39, P < .0001), and moderate agreement between patient self-assignment via selection of representative pictures and patient self-assignment via answering the written question (Kappa coefficient 0.43, P < .0001). For exploding headaches, there was weak agreement between physician diagnosis according to scripted questionnaire and patient

self-assignment via selection of representative pictures (Kappa coefficient 0.33, P < .0001), weak agreement between physician diagnosis according to scripted questionnaire and patient self-assignment via answering the written question (Kappa coefficient 0.35, P < .0001), and weak agreement between patient self-assignment selleck compound via selection of representative pictures and patient self-assignment via answering the written question (Kappa coefficient 0.39, P < .0001). For ocular headaches, there was moderate agreement learn more between physician diagnosis according to scripted questionnaire and patient self-assignment via selection of representative pictures (Kappa coefficient 0.42, P < .0001), weak agreement between physician diagnosis according to scripted questionnaire and patient self-assignment via answering the written question (Kappa coefficient 0.37, P < .0001), and moderate agreement between patient self-assignment via selection of representative

pictures and patient self-assignment via answering the written question (Kappa coefficient 0.57, P < .0001). Responses to migraine therapies vary substantially among patients. For example, when measuring response to prophylactic therapy as at least a 50% reduction in headache frequency, less than one-half of patients treating with a first-line therapy are responders.[4] Identification of clinical factors that predict a patient's likelihood of responding to a specific migraine therapy would transition the treatment of migraine from a process of trial-and-error to a 上海皓元 process of individualized medicine, maximize patient outcomes, and

minimize patient exposure to the potential adverse events from medications to which they are unlikely to respond. Published reports have suggested that migraine pain directionality is predictive of a response to onabotulinumtoxin A therapy. Studies have found an association between headache pain directionality and response to onabotulinumtoxin A[3, 5, 8] and more recently to botulinum toxin B.[7] Headache pain directionality has been described as imploding (a vice-like pain and pressure squeezing in), exploding (pain and pressure pushing outward), or ocular (pain focused on the eye).[3, 7] However, methods for determination of headache pain directionality have not been standardized. A number of different methods for determining headache pain directionality have been described.

Table 2 summarizes the diagnostic power of EUS-FNA and PJC. The EUS-FNA results were: sensitivity 86.0%, specificity 100%, positive predictive value 100%, negative predictive value 70.5%, and accuracy 89.5%. The PJC results were: sensitivity 71.4%, specificity 100%, positive predictive value 100%, negative predictive value 84.4%, and accuracy 88.8%. No significant differences were seen in sensitivity, specificity, positive predictive

value, negative Temozolomide predictive value, and accuracy between EUS-FNA and PJC. When the EUS-FNA and PJC results were combined, the results were as follows: sensitivity 92.5%, specificity 100%, positive predictive value 100%, negative predictive value 91.7%, and accuracy 95.9%. The accuracy of EUS-FNA and/or PJC was significantly higher than that of EUS-FNA (P = 0.031) or PJC (P = 0.027) alone. Table 3 shows the diagnostic sensitivities of EUS-FNA and/ or PJC in subgroups of pancreatic malignancy. Sensitivities for pancreatic selleck chemicals llc malignancy were 95.0% in the head, 96.7% in the body, and 97.3% in the tail of the pancreas. Sensitivities were 90.6% for carcinomas ≤ 20 mm, 97.4% for 21–40 mm, 100% for 41–60 mm, and 100% for carcinomas ≥ 61 mm. Sensitivities were 100% for Tis, 100% for T1, 95% for T2, 82.4% for T3, and 100% for T4. No significant

differences were seen in diagnostic sensitivity among any subgroups of pancreatic malignancy. Five patients (2.9%) in this study developed complications following EUS-FNA and/or PJC; all five cases developed pancreatitis after PJC, but not EUS-FNA, and were cured by conservative treatment. A case of early pancreatic cancer that could be diagnosed by PJC alone is presented. In a 79-year-old man, CT of the abdomen found a dilatation MCE公司 of the main duct in the body and tail of the pancreas, which suggested a pancreatic-ductal stricture in the tail of the pancreas (Fig. 1a). ERCP indicated a pancreatic-ductal stricture in the body of the pancreas (Fig. 1b). PJC of the stricture revealed malignant cells (Fig. 1c). Pathologic examination of the resected specimen disclosed a noninvasive ductal carcinoma of the pancreas, which was present in the strictured main duct (Fig. 1d). Previous reports have

shown that the accuracy of EUS-FNA for the diagnosis was 85–90.7%, with sensitivity of 80–89.5%, specificity of 96–100%, positive predictive value of 98.8–100%, and negative predictive value of 51–68.8%.[1, 12-14] The present results were similar to the previously reported results. However, it is difficult to strengthen the diagnostic power of EUS-FNA because EUS cannot detect minimally invasive carcinoma, and EUS-FNA cannot be performed for cases with a potential for bleeding or those with IPMC because of the potential for needle tract seeding.[3, 4] PJC has yielded sensitivities for pancreatic cancer that ranged from 33.3% to 67%, with specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 27.3%–98%, and accuracy 46.7%–93%.

nov. Basionym: Anabaena aphanizomenoides Forti (Atti Mem. Acad. Agric. Sci. Lett. Arti Comm. Verona, ser. 4, 12: 126, fig. 2, 1911). Sphaerospermopsis kisseleviana (Elenkin) Zapomělová, Jezberová, Hrouzek, Hisem, Řeháková et Komárková, comb. nov. Basionym: selleck compound Anabaena kisseleviana Elenkin, (Monogr. Alg. Cyanoph., Pars Spec., 1: 777, 1938). We are grateful to Michael and Wendy Guiry for assistance with

nomenclature. “
“The new species Rhipilia coppejansii is described from Guam. This species, which has the external appearance of a Chlorodesmis species, features tenacula upon microscopical examination, a diagnostic character of Rhipilia. This unique morphology, along with the tufA and rbcL data presented herein, set this species apart from others in the respective genera. Phylogenetic analyses show that the taxon is nested within the Rhipiliaceae. We discuss the diversity and possible adaptation of morphological types in the Udoteaceae and Rhipiliaceae. “
“Five cyanobacterial species (Phormidium sp., Nostoc sp., Anabaena sp. Aphanothece conferta, and Synechocystis aquatilis) isolated from the Suez Canal coast at the city of Ismailia (Egypt) were tested for biodegradation of four hydrocarbon (HC) compounds: two aliphatic compounds (n-octadecane and pristine) and two aromatic compounds (phenanthrene and dibenzothiophene).

High degradation efficiencies for the two aliphatic compounds were measured for JQ1 cell line A. conferta (64% for n-octadecane and 78% for pristine) and S. aquatilis (85% for n-octadecane and 90% for pristane). MCE However, the other biodegradation percentages ranged between weak and moderate percentages. “
“Accurately defining species boundaries in the green algae (Chlorophyta) is integral for studies of biodiversity and conservation, water-quality assessments, and the use of particular species as paleoindicators. Recent molecular phylogenetic and SEM analyses of the family Hydrodictyaceae (Chlorophyta) resolved three phylogenetic lineages

of isolates with the Pediastrum duplex Meyen 1829 phenotype. The present study employed analyses of cell shape and cell wall ultrastructure to determine if the three lineages possessing the P. duplex morphotype were distinguishable. Only one of the groups, containing isolates with the P. duplex var. gracillimum West et G. S. West phenotype, was shown to be morphologically distinct from the other two P. duplex groups. The erection of a new genus, Lacunastrum, is proposed to recognize this group as a separate taxon. “
“We provide molecular phylogenetic evidence that the obscure genera Palmophyllum Kütz. and Verdigellas D. L. Ballant. et J. N. Norris form a distinct and early diverging lineage of green algae. These palmelloid seaweeds generally persist in deep waters, where grazing pressure and competition for space are reduced. Their distinctness warrants recognition as a new order, the Palmophyllales.

[29, 30] High genomic similarity between genotype 4 HEV strains isolated from our patient and those previously reported from Aichi may support the zoonotic food-borne transmission of HEV from wild boar infected with genotype 4 HEV to our patient. Ku-0059436 datasheet In the present study, raw pig liver as food sold in grocery stores in Mie was found to be contaminated with HEV at the frequency of 4.9% of the total examined packages (12/243). The detection of HEV RNA in raw pig liver intended for human consumption in Mie is not surprising, because

contamination of commercially sold pig livers with HEV has been reported not only in Japan,[11] but also in the USA,[15] the Netherlands,[31] India,[32] France[33] and Germany.[34] However, this finding was contrary to our assumptions, because HEV RNA was detected significantly more frequently in commercially sold pig livers in Mie than in Hokkaido (4.9% vs 1.9% [7/363], P = 0.0372), where hepatitis E is endemic and approximately one-third of hepatitis E patients in Japan have been reported annually.[14] Some Japanese people Rucaparib nmr have a habit of eating raw pig liver, and it is served

at some restaurants in Japan. Based on the evidence that HEV infection is distributed widely in domestic pigs in Japan,[8, 35] it is very likely that the raw pig livers as food sold in grocery stores or supermarkets throughout Japan are contaminated with HEV, although the rate of virus contamination may differ by region, and should be examined

in various areas in Japan, including both endemic and non-endemic regions (northern and southern parts, respectively, of Japan),[36] to assess the actual MCE risk of HEV transmission from pig livers to humans. Importantly, the contaminating virus in commercial pig livers sold in local grocery stores remains infectious when inoculated into pigs[15] and cultured cells.[37] Of note, the virus sequences recovered from pig livers (nos. 152 and 193) were 99.5–100% identical to the viruses recovered from hepatitis E patients (nos. 13 and 17). However, these two patients did not remember consuming pig liver before the onset of hepatitis E (Table 2). The route of HEV transmission was unknown for patient nos. 13 and 17, although patient no. 17 reported frequent ingestion of raw horse meat and sushi. The HEV sequences recovered from the two patients and two pig liver specimens differed by 7.8% or more from the deposited HEV sequences as of June 2013, thus suggesting the uniqueness of these human and swine HEV sequences, and that the source of the HEV in the patients was likely pigs. It is now evident that pigs constitute a major reservoir, and are able to shed the virus into the environment.[12, 38] Contrary to our expectation, the distribution of HEV genotype/subgenotype was different between hepatitis E patients and purchased pig liver packages (Table 4). The reason for this discrepancy remains unknown.

“
“A woman, aged 50, was admitted to hospital with anemia. Ten years previously, she had been diagnosed with non-cirrhotic portal hypertension. Physical examination revealed pallor and an enlarged spleen, 6 cm below the left costal margin. Blood tests revealed a hemoglobin of 48 g/l (4.8 g/dL), a white cell count of 1.9 × 109/l, a platelet count of 35 × 109/l and a reticulocyte count of 4.4%. Renal and liver function tests were normal. Upper gastrointestinal endoscopy revealed small esophageal varices (Grade

I). An upper abdominal ultrasound study showed an enlarged spleen, marked dilatation of the splenic vein (5 cm) in the splenic hilum and other features of portal hypertension. A contrast-enhanced computed tomography (CT) scan showed a large aneurysm arising from the splenic vein that measured 63 × 53 mm in size (Figures 1 and 2). The patient was managed GSK-3 cancer by excision of the aneurysm and splenectomy. Aneurysms of the splanchnic veins are rare. Approximately 50% of these aneurysms arise from the portal vein and 30% from the splenic vein. Predisposing factors include portal hypertension, pancreatitis and congenital

weakness of the venous wall. Most of the aneurysms are asymptomatic and have been detected on imaging studies. However, there are case reports where aneurysms have become symptomatic because of thrombosis or bleeding. Asymptomatic aneurysms have mostly been observed without surgery. However, in the patient described above,

splenectomy was performed see more because of typical features of hypersplenism 上海皓元医药股份有限公司 as well as concerns about the size of the aneurysm and the risk of bleeding in the presence of thrombocytopenia. However, there are insufficient cases in the medical literature to determine whether aneurysms associated with portal hypertension or coagulopathy are more likely to be complicated by bleeding than aneurysms that occur in the absence of portal hypertension or coagulopathy. Only rare patients with cirrhosis or non-cirrhotic portal hypertension have a splenectomy for hypersplenism. However, when splenectomy is performed, there is usually a rapid improvement in anemia, neutropenia and thrombocytopenia and at least some reduction in portal pressure. In the longer-term, some patients with cirrhosis may have persistent thrombocytopenia because of impaired synthesis of thrombopoietin. Contributed by “
“The conclusion of the article by Vitale et al. that a Markov decision analysis suggests that sorafenib neoadjuvant therapy is cost-effective and supports the need for clinical trials deserves several comments and must be challenged.1 Markov decision processes model problems of sequential decision-making. However, here, the tested hypotheses are characterized by lack of evidence or uncertainty: The modest effectiveness of sorafenib is only documented for treating patients with advanced hepatocellular carcinoma (HCC) for whom surgical or locoregional therapies had failed or were not suitable.

“
“A woman, aged 50, was admitted to hospital with anemia. Ten years previously, she had been diagnosed with non-cirrhotic portal hypertension. Physical examination revealed pallor and an enlarged spleen, 6 cm below the left costal margin. Blood tests revealed a hemoglobin of 48 g/l (4.8 g/dL), a white cell count of 1.9 × 109/l, a platelet count of 35 × 109/l and a reticulocyte count of 4.4%. Renal and liver function tests were normal. Upper gastrointestinal endoscopy revealed small esophageal varices (Grade

I). An upper abdominal ultrasound study showed an enlarged spleen, marked dilatation of the splenic vein (5 cm) in the splenic hilum and other features of portal hypertension. A contrast-enhanced computed tomography (CT) scan showed a large aneurysm arising from the splenic vein that measured 63 × 53 mm in size (Figures 1 and 2). The patient was managed Rucaparib concentration by excision of the aneurysm and splenectomy. Aneurysms of the splanchnic veins are rare. Approximately 50% of these aneurysms arise from the portal vein and 30% from the splenic vein. Predisposing factors include portal hypertension, pancreatitis and congenital

weakness of the venous wall. Most of the aneurysms are asymptomatic and have been detected on imaging studies. However, there are case reports where aneurysms have become symptomatic because of thrombosis or bleeding. Asymptomatic aneurysms have mostly been observed without surgery. However, in the patient described above,

splenectomy was performed Estrogen antagonist because of typical features of hypersplenism 上海皓元 as well as concerns about the size of the aneurysm and the risk of bleeding in the presence of thrombocytopenia. However, there are insufficient cases in the medical literature to determine whether aneurysms associated with portal hypertension or coagulopathy are more likely to be complicated by bleeding than aneurysms that occur in the absence of portal hypertension or coagulopathy. Only rare patients with cirrhosis or non-cirrhotic portal hypertension have a splenectomy for hypersplenism. However, when splenectomy is performed, there is usually a rapid improvement in anemia, neutropenia and thrombocytopenia and at least some reduction in portal pressure. In the longer-term, some patients with cirrhosis may have persistent thrombocytopenia because of impaired synthesis of thrombopoietin. Contributed by “
“The conclusion of the article by Vitale et al. that a Markov decision analysis suggests that sorafenib neoadjuvant therapy is cost-effective and supports the need for clinical trials deserves several comments and must be challenged.1 Markov decision processes model problems of sequential decision-making. However, here, the tested hypotheses are characterized by lack of evidence or uncertainty: The modest effectiveness of sorafenib is only documented for treating patients with advanced hepatocellular carcinoma (HCC) for whom surgical or locoregional therapies had failed or were not suitable.

Many of

the causes are reported by tumoral lesions of the intestinal tract. We elucidate clinical feature of intussusception of adult. Methods: From 2005 to 2013, 29 cases of intussusception were diagnosed at Ehime http://www.selleckchem.com/products/AZD2281(Olaparib).html Prefectural Central Hospital (69.0 ± 16.5 years old). We evaluated their clinical backgrounds. Results: Average age was 69.0 ± 16.5 years old (range: 16∼89, male : female = 15:14). Intussusception of small intestine were in 10 (34.5%), ileocecal region in 3 (10.3%), and colon in 16 (55.2%). In colon cases, the location was ascending colon in 13 (44.8%), transverse in 2 (6.9%), and descending in 1 (3.4%). All 29 cases could be devided into 2 types; with and without tumors. Seventeen (58.6%) were caused by tumors. Colonic cancer: 11 (37.9%), malignant lymphoma: 3 (10.3%), lipoma: 2 (6.9%), GIST : 1 (3.4%). Twelve were without tumors, postoperative

adhesion were 4 (13.8%), appendicitis were 2 (6.9%) and others (inflammation: 2, dietary by egg-plant: 1, colonic anisakis: 1, ileus tube: 1, small-intestine tumor: 1) were this website 6. Four were treated conservatively (13.8%), 19 were treated with recection (65.5%), 2 could not be treated due to bad general condition (6.9%), and 1 was cared by chemotherapy (3.4%). One case died by other disease (3.4%). Conclusion: In the present study, approximately 40% were not caused by tumors. It is important to keep in mind that there are intussusception cases without tumors and some of them can be treated conservatively. Key Word(s): 1. intussusception; 2. adult Presenting Author: KHONDOKER JAHENGIR ALAM Additional Authors: KHONDOKER JAHENGIR ALAM, JI-SU MO, SUCK-CHEI CHOI Corresponding Author:

KHONDOKER JAHENGIR ALAM Affiliations: School of Medicine, Wonkwang University, School of Medicine, Wonkwang University, School of Medicine, Wonkwang University Objective: MicroRNAs (miRNAs) are small non-coding RNAs which down-regulate gene expression of protein-coding genes by either translational repression or mRNA degradation. The present study aimed to investigate the miRNAs associated with the pathogenesis of colon cancer, and to identify their target genes. Methods: The candidate miRNAs were extracted and isolated by analysis of the miRNA microarray chips results between MCE colon cancer and normal colon. The expression levels of differentially expressed miRNAs using quantitative real-time polymerase chain reaction (RT-qPCR) was validated. Results: One of them, miR375 was detected as lower expression level in colon cancer than normal colon tissue. The miR375 targets were predicted using the mRNA microarray analysis of the human colon cell lines, Caco2 and SW480, between the normal cells and the candidate miRNA over-expressed cells. The several candidate target genes for MIR375 were identified and validated.

Disclosures: The following people have nothing to disclose:

Yasuhiro Miyamoto, Amy S. Mauer, Harmeet Malhi Recent findings that excessive lipid accumulation decreases cellular levels of autophagy, and that autophagy modulates immune responses, suggested that alterations in macrophage autophagy with obesity may regulate innate immunity in NASH. We hypothesized that an obesity-induced impairment of macrophage autophagy promotes NASH development by altering proinflammatory M1 and anti-inflammatory M2 mac-rophage polarization which AZD2281 nmr leads to an overactive innate immune response. Methods: Wild-type mice and mice with a LysM-Cre-mediated macrophage knockout of the autophagy gene Atg5 were fed a high fat diet (HFD) alone or together with low-dose lipopolysaccharide (LPS; 0.25 mg/day). Results: Primary bone marrow-derived macrophages (BMDM) and peritoneal NSC 683864 concentration macrophages from wild-type mice fed 16-20 weeks of HFD had

decreased levels of autophagic flux indicating an impairment of macrophage autophagy in obesity. With 12 weeks of HFD combined with 2 weeks of LPS, macrophage Atg5 knockout mice, but not littermate controls, developed systemic and hepatic inflammation. Contrary to prior reports that autophagy regulates only inflammasome-generated IL-1β, Atg5 null mice had increased serum protein and hepatic mRNA levels for the inflammasome-independent proinflammatory cytokines TNF and IL-6. This effect was liver specific as white adipose tissue cytokine expression was equivalent in control and knockout mice. Hepatic macrophage number was unchanged in knockout mice by F4/80 mRNA levels and CD68 immunofluores-cence. The mechanism by which loss of autophagy promoted inflammation was through effects on macrophage polarization. BMDM and Kupffer cells from HFD-fed, LPS-treated knockout mice stimulated with LPS/IFNβ or IL-4/IL-13 in vitro assumed a more inflammatory phenotype with both increased proinflam-matory M1 and decreased anti-inflammatory M2 polarization as determined by measures of M1/M2 marker genes and proteins. Loss of autophagy altered MCE a number of cellular

signaling pathways that mediate M1/M2 polarization including STAT6, JNK and Akt. The heightened inflammation in HFD-fed, LPS-treated knockout mice triggered liver injury without affecting steatosis. Knockout mice had statistically significant increases in histological grade of liver injury (1.0 vs. 0.2), TUNEL staining (2.1 vs. 0.2 cells/HPF) and caspase 3 and 7 cleavage. Conclusions: Autophagy has critical functions in both M1 and M2 polarization that determine hepatic macrophage pheno-type and down regulate liver inflammation. Obesity impairs macrophage autophagy which promotes proinflammatory mac-rophage activation leading to the progression of simple steato-sis to liver inflammation and hepatocyte injury. Disclosures: Mark J. Czaja – Consulting: Oncozyme Pharma Inc.; Grant/Research Support: Oncozyme Pharma Inc.

1–3 T2D may cause metabolic fatty liver disease (so-called NAFLD) and, like diabetes,NAFLD is now considered a manifestation of metabolic syndrome (MetS).1 Insulin resistance, the primary pathophysiological disorder leading to T2D and MetS is so often found in NAFLD that this form of liver disease may be regarded as similar to or a complication of ‘pre-diabetes’, thereby indicating the high future risk for onset of diabetes as well as cardiovascular disease.1,3 In several studies, NAFLD diagnosed by

ultrasonography together with unexplained elevation of liver enzymes predicted diabetes risk, independent of obesity selleck products and other components of MetS.4–11 Thus, the concept has arisen that NAFLD may signify more than just the presence of a liver disease; it may also be an early mediator of T2D and MetS. Aloxistatin solubility dmso Although histological examination remains the gold standard for diagnosis of NAFLD, pathological definition is often not

possible in community-based epidemiological studies. Alternatively, in subjects without substantial alcohol consumption or other causes of liver disease, persistent elevation of alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) is regarded as a surrogate marker of NAFLD.1,12 In 1998, a longitudinal study examined the association of elevated liver enzymes with incident diabetes.4 Since then, high values of ALT and GGT, even within the normal range, have been reported to predict incident diabetes and MetS; some studies demonstrated stronger association between GGT MCE公司 and diabetes than ALT, while other studies reported the

opposite.4–6 In a meta-analysis of results from prospective population-based studies fully adjusted for other diabetes risk factors (albeit variably adjusted), 1 U/L increase of loge ALT was associated with 85% increase in diabetes risk, and 1 U/L increase of loge GGT with 92% increase.4 This indicates that elevations in liver enzymes attributable to NAFLD increase incident diabetes rate independently of commonly measured diabetes risk factors. Recently, Adams et al. found subjects with elevated liver enzymes attributed to NAFLD were at increased risk of developing metabolic complications at 11 years follow up; they were threefold more likely to develop diabetes and 50% more likely to develop MetS compared with the age-matched population.5 Multivariate modeling showed that the increased risk of metabolic complications could be explained by associated visceral obesity and subsequent insulin resistance, which almost invariably accompanies patients with NAFLD. In contrast to this high risk of diabetes, only a small minority of subjects with NAFLD develop cirrhosis over 10 years, with an even smaller proportion dying from liver disease during this period of follow up.

Furthermore, a consistent risk increase was found for mental and cardiovascular diseases and diseases of the digestive system and musculoskeletal disorders, which represent the major causes of disability in this occupational group. The results of the association of γ-GT on all-cause disability pension are consistent with those from a previous analysis of our cohort, where a modest but significant increase in risk of occupational disability was seen at γ-GT levels above 28 U/L (measured at 25°C, corresponding to a γ-GT threshold level of 55 U/L measured at 37°C).16 However, our previous analysis was confined to all-cause disability as the sole U0126 endpoint. Although the association

of γ-GT Stem Cell Compound Library with all-cause disability pension was partly explained in our cohort by factors related to enzyme activity, such as alcohol consumption, obesity, smoking, cholesterol and cardiovascular diseases, diabetes mellitus, and diseases of the liver, bile, and pancreas, controlling for these factors or exclusion of persons with these diseases only slightly reduced the prognostic impact of γ-GT on occupational disability. This indicates that the relationship of elevated γ-GT activity on disability pension was not merely explained by these

confounding factors. Further possible causes of increased γ-GT levels could be hepatotoxic agents and other nonhepatic factors such as renal, pulmonary, and myogenic (including cardiac) disorders, which may also account for some of the increased risk of occupational disability. The positive association between γ-GT and disability due to cardiovascular diseases is consistent, albeit somewhat weaker, than corresponding results from epidemiological studies assessing the association between γ-GT and mortality. This difference in quantity may be explained by the relatively low mortality and disability rates due to cardiovascular diseases in construction workers.23, 24 However, in our cohort the increase in disability risk remained significant in the two top

quartiles of γ-GT. The relationship of γ-GT with disability due to the digestive system was particularly pronounced by hepatic diseases, whose associations with elevated γ-GT levels are likewise well established.1 MCE公司 Our findings, that γ-GT predicts disability pension due to diseases of the digestive system, are in line with these findings. The positive association of γ-GT with increased risk of disability due to mental diseases in the highest quartile in our study is more difficult to interpret. A possible explanation could be residual confounding due to solvents, which were in widespread use in the construction industry. It has been reported that the combined effect of occupational solvent exposure and alcohol intake could be an important cause of organic brain damage, which is responsible for several mental diseases such as dementia and cerebral atrophy.