Application of acoustic radiation force impulse elastography combined with serum markers in Child-Pugh grading

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.

Antioxidant and Hepatoprotective Properties from the Extract and Fractions of Annona senegalensis Pers (Annonaceae) Stem Bark Grown in Nigeria

Aim: This study was carried out to assess the antioxidant and hepatoprotective properties of the extract and fractions of Annona senegalensis stem bark through in vitro and in vivo experimental models. Study Design: The study followed a completely randomized design (CRD) of groups of treatments and control samples for all the tests. Place and Duration of Study: Department of Pharmacognosy and Environmental Medicines, University of Nigeria, Nsukka, between January and September 2016. Methodology: Phytochemical constituents and in vitro antioxidant activities using different models (reducing power, DPPH free radical scavenging, ABTS radical scavenging, Hydroxyl radical scavenging, Hydrogen peroxide scavenging, β-carotene bleaching, FRAP scavenging and superoxide radical scavenging assays) were carried out. In vivo antioxidant activity was determined from the assays of lipid peroxidation, superoxide dismutase and total protein while hepatoprotective activity was evaluated against CCI4 induced liver damage and elevated serum marker enzymes. Results: The results showed that the extract and fractions of stem bark of A. senegalensis had appreciable amounts of total flavonoids (845.67±93.62 mg/g) and total phenols (866.67±8.41), and exhibited good antioxidant activities at higher concentrations. Doses of the extract and fractions administered at 400 mg/kg protected the CCI4–induced lipid peroxidation and significantly (P = .05) reduced the elevated serum marker enzymes - aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphate (ALP), and bilirubin level on a dose and solvent dependent fashion. At 200 and 400 mg/kg extract, the serum AST was reduced (by 40.34% and 45.66% respectively) as much as the MeOH fraction (43.88%) and control (43.44%), whereas EtOAc fractions gave significantly the best reduction (52.49%). The ethyl acetate fraction gave the best activity among all the fractions. Conclusion: The results showed that the stem bark is a potential source of natural antioxidants and hepatoprotective agents, and justifies its use in traditional herbal practice.

Clinical performance evaluation of HBV serological biomarkers using SYSMEX HISCL5000 chemiluminescence analyzer / 医疗卫生装备

Objective To assess the detection performance of SYSMEX HISCL5000 automatic chemiluminescence immunoassay analyzer for serum hepatitis B virus (HBV) biomarkers.Methods Serological HBV biomarkers,including HBsAg,HBsAb,HBeAg,HbeAb and HbcAb,were measured by HISCLS000 analyzer.Further,a panel of parameters were analyzed,including precision,cross contamination rate,linear range,concordance rate,biological reference interval and limit of detection.According to the guideline from Clinical & Laboratory Standards Institues (CLSI) EP system,the potential clinical application of using HISCL5000 analyzer to measure serum HBV biomarkers were evaluated.Results A panel of five serum HBV biomarkers was measure by using HISCLS000 analyzer.The coefficient of variation (CV) value of the within-run imprecision was from 0.60％ to 4.17％,and CV value of the between-run imprecision was from 0.04％ to 5.35％.Linear verification showed that r2 was between 0.980 5 and 0.998 7,and a was between 0.970 9 and 1.022 6.The ratio of cross contamination was 0.00％.The coincident rate of HISCL5000 analyzer with other methods was between 96.00％ and 100.00％.Biological reference interval and limit of detectionderived from this analyzer were also proved qualified.Conclusion HISCL5000 analyzer can be used clinically to detect HBV biomarkers.

Clinical performance evaluation of HBV serological biomarkers using SYSMEX HISCL5000 chemiluminescence analyzer / 医疗卫生装备

Objective To assess the detection performance of SYSMEX HISCL5000 automatic chemiluminescence immunoassay analyzer for serum hepatitis B virus (HBV) biomarkers.Methods Serological HBV biomarkers,including HBsAg,HBsAb,HBeAg,HbeAb and HbcAb,were measured by HISCLS000 analyzer.Further,a panel of parameters were analyzed,including precision,cross contamination rate,linear range,concordance rate,biological reference interval and limit of detection.According to the guideline from Clinical & Laboratory Standards Institues (CLSI) EP system,the potential clinical application of using HISCL5000 analyzer to measure serum HBV biomarkers were evaluated.Results A panel of five serum HBV biomarkers was measure by using HISCLS000 analyzer.The coefficient of variation (CV) value of the within-run imprecision was from 0.60％ to 4.17％,and CV value of the between-run imprecision was from 0.04％ to 5.35％.Linear verification showed that r2 was between 0.980 5 and 0.998 7,and a was between 0.970 9 and 1.022 6.The ratio of cross contamination was 0.00％.The coincident rate of HISCL5000 analyzer with other methods was between 96.00％ and 100.00％.Biological reference interval and limit of detectionderived from this analyzer were also proved qualified.Conclusion HISCL5000 analyzer can be used clinically to detect HBV biomarkers.

Estimation of serum lactate dehydrogenase in smokeless tobacco consumers.

Statement of Problem: Salivary and serum lactate dehydrogenase (LDH) levels have been correlated with potentially malignant lesions. Salivary LDH levels require special testing and can be expensive. The need for a simple and cost‑effective analysis tool is essential to detect the oral malignant lesions to benefit rural populations. Aim: The aim of this study is to estimate the serum LDH in patients with oral lesions due to the consumption of smokeless tobacco. Materials and Methods: Thirty‑five patients with lesions were selected for this study while twenty patients served as a control. Levels of serum LDH were assessed. Age‑ and sex‑matched controls (n = 10) with no smokeless consumption habit and with the habit but without lesion (n = 10) also had their blood drawn to assess the basal level of LDH. The results were then analyzed through the two‑tailed t‑test and Chi‑square analysis using the SPSS statistics software. Results: The mean LDH value of patients with habit and lesion is 446.8 U/L; the mean LDH value for patients with habit but without the presence of a lesion is 421.2 U/L, and the mean LDH value for patients without a habit or lesion is 269.4 U/L. The patients having the habit of using smokeless tobacco had higher LDH values compared to the other two groups, and it is found to be statistically significant (p < 0.05). Conclusion: Serum LDH values increased in patients with the habit of chewing smokeless tobacco.

RE: Liver Shear-Wave Velocity to Diagnose Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B

No abstract available.

A study on the regional parameters of triple screening model of Down syndrome in the second trimester in Jinhua City / 预防医学

Objective To explore the regional parameters of triple screening model of Down syndrome in the second trimester in Jinhua City.Methods A total of 20 232 second trimester pregnant women with single fetus (gestational age at 15 -20 +6 weeks)was enrolled,and their serum samples were determined by American Perkin Elmer company Auto DELFIA automatic time -resolved fluorescence immunoassay analyzer for Down syndrome screening with triple markers, namely AFP,free β-hCG and uE3 .The risks of Down syndrome were evaluated by Lifecycle 3.2 software.And the risks of Down syndrome were re -calculated by local statistical median equations.Pregnant women were suggested to receive amniotic fluid fetal karyotype analysis if the risk of Down syndrome were equal or above 1 /270.Results Local median marker levels were significantly higher than the software built -in median levels (P <0.01).Both true -positive detection rates (sensitivity)were 87.50%.The false positive rate of local median equations was 4.24%,while the built -in median equations was 4.74%.Conclusion There are significant differences on the race and region by using the LifeCycle 3.2 median equations.The local equations may lower the false positive rate.

Can serum interleukin-2 receptor alpha predict lymph node metastasis in early gastric cancer? / 대한외과학회지

PURPOSE: Although local resection like endoscopic mucosal resection for early gastric cancer is accepted as a treatment option, one of the most important drawbacks of such an approach is the inability to predictlymph node metastasis. The aim of this study was to evaluate the serum soluble receptor alpha for interleukin-2 (IL-2Ralpha) level as a predictor of lymph node metastasis in the patients with early gastric cancer. METHODS: Assessment of pre-operative serum IL-2Ralpha levels was performed on 86 patients with early gastric cancer treated by gastrectomies combined with D2 lymph node resections and 20 healthy controls at Samsung Medical Center. Data on patient age and gender, tumor size, depth of invasion, histologic differentiation, and endoscopic findings were reviewed post-operatively. The submucosal lesions were divided into three layers (sm1, sm2, and sm3) in accordance with the depth of invasion. RESULTS: Lymph node metastasis was observed in 16 patients (18.6%). Statistically, the serum IL-2Ralpha level was an important predictive factor of lymph node metastasis in undifferentiated gastric cancer, and the cut-off point for the predictive value of serum IL-2Ralpha level was 200 U/mL. CONCLUSION: The serum IL-2Ralpha level might be a good predictor of lymph node metastasis in undifferentiated early gastric cancer.

Antidiabetic and Hypolipidemic effect of methanol extract of Lippia nodiflora L. in streptozotocin induced diabetic rats

Objective: To assess the antidiabetic and hypolipidemic properties of Lippia nodiflora (L. nodiflora).Methods:Acute toxicity test was done to check the toxicity of L. nodiflora methanol extract and oral glucose tolerance test was performed in normal rats. L. nodiflora methanol extract at three dose levels was administerd orally to streptozotocin (STZ) (40mg/kg bw) induced diabetic rats for 15 days. The various parameters were studied including body weight, fasting blood glucose levels, plasma insulin, lipid profile, glycogen content, glycoslylated hemoglobin (HbA1c) and serum marker enzyme levels in normal, treated and diabetic rats. Histochemical analysis of pancreas was also carried out in normal, treated and diabetic rats. Results: The treatment group with the extract at three dose levels showed a significant increase in the liver, muscle glycogen and serum insulin level and a significant decrease in fasting blood glucose, glycosylated hemoglobin levels and serum marker enzyme levels. The total cholesterol and serum triglycerides levels were also significantly reduced and the high density lipoprotein level was significantly increased upon treatment with the L. nodiflora methanol extract. Histochemical study of pancreas also confirmed the biochemical findings. Acute toxicity studies revealed the non-toxic nature of the L. nodiflora methanol extract. Conclusions: The results of the experiments presented here suggest that methanol extract of L. nodiflora exerts significant antidiabetic and hypolipidaemic effect in STZ-induced diabetic rats.

Korean-Specific Parameter Models for Calculating the Risk of Down Syndrome in the Second Trimester of Pregnancy

The purpose of the current study was to propose a Korean-specific parameter set for calculating the risk of Down syndrome in the second trimester of pregnancy and to determine the screening performances of triple and quadruple tests in Korean women. Using the data on triple or quadruple screening from three hospitals in Korea during 7 yr, we re-converted the concentrations of four serum markers to multiple of median values according to gestational age and maternal weight. After re-calculating the risk of Down syndrome in each pregnancy by multiplying maternal age-specific risk by the likelihood ratio values for the serum markers, screening performances and optimal cut-off values of triple and quadruple tests were analyzed. Among 16,077 pregnancies, 23 cases had Down syndrome (1.4/1,000 deliveries). Compared to the previous program, the tests with new parameters had improved screening performance. The triple and quadruple tests had detection rates of 65.2% and 72.7%, respectively, at a false-positive rate of 5%. The optimal cut-off value for the quadruple and triple tests was 1:250. We have presented a Korean-specific parameter set for Down syndrome screening. The proposed screening test using this parameter set may improve the performance of Down syndrome screening for Korean women.

Hepatoprotective activity of Luffa acutangula against CCl4 and rifampicin induced liver toxicity in rats: A biochemical and histopathological evaluation.

Hepatoprotective activity of hydroalcoholic extract of Luffa acutangula (HAELA) against carbon tetrachloride (CCl4) and rifampicin-induced hepatotoxicity in rats was evaluated and probable mechanism(s) of action has been suggested. Administration of standard drug- silymarin and HAELA showed significant hepatoprotection against CCl4 and rifampicin induced hepatotoxicity in rats. Hepatoprotective activity of HAELA was due to the decreased levels of serum marker enzymes viz., (AST, ALT, ALP and LDH) and increased total protein including the improvement in histoarchitecture of liver cells of the treated groups as compared to the control group. HAELA also showed significant decrease in malondialdehyde (MDA) formation, increased activity of non-enzymatic intracellular antioxidant, glutathione and enzymatic antioxidants, catalase and superoxide dismutase. Results of this study demonstrated that endogenous antioxidants and inhibition of lipid peroxidation of membrane contribute to hepatoprotective activity of HAELA.

Relation between Serum S100beta and Severity and Prognosis in Traumatic Brain Injury

PURPOSE: S100beta, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100beta, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100beta, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100beta, and neurologic outcome, and severity in traumatic brain injury. METHODS: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100beta, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). RESULTS: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100beta, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74+/-50 microgram/L vs 7.62+/-6.53 microgram/L P=0.002). A negative correlation existed between serum S100beta, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100beta, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100beta, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100beta. was 7.62 beta partial differential/L (SD=+/-6.53) in the expired patients, 1.15 microgram/L in the mildly disable patient, and 0.727 microgram/L (SD=+/-0.73) in the recovered patients. These differences are statistically significant (p<0.001). CONCLUSION: In traumatic brain injury, a higher level of serum concentration of S100beta, has a poor prognosis for neurologic outcome.

Maternal Serum and Amniotic Fluid Inhibin A Levels in Women who Subsequently Develop Severe Preeclampsia

The purpose of this study was to evaluate whether maternal serum (MS) and amniotic fluid (AF) inhibin A levels are elevated in patients who subsequently develop severe preecalmpsia, and to investigate the correlation between MS and AF inhibin A levels in the second trimester. The study included 40 patients who subsequently developed severe preecalmpsia and 80 normal pregnant women. Inhibin A levels in MS and AF were measured with enzyme-linked immunosorbent assay (ELISA). The MS and AF inhibin A levels in patients who developed severe preeclampsia were significantly higher than those in the control group (both for p<0.001). There was a positive correlation between MS and AF inhibin A levels in patients who developed severe preeclampsia (r=0.397, p=0.011), but not in the control group (r=0.185, p=0.126). The best cutoff values of MS and AF inhibin A levels for the prediction of severe preeclampsia were 427 pg/mL and 599 pg/mL, respectively; the estimated ORs that were associated with these cut-off values were 9.95 (95% CI 3.8-25.9, p<0.001) and 6.0 (95% CI 2.3-15.8, p<0.001). An elevated level of inhibin A in MS and AF at the time of second trimester amniocentesis may be a risk factor for the subsequent development of severe preeclampsia.

Assessing Liver Fibrosis with Non-Invasive Methods / 中国普外基础与临床杂志

Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis.Methods By summarized current situation and advancement of serum fibrotic markers,ultrasound,CT and MRI in assessing liver fibrosis,we investigated their value and limitations.Results In addition to diagnosis,non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis.For liver fibrosis,however,non-invasive methods can not monitor effectively reaction to therapy and progression.Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis,and reduce the need of liver biopsy.

Multivariate Analysis of Adverse Pregnancy Outcome by Multiprediction Factors / 대한산부인과학회잡지

PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( 2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.

Clinical analysis of triple marker screening test for fetal Down syndrome in midtrimester of pregnancy-Low sensitivity of triple marker screening test / 대한산부인과학회잡지

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.

Adverse Pregnancy Outcomes after a False-PositiveScreen for Down Syndrome using Triple Serum Markers / 대한산부인과학회잡지

OBJECT: To assess the relative risk of an adverse pregnancy outcome in women with a false-positive riskfor Down syndrome by prenatal screeen using triple markers(maternal serum alpha-fetoprotein[AFP], unconjugated estrio[uE3], and human chorionic gpna dotropin[hGC] levels) and age. METHODE: Case-Control study including sixity four women with false-positive screens for Down sydromeand a matched control group of 128 women whose screen indicated a risk for Down syndrome of less than1 :270. The risk for adverse pregnancy outcome was compared for the two groups,and the roles of maternal serum AFP, uE3, and hCG as predictors of adverse pregnancy outcome weredetermined. RESULT: Women with false-positive screen for Down syndrome were not significantly different from theirmatched controls in the incidence of preterm delivery (5% versus 2%), pretermpremature rupture of membrane(3% versus 0%), placental abruption(0% versus 1%),preeclampsia(3% versus 1%), small for gestational age newborns(5% versus 6%), and fetal demise after20 week's gestation(2% versus 0%). The occurrence of an adverse outcome in 7 of 64(11%) pregnancieswith a flase positive screen for Down syndrome was not different from that in 12 of 128(9%) matchedcontrol pregnancies.Only maternal age (odds ratio 1.19,95% cofidence interval 1.05~1.34, p < 0.005) was siginificantly associatedwith adverse outcome after controlling for the effects of maternal serum AFP, hCG and uF3. CONCLUSION: Althought the sample on this study, women with a false-positive screen for Down syndromedo not seem to be at increased risk for a adverse pregnancy outcome when compared to those with a negativescreen result. Among maternal age, maternal serum AFP, hCG, and uE3level, only maternal age seemed tobe a predictorof an adverse pregnancy outcome.

Adverse Pregnancy Outcomes after a False-PositiveScreen for Down Syndrome using Triple Serum Markers / 대한산부인과학회잡지

OBJECT: To assess the relative risk of an adverse pregnancy outcome in women with a false-positive riskfor Down syndrome by prenatal screeen using triple markers(maternal serum alpha-fetoprotein[AFP], unconjugated estrio[uE3], and human chorionic gpna dotropin[hGC] levels) and age. METHODE: Case-Control study including sixity four women with false-positive screens for Down sydromeand a matched control group of 128 women whose screen indicated a risk for Down syndrome of less than1 :270. The risk for adverse pregnancy outcome was compared for the two groups,and the roles of maternal serum AFP, uE3, and hCG as predictors of adverse pregnancy outcome weredetermined. RESULT: Women with false-positive screen for Down syndrome were not significantly different from theirmatched controls in the incidence of preterm delivery (5% versus 2%), pretermpremature rupture of membrane(3% versus 0%), placental abruption(0% versus 1%),preeclampsia(3% versus 1%), small for gestational age newborns(5% versus 6%), and fetal demise after20 week's gestation(2% versus 0%). The occurrence of an adverse outcome in 7 of 64(11%) pregnancieswith a flase positive screen for Down syndrome was not different from that in 12 of 128(9%) matchedcontrol pregnancies.Only maternal age (odds ratio 1.19,95% cofidence interval 1.05~1.34, p < 0.005) was siginificantly associatedwith adverse outcome after controlling for the effects of maternal serum AFP, hCG and uF3. CONCLUSION: Althought the sample on this study, women with a false-positive screen for Down syndromedo not seem to be at increased risk for a adverse pregnancy outcome when compared to those with a negativescreen result. Among maternal age, maternal serum AFP, hCG, and uE3level, only maternal age seemed tobe a predictorof an adverse pregnancy outcome.