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BACKGROUND: Matrix Gla protein (MGP) is a vitamin K dependent peptide which has an established role in suppression of vascular calcification. Recent studies have pointed to a possible link between immunomodulatory effect of MGP and inflammatory bowel disease (IBD). AIM: To compare plasma levels of dephosphorylated and uncarboxylated MGP (dp-ucMGP) between IBD patients and controls. METHODS: This cross-sectional study was conducted on 70 patients with IBD (30 patients with ulcerative colitis and 40 patients with Crohn's disease) and 60 age and gender matching healthy controls. Plasma dp-ucMGP levels were analyzed from blood samples by CLIA method using IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) according to the manufacturer's instructions. fecal calprotectin (FC) levels were determined from stool samples by turbidimetric immunoassay method using Bühlmann fecal calprotectin turbo assay (Bühlmann Laboratories Aktiengesellschaft, Schonenbuch, Switzerland). Other parameters were analyzed according to the standard laboratory procedures. RESULTS: Plasma levels of dp-ucMGP were significantly higher in patients with IBD compared to the healthy control group (629.83 ± 124.20 pmol/mL vs 546.7 ± 122.09 pmol/mL, P < 0.001), and there was no significant difference between patients with Crohn's disease and patients with ulcerative colitis (640.02 ± 131.88 pmol/mL vs 616.23 ± 113.92 pmol/mL, P = 0.432). Furthermore, a significant positive correlation of plasma dp-ucMGP levels was found with both FC levels (r = 0.396, P < 0.001) and high sensitivity C-reactive protein (hsCRP) levels (r = 0.477, P < 0.001). Moreover, in the total study population a significant positive correlation was found between dp-ucMGP with age (r = 0.210, P = 0.016) and waist circumference (r = 0.264, P = 0.002). Multiple linear regression analysis showed that dp-ucMGP levels retained significant association with FC (ß ± SE, 0.06 ± 0.02, P = 0.003). CONCLUSION: Study results support experimental data of MGP immunomodulatory IBD effect and indicate potential involvement in the pathophysiology of the disease, and possibly extraintestinal manifestations.

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Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). The aim of this study was to compare serum adropin levels between 55 patients with IBD (30 Ulcerative colitis (UC) patients, 25 Crohn's disease (CD) patients) and 50 age/gender matched controls. Furthermore, we explored adropin correlations with IBD severity scores, hsCRP, fecal calprotectin, fasting glucose and insulin levels. Serum adropin levels were significantly lower in patients with IBD in comparison with the control group (2.89 ± 0.94 vs 3.37 ± 0.60 ng/mL, P = 0.002), while there was no significant difference in comparison of UC patients with CD patients (P = 0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r = -0.303, P = 0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r = -0.222, P = 0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251-0.823, P = 0.009). Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings.

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BACKGROUND: There is a lack of data concerning diagnostic performance of magnetic resonance imaging (MRI) in patients with new or increasing microcalcifications. PURPOSE: To evaluate suspicious microcalcifications by using comparison mammography, MRI, and a combination of both methods. MATERIAL AND METHODS: Our study group consisted of 55 patients with mammographically detected BI-RADS (Breast Imaging Reporting and Data System) 3-5 microcalcifications for whom comparison mammograms were available. All patients underwent breast MRI before SVAB (stereotactic vacuum-assisted biopsy). Diagnostic performances of comparison mammography and MRI were evaluated, as well as the combination of the respective imaging findings. RESULTS: Of the 55 microcalcification cases, 35 showed progression and 20 were stable between interval screenings. The negative predictive value (NPV) of comparison mammography was 100%, whereas the NPV of MRI was 92%. However, the specificity of combination of findings was 97%, significantly higher than the 42% specificity of comparison mammography (P < 0.001). Additionally, the positive predictive value of combination of findings was 93% versus 44% of comparison mammography (P = 0.001). CONCLUSION: A biopsy is recommended when MRI positive lesion corresponding the area of new or increasing mammographic microcalcifications is detected. Patients with stable microcalcifications can continue follow-up mammography, regardless of MRI result.

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OBJECTIVES: To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH). MATERIALS AND METHODS: Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria. RESULTS: Of 123 patients, LS was successfully measured in 79.7% and SS in 53.7%. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index. CONCLUSIONS: RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC. KEY POINTS: • RT 2D-SWE is an accurate method for assessment of liver fibrosis. • RT 2D-SWE is applicable in 80% of patients with chronic viral hepatitis. • RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. • Both liver and spleen stiffness increase with progression of liver fibrosis. • In cirrhosis, the difference between liver and spleen stiffness decreases.

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In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks, and thus, we insist on a physical examination, as the best indicator of injury.

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