and through reanalysis of findings from prior validation studies. Findings suggest extant neuropsychological validity tests are collinear and contribute redundant information to the prediction of malingering among forensic examinees. Findings further suggest that existing diagnostic algorithms may miss diagnostic accuracy targets under most realistic conditions. The review makes several recommendations to address these concerns, including (a) reporting of full confusion table statistics with 95% confidence intervals in diagnostic trials, (b) the use of logistic regression, and (c) adoption of the consensus model on the "transparent reporting of multivariate prediction models for individual prognosis or diagnosis" (TRIPOD) in the malingering literature.

The Value of MRI Combined with AFP, AFP-L3, GP73, and DCP in the Diagnosis of Early Primary Liver Cancer

Objective

To investigate the diagnostic value of magnetic resonance imaging (MRI) combined with serum alpha-fetoprotein (AFP), alpha-fetoprotein (AFP-L3), Golgi protein 73 (GP73), and des-γ-carboxyprothrombin (DCP) on early-stage primary liver cancer (PHC).

Methods

A total of 122 patients who were treated in our hospital from January 2019 to May 2022 were included in this study, including 62 patients with early PHC (referred to as the observation group) and 60 patients with benign liver disease (referred to as the control group). MRI scans were performed on all participants, and MRI image features were compared. Subsequently, the differences in serum AFP, AFP-L3, GP73, and DCP concentrations of the two groups of patients were detected and compared. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of MRI and each of the above tumor markers in diagnosing early PHC.

Results

The proportion of low or slightly low signal on T1WI in the observation group was significantly greater than that in the control group, while the proportions of equisignal and high signal were lower than those in the control group. The proportion of high signal on T2WI and high signal on DWI in the observation group was higher than that in the control group, while the proportion of low or slightly low signal and equisignal was lower than that in the control group. Compared with the control group, the serum concentrations of AFP, AFP-L3, GP73, and DCP in the observation group were significantly increased (all P < 0.05). For the diagnosis of early-stage PHC patients, MRI combined with these four markers showed favorable diagnostic value compared with parameter alone (area under the ROC curve, sensitivity, and specificity were 0.943, 0.919, and 0.833, respectively).

Conclusion

MRI combined with serum AFP, AFP-L3, GP73, and DCP detection has good value in the diagnosis of early PHC patients, and can serve as an effective strategy to improve the early diagnosis rate of PHC.

Targeting Akt in Hepatocellular Carcinoma and Its Tumor Microenvironment

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide, and its incidence is rising. HCC develops almost exclusively on the background of chronic liver inflammation, which can be caused by chronic alcohol consumption, viral hepatitis, or an unhealthy diet. The key role of chronic inflammation in the process of hepatocarcinogenesis, including in the deregulation of innate and adaptive immune responses, has been demonstrated. The inhibition of Akt (also known as Protein Kinase B) directly affects cancer cells, but this therapeutic strategy also exhibits indirect anti-tumor activity mediated by the modulation of the tumor microenvironment, as demonstrated by using Akt inhibitors AZD5363, MK-2206, or ARQ 092. Moreover, the isoforms of Akt converge and diverge in their designated roles, but the currently available Akt inhibitors fail to display an isoform specificity. Thus, selective Akt inhibition needs to be better explored in the context of HCC and its possible combination with immunotherapy. This review presents a compact overview of the current knowledge concerning the role of Akt in HCC and the effect of Akt inhibition on the HCC and liver tumor microenvironment.