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Liver elastography is a noninvasive method for diagnosing fibrosis that has been developed over the last decade in response to the limitations of liver biopsies, blood markers, and traditional imaging modalities. There are different methods of measuring tissue stiffness through ultrasound; thus far, shear wave elastography has proven superior for diagnosing clinically significant liver fibrosis, where early detection modifies the approach to treatment and improves prognosis. This article aims to provide a brief review of the different methods for performing elastography with ultrasound, focusing especially on shear wave elastography and on technical aspects for carrying out the procedure and key points for interpreting the findings.

Purpose/Objective(s) The prognostic value of inflammatory blood markers (IBMs) in breast cancer patients have been an area of growing interest. Most of the studies took parameters from one defined point, usually the pretreatment ones. Current study aims to investigate the potential prognostic significance of IBMs among patients with stage II-III breast cancer receiving neo-adjuvant therapy (NAT). Materials/Methods Patients with stage II-III breast cancer who received NAT and postoperative radiotherapy (RT) at a single institute from Jan 2009 to Dec 2016 were retrospectively reviewed. The neutrophil, lymphocyte, platelet and monocyte count were collected at different stages of treatment, after NAT but before surgery, before and after RT, respectively. LMR and SII was calculated for each patient. The breast cancer specific survival (BCSS) and locoregional recurrence free survival (LRRFS) were defined from the date of the start of RT until last follow up. Univariate and multivariate Cox regression analysis was performed to identify independent predictors for BCSS and LRRFS. Model performance was evaluated by the concordance index (c-index). Results In total, 205 patients were enrolled. After a median follow-up of 65 months, 19 BCSS events were identified. The optimal cutoff value of SII and LMR after NAT but before surgery by receiver operating characteristic curve were 467.76 × 109 (AUC = 0.63) and 1.57 (AUC = 0.65). The five-year BCSS of the group with lower LMR (LMR≤1.57) and higher LMR (LMR > 1.57) were 74.2% and 93.7%, respectively (P = 0.001). The 5-year risk of BCSS in patients with high SII value (SII > 467.76 × 109) and low SII value (SII≤467.76 × 109) were 81.5% vs 96.4%, respectively, P = 0.003. The multivariate analysis found that in addition to the traditional prognostic factors including hormone receptor, ypT, ypN stage and lymphovascular invasion, both post-NAT LMR (HR = 0.28, 95% CI = 0.10-0.81, P = 0.02) and SII (HR = 4.06, 95% CI = 1.37-12.00, P = 0.01) were independent predictors for BCSS. The C-index of the multivariate model of Neo-Bioscore for BCSS was 0.71(95% CI = 0.83-0.59), which was improved to 0.80((95% CI = 0.94-0.67) by adding LMR and SII. The prognosis of pre-RT and post-RT SII on LRRFS was analyzed in124 patients. The optimal cutoff value of SII before and after RT were 412.2 × 109 (AUC = 0.71) and 571.48 × 109 (AUC = 0.69) respectively. Patients with pre-RT SII > 412.2 × 109 or post-RT SII > 571.48 × 109 had a higher rate of locoregional failure (P = 0.02 and P = 0.01). After adjusting for cT, cN stage and age, post-RT SII remained predictive of locoregional failure (HR = 10.22, 95% CI = 1.25-83.45, P = 0.03). Conclusion IBMs after NAT was useful prognostic factor for stage II-III breast cancer patients. Adding LMR and SII to Neo-Bioscore can further stratify the prognosis of BCSS. High level of SII after RT had a negative impact on local-regional control, whether it reflects preclinical studies of post-RT inflammation-mediated tumor recurrence needs further study.

Since the advent of the HER2 biomarker allowing access to treatment with trastuzumab, we observe an explosion in research for biomarkers, in which the economic pressure linked to the costs of developing new products must not be overlooked, in order to better select the molecules to be developed and the patients who can benefit from them. Personalized medicine takes a little more space each year in the overall care of our patients and the search for specific indicators, has become unavoidable. Rapid identification of oncogenic changes, their therapeutic targeting and the anticipation of resistance or toxicity mechanisms is a challenge. From blood markers, proteins to tumor genomic profiling and new markers in medical imaging, clinicians, researchers, and patients all are looking for the Holy Grail. This article synthetizes oncology resident's reflexions during the ESMO congress which took place in Copenhagen from 7 to 11 October 2016. The aim was to select the most relevant or promising results for future clinical practice.

The objective of this study was to determine effect of the diet containing 1200 betaine diet on blood biomarkers, electrolytes, gas and cecum short-chain fatty acid profile in meat ducks exposed to very hot environment (high relative humidity) conditions from d 21–42 (11:00 to 17:00 h; 33–43 °C; 70% relative humidity). On the day of hatching, a total of 320 meat ducks(average, 48.6 g body weight) were randomly assigned to 4 treatments with 4 pens per treatment and 20 ducks per pen for 42 d. Dietary treatments consisted of: 1) the control diet fed ad libitum, 2) the betaine diet fed ad libitum, 3) the betaine diet fed from 05:00 to 10:00 and 17:00 to 20:00 h, and 4) the betaine diet fed from 17:00 to 20:00 h. Ducks fed the betaine diets had greater body weight at d 42 than those fed the control diet (P

In highly stressful environments, individuals with diverging stress-reactivity can perform differently. Identification of blood markers of stress-reactivity is of major significance to help human performance during stress. Candidate transcripts were identified between stressed and non-stressed strains of rats’ blood and brain, and overlapping significant differentially expressed genes were selected. Serum levels of human orthologues of these proteins, in lieu of blood RNA, in addition to classic stress and general clinical markers, were measured in 33 Battlefield Airmen undergoing a 52 day long preparatory training course before their course of initial entry (COIE). Blood samples and factors of affective state, negative valence “Threat” and positive valence “Challenge”, were obtained five times across different days of training which included either routine physical exercise or prolonged and intense physical and mental training. During training, levels of chloride (Cl), dehydroepiandrosterone-sulfate (DHEA-S), creatinine kinase (CK), and total carbon dioxide (TCO2) differed between airmen who subsequently graduated from their COIE and those who did not. Time dependent changes of serum TCO2 and neuropeptide Y (NPY), as well as the affective factor Challenge differed by future graduation status throughout the training. Serum levels of parvin beta (PARVB) correlated with the affective factor Threat, while those of NPY, testosterone, coactosin like F-actin binding protein 1 (COTL1) and C-reactive protein (CRP) correlated with factor Challenge during the extended, intensive periods of training, consistently. These pilot data suggest that the identified panel of blood markers can measure stress responsiveness, which has the potential to advance individualized stress-management strategies., Highlights • Levels of novel and classical serum markers signal stress severity in men. • Biomarker levels reflect stress reactivity of Battlefield Airmen in training. • Affective measures correlate with serum biomarkers after extended stress.

The purpose of this review was to critically discuss studies that investigated the effects of supplementation with dietary antioxidant phytochemicals on recovery from eccentric exercise-induced muscle damage. The performance of physical activities that involve unaccustomed eccentric muscle actions-such as lowering a weight or downhill walking-can result in muscle damage, oxidative stress, and inflammation. These events may be accompanied by muscle weakness and delayed-onset muscle soreness. According to the current evidences, supplementation with dietary antioxidant phytochemicals appears to have the potential to attenuate symptoms associated with eccentric exercise-induced muscle damage. However, there are inconsistencies regarding the relationship between muscle damage and blood markers of oxidative stress and inflammation. Furthermore, the effectiveness of strategies appear to depend on a number of aspects inherent to phytochemical compounds as well as its food matrix. Methodological issues also may interfere with the proper interpretation of supplementation effects. Thus, the study may contribute to updating professionals involved in sport nutrition as well as highlighting the interest of scientists in new perspectives that can widen dietary strategies applied to training.

Background It has been suggested that stroke in patients with cancer may differ from the conventional pattern. The aim of this study was to evaluate the burden of vascular risk factors, stroke etiology, and short-term outcome in patients with active and nonactive malignancy compared with patients without cancer. Methods This is a prospective cohort study of consecutive acute stroke patients admitted to our department between September 2006 and September 2011. We distinguished between the following: (1) patients with active malignancy (AM, diagnosed not earlier than 12 months before stroke); (2) patients with nonactive malignancy (non-AM); and (3) cancer-free (CF) patients, used as a reference. Results Pre-existing cancer was found in 90 of 1558 patients, including 41 (2.6%) cases with AM and 49 (3.1%) cases with non-AM. Compared with CF patients, AM patients less frequently had a history of previous stroke (2.4% versus 17.9%, P = .018) and more frequently experienced ischemic strokes of undetermined etiology (62.5% versus 38.3%, P = .002). Non-AM patients did not differ in the distribution of vascular risk factors but more often experienced stroke caused by small vessel occlusion (20.0% versus 8.0%, P = .004). Inflammatory blood markers were elevated especially in patients with AM. Short-term prognosis was similar across all groups. Conclusions Stroke pattern in patients with non-AM appears very similar to that observed in the CF patients. However, our findings support the thesis that cancer-specific prothrombotic mechanisms play an important role in stroke patients with AM, which may be related to active inflammatory and immune processes. Malignancy does not influence short-term prognosis of stroke.

The identification of menstrual blood is an important issue in forensic biology, but currently, there are no confirmatory methods for its detection. Here, we demonstrate a highly reliable simple heptaplex method that allows for the discrimination between menstrual and peripheral blood. The test has been used successfully in criminal casework, in which the origin of blood on a rape victim's underwear and trousers was questioned as being menstrual or traumatic peripheral blood. To solve this problem, transcripts of the following genes were used: mucin 4 (MUC4), human β-defensin 1 (HBD1), two matrix metalloproteinases (MMP7, MMP11), δ-aminolevulinate synthase 2 (ALAS2), hemoglobin alpha (HBA) and glucose 6-phosphate dehydrogenase (G6PDH). The sensitivity of the test is 0.3ng of RNA. The possibility of the detection and differentiation of menstrual and peripheral blood in mixtures that contain other body fluids was investigated. Reliable detection is possible for menstrual blood stains that are up to 1-2 years old if stored at room temperature. This easy approach, thanks to the amplification of 4 vaginal and 2 blood markers, minimizes the risk of false negative results.

Occult hepatitis B virus infection is defined as detectable HBV-DNA in liver of HBsAg-negative individuals, with or without detectable serum HBV-DNA. In deceased liver donors, results of tissue analysis cannot be obtained prior to allocation for liver transplantation.we investigated prevalence and predictability of occult hepatitis B using blood markers of viral exposure/infection in deceased liver donors.In 50 consecutive HBsAg-negative/anti-HBc-positive and 20 age-matched HBsAg-negative/anti-HBc-negative donors, a nested-PCR assay was employed in liver biopsies for diagnosis of occult hepatitis B according to Taormina criteria. All donors were characterized for plasma HBV-DNA and serum anti-HBs/anti-HBe.In liver tissue, occult hepatitis B was present in 30/50 anti-HBc-positive (60%) and in 0/20 anti-HBc-negative donors (p0.0001). All anti-HBc-positive donors with detectable HBV-DNA in plasma (n=5) or anti-HBs1,000 mIU/mL (n=5) eventually showed occult infection, i.e, 10/30 occult hepatitis B-positive donors which could have been identified prior to transplantation. In the remaining 40 anti-HBc-positive donors, probability of occult infection was 62% for anti-HBe-positive and/or anti-HBs ≥ 58 mIU/mL; 29% for anti-HBe-negative and anti-HBs58 mIU/mL.In deceased donors, combining anti-HBc with other blood markers of hepatitis B exposure/infection allows to predict occult hepatitis B with certainty and speed in one third of cases. These findings might help refine the allocation of livers from anti-HBc-positive donors.

The aim of this study is to estimate whether the occupational exposure to low dose anesthetic gases could cause alterations of blood parameters in health care workers. 119 exposed subjects and 184 not exposed controls were included in the study. Each worker underwent the complete blood count test (CBC), proteinaemia, leukocyte count, serum lipids, liver and kidney blood markers. The liver blood markers show statistically significant differences in health care workers compared with controls (p0.05), a statistically significant decrease in neutrophils and an increase of lymphocytes in health care workers compared with controls (p0.05). The prevalence of values outside the range for GPT, GGT, total bilirubin, lymphocytes and neutrophils was statistically significant in health care workers compared with controls (p0.05). The results suggest that occupational exposure to low dose anesthetic gases could influence some haematochemical hepatic and hematopoietic parameters in exposed health care workers.

Objectives No ideal blood marker exists for the diagnosis of ischemic stroke. Combined use of multiple blood markers would enhance the ability of clinical diagnosis of ischemic stroke. Design and methods Blood concentrations of neuronal markers (NSE, VSNL-1, hFABP, and Ngb), astroglial markers (S100B and GFAP), inflammatory markers (IL-6 and TNF-α), blood–brain barrier marker (MMP-9), and hemostatic markers (PAI-1) were measured within 6–24 h of stroke onset. The area under the receiver operator characteristic (AUROC) curve of patients with ischemic stroke and stroke-mimic was compared after adding individual or a combination of blood markers to the clinical diagnostic assessment (age, atrial fibrillation, and Face–Arm–Speech Test [FAST]). Results Despite acute elevations of blood IL-6, S100B, MMP-9, hFABP, and PAI-1 in univariate analysis, only IL-6, S100B, and MMP-9 were independently associated with ischemic stroke in multivariate analysis. The addition of biomarkers (IL-6, S100B, and MMP-9) did not improve the diagnostic performance of baseline clinical models with added biomarkers versus baseline clinical models alone (AUROC, 0.865 vs. 0.837, p = 0.069). Conclusions IL-6, S100B, and MMP-9 markers are elevated in the peripheral blood during the acute phase of ischemic stroke. However, the clinical usefulness of these biomarkers is limited due to low discriminating ability when compared to clinical parameters alone in diagnosis of ischemic stroke.

Objectives To assess the reliability of the CCT110%, a high-intensity cycling capacity test performed to exhaustion. Design 27 recreationally active participants (age 23 ± 4 y; height 1.79 ± 0.06 m; body mass 78.0 ± 8.8 kg; Powermax 306 ± 49 W) performed the CCT110% on two occasions. Methods Performance measures determined from the CCT110% were time to exhaustion (TTE) and total work done (TWD). Blood pH, lactate, bicarbonate and base excess were determined before exercise, immediately after exercise, and 5 min after exercise. Exercise capacity data were analysed using intra-class correlations (ICC), systematic bias ratio, ratio limits of agreement, coefficient of variation (CV) and t-tests. Blood variables were analysed using repeated measures ANOVA and Tukey tests for post hoc comparisons. Results TTE (mean ± SD: 134 ± 20 s and 135 ± 20 s, P = 0.75) and TWD (42.2 ± 10.3 kJ and 42.2 ± 9.8 kJ, P = 0.97) were not different between trials. The ICC between trials was r = 0.88 for TTE and r = 0.94 for TWD, with the CV being 4.43% for TTE and 4.94% for TWD. There were no between trial differences in blood markers at any time point except immediately post-exercise pH (7.246 ± 0.041 vs. 7.269 ± 0.064, P = 0.004). Conclusions The CCT110% is a reliable exercise protocol that can be used for nutritional interventions designed to affect intracellular and extracellular pH changes. Although blood pH was significantly different between trials immediately post-exercise, the absolute differences are much smaller than those expected to be seen using nutritional interventions intended to alter extracellular pH during exercise.

Background This study aimed to develop and evaluate a predictive score named Fibrosis Routine Test (FRT) for liver fibrosis staging and to compare FRT with APRI, Lok, GUCI, FI, FibroQ, FCI, FIB-4 and 4RLB scores in large numbers of untreated HCV-monoinfected patients. Methods Large numbers of estimation (N = 2045) and validation patients (N = 3212) were included in this study. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score comprising age, AFP, APRI and albumin. Results In the estimation study, FRT produced AUCs 0.84, 0.85 and 0.86 for significant (F2–F4), advanced fibrosis (F3–F4) and cirrhosis (F4), respectively. FRT > 4 was 83% specific and 73% sensitive for F2–F4, FRT > 5 was 83% specific and 71% sensitive for F3–F4 and FRT > 5.5 was 81% specific and 73% sensitive for F4. In the validation study, FRT produced AUCs 0.81, 0.89 and 0.95 for F2–F4, F3–F4 and F4, respectively. The above eight scores demonstrated lower AUCs than FRT. Conclusion While liver biopsy is invasive, costly and associated with complications, Fibrosis Routine Test (FRT) is a non-invasive, inexpensive, simple and may reduce the need of liver biopsy.

Background This study was undertaken to investigate whether serum cytokeratin-1 (CK1) could complement alpha-fetoprotein (AFP) to improve the diagnosis of hepatocellular carcinoma (HCC). Methods CK1 was identified using western blot and ELISA in serum samples from 250 Egyptian patients including 150 with HCC, 100 with liver cirrhosis (LC) and 50 healthy controls. Multivariate discriminant analysis (MDA) and ROC curve analyses were used to create a predictive model including CK1 in addition to a panel of routine blood markers. Results CK1 was identified at 67 kDa and quantified in sera of HCC patients using western blot and ELISA. MDA selected a score for the prediction of HCC from LC patients based on levels of CK1, albumin and AFP. An area under the ROC curves (AUC) of the score was 0.87. The score showed a sensitivity of 87% vs 39% sensitivity of AFP at cutoff value of 200 IU/ml for prediction HCC. Absolute specificity (100%) was obtained to discriminate HCC from healthy individuals. Conclusions This study suggests that the use of a combination of score including CK1, AFP and albumin in clinical practice provides a non invasive and simple test that could increase significantly the sensitivity of HCC diagnosis.

Despite intensive research over past decades, infections and organ failure remain the most common severe complications in the critically ill surgical patient. Multiple-organ dysfunction syndrome represents the clinical endpoint of a cascade of mainly immunologic and cardiovascular events, ultimately leading to progressive patient deterioration and high mortality. Few clinicians have contributed as vigorously as Hiram C. Polk, Jr, to improve the treatment and outcome in surgical patients suffering from these disorders. His effort to standardize perioperative antibiotic prophylaxis, to introduce quantitative tracheal cultures for the diagnosis of pneumonia in trauma patients, or to use blood markers such as monocyte HLA-DR expression to identify patients at risk for adverse outcome are but some excerpts of his career as an academic surgeon. This article describes surgical infections and organ failure from a historical perspective, with emphasis on Polk's contributions, and describes our current understanding of the pathophysiology of organ dysfunction in surgical patients.

(51)Chromium-labeled ethylenediamine tetra-acetic acid ((51)Cr-EDTA) is the gold standard probe for assessing intestinal permeability (IP) in dogs, but exposure to radioactivity is a disadvantage. Iohexol is a safe contrast medium commonly used for medical imaging purposes and has been successfully applied more recently for the assessment of IP in animal models and humans. This study aimed at comparing (51)Cr-EDTA and iohexol as IP blood markers in dogs. A test solution containing (51)Cr-EDTA and iohexol was administered intragastrically to seven healthy laboratory Beagle dogs, and percentage recoveries in serum were calculated. The strong linear association (correlation, r=0.76 and linear regression, y=0.03+5.04x) between (51)Cr-EDTA and iohexol supports the potential usefulness of iohexol as an IP blood marker in dogs.

In this study, 23 years old human blood stains on different and problematic carrier materials, such as jeans, leather, wood, wallpaper, carpet, wool, and nylon fabric, were investigated by mRNA analysis of the blood markers HBB and SPTB. HBB turned out to be a very stable marker that could be detected in all blood samples from all carrier materials whereas SPTB showed no positive result in any of these old samples. Typing of co-extracted genomic DNA provided full STR profiles with the exception of one stain resulting in a partial profile. No differences were observed regarding the quality of results due to possible inhibitorial substances from carrier materials such as jeans or leather, whereas some difficulties to extract nucleic acids were caused by the physical properties of materials such as carpet fibres. HBB can be highly recommended for the identification of old blood stains in forensic casework as it was possible to detect HBB even in stains that failed to provide a full DNA profile.

Tai Chi is an ancient exercise originated from China. The slow movements of Tai Chi are not thought to evoke an increase in heart rate above 60% HRM, and yet Tai Chi has been found to improve vascular health. We are interested in the response to a single session of Tai Chi, as a mild physical stressor. The acute response to exercise is very important as a stimulus for adaptation, but to our knowledge, no previous studies have assessed the acute response to Tai Chi. The aim of this study was to investigate the response to a single session of Tai Chi. Blood markers of oxidative stress (lipid peroxidation, antioxidant capacity) and inflammation (IL-6) were assessed along with flow-mediated dilation (FMD) in young (18-25years old) and elderly participants (65–75 years old). Participants visited the laboratory twice to undertake Tai Chi or a control visit. Blood withdrawal and FMD assessment were performed every hour, for 4 consecutive hours. Inflammation at baseline was increased in older participants, compared to young and MDA and IL-6 increased immediately after Tai Chi in both groups. Antioxidant capacity increased immediately and post one hour after Tai Chi in both groups. A single bout of Tai Chi was seen to promote cytokine release and increased antioxidant capacity, and may have a beneficial effect in improving human vasculature via these mechanisms in both old and young.

Carbohydrate-deficient transferrin (CDT) has been widely investigated as a biological marker of heavy alcohol consumption. In general, it has been found to be at least as sensitive and probably more specific than γ-glutamyltransferase (GGT). Because the two analytes are not highly correlated, their use in parallel enhances the sensitivity of detection of heavy alcohol consumption, especially in clinical populations. Women as a group produce more CDT under natural conditions and may produce less CDT in response to heavy drinking. Carbohydrate-deficient transferrin has found a place in the monitoring of alcoholics during treatment. Changes in CDT levels from individualized baseline values seem to be more sensitive to lower level relapse drinking than is the use of raw cut-off values. There are some conditions such as severe liver disease in which higher than normal levels of CDT are produced, thereby reducing the specificity of this marker for detecting heavy drinking under certain conditions. Future directions for the use of CDT include standardization and automation of measurement technology, evaluation of how to use it wisely in myriad medical and institutional settings, understanding more thoroughly the gender issues in its production, and greater evaluation of its performance as a monitoring tool during treatment and follow-up situations. How to combine CDT with both verbal tools of alcohol assessment and newer biological markers will also need more extensive evaluation.

Relationships between ten Spanish goat breeds were studied using qualitative and quantitative analyses of data from 26 morphological characters. The average morphological distance between breeds, measured as MCD (mean character difference), has a value of (0.6615 ± 0.1042), with extreme values of 0.4231 between Negra Serrana-Blanca Celtiberica and Malaguena-Canaria pairs, and 0.8846 for the Canaria-Blanca Andaluza pair. Two well-defined clusters can be appreciated in the dendrograms. One formed by Malaguena, Canaria, Verata and Murciano-Granadina breeds, and the other one composed by Negra Serrana, Blanca Celtiberica, Retinta Extremena and Blanca Andaluza breeds. Pirenaica and Guadarrama breeds are included in one or the other cluster depending on the program used (PAUP vs. PHYLIP). Relationships between the goat breeds and their possible ancestral origins are discussed in relation to classifications made by other authors. Although these results agree with results obtained with blood markers, it is difficult to interpret the phylogenetic relationships between goat breeds in relation to ancestral trunks. However, the racial classifications obtained adjust perfectly to the three production systems (meat, milk, and dual-purpose aptitudes).

liver fat, and the addition of common CVD blood markers (TG, HDL, hsCRP) increased the predictive power to 43%. However, addition of the novel Omega-3 Index, and red blood cell n-6/n-3 ratio to the model did not meaningfully or statistically improve the prediction of liver fat. Conclusions: Against our hypothesis, the Omega3 Index was positively correlated with liver fat. NAFLD is an important risk factor for CVD, and further research is needed to test the predictive capacity of the Omega-3 Index in higher risk populations. In healthy overweight/obese adults, simple routine clinical measurements are useful for predicting those at increased risk of NAFLD. Funding source(s): Blackmores Ltd. and Diabetes Australia Research Trust.