Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

BACKGROUND Gastric cancer(GC)is one of the most common cancers worldwide.Morbidity and mortality have increased in recent years,making it an urgent issue to address.La-paroscopic radical surgery(LRS)is a crucial method for treating patients with GC;However,its influence on tumor markers is still under investigation.The data of 194 patients treated at Chongqing University Cancer Hospital bet-ween January 2018 and January 2019 were retrospectively analyzed.Patients who underwent traditional open surgery and LRS were assigned to the control(n=90)and observation groups(n=104),respectively.Independent sample t-tests andχ2 tests were used to compare the two groups based on clinical efficacy,changes in tumor marker levels after treatment,clinical data,and the incidence of posto-perative complications.To investigate the association between tumor marker levels and clinical efficacy in patients with GC,three-year recurrence rates in the two groups were compared.RESULTS Patients in the observation group had a shorter duration of operation,less in-traoperative blood loss,an earlier postoperative eating time,and a shorter hospital stay than those in the control group(P<0.05).No significant difference was observed between the two groups regarding the number of lymph node dissections(P>0.05).After treatment,the overall response rate in the control group was significantly lower than that in the observation group(P=0.001).Furthermore,after treatment,the levels of carbohydrate antigen 19-9,cancer antigen 72-4,carcinoembryonic antigen,and cancer antigen 125 decreased significantly.The observation group also exhibited a significantly lower incidence rate of postoperative complications compared to the control group(P<0.001).Additionally,the two groups did not significantly differ in terms of three-year survival and recurrence rates(P>0.05).CONCLUSION LRS effectively treats early gastric cancer by reducing intraoperative bleeding,length of hospital stays,and postoperative complications.It also significantly lowers tumor marker levels,thus improving the short-term prognosis of the disease.

Efficacy of concurrent chemoradiotherapy with thalidomide and S-1 for esophageal carcinoma and its influence on serum tumor markers

BACKGROUND Although the current conventional treatment strategies for esophageal carcinoma(EC)have been proven effective,they are often accompanied by serious adverse events.Therefore,it is still necessary to continue to explore new therapeutic strategies for EC to improve the clinical outcome of patients.AIM To elucidate the clinical efficacy of concurrent chemoradiotherapy(CCRT)with thalidomide(THAL)and S-1(tegafur,gimeracil,and oteracil potassium capsules)in the treatment of EC as well as its influence on serum tumor markers(STMs).METHODS First,62 patients with EC treated at the Zibo 148 Hospital between November 2019 and November 2022 were selected and grouped according to the received treatment.Among these,30 patients undergoing CCRT with cis-platinum and 5-fluorouracil were assigned to the control group(Con),and 32 patients receiving CCRT with THAL and S-1 were assigned to the research group(Res).Second,inter-group comparisons were carried out with respect to curative efficacy,incidence of drug toxicities,STMs[carbohydrate antigen 125(CA125)and macrophage inflammatory protein-3α(MIP-3α)],angiogenesis-related indicators[vascular endothelial growth factor(VEGF);VEGF receptor-1(VEGFR-1);basic fibroblast growth factor(bFGF);angiogenin-2(Ang-2)],and quality of life(QoL)[QoL core 30(QLQ-C30)]after one month of treatment.RESULTS The analysis showed no statistical difference in the overall response rate and disease control rate between the two patient cohorts;however,the incidences of grade I–II myelosuppression and gastrointestinal reactions were significantly lower in the Res than in the Con.Besides,the post-treatment CA125,MIP-3α,VEGF,VEGFR-1,bFGF,and Ang-2 Levels in the Res were markedly lower compared with the pre-treatment levels and the corresponding post-treatment levels in the Con.Furthermore,more evident improvements in QLQ-C30 scores from the dimensions of physical,role,emotional,and social functions were determined in the Res.CONCLUSION The above results demonstrate the effectiveness of THAL+S-1 CCRT for EC,which contributes to mild side effects and significant reduction of CA125,MIP-3α,VEGF,VEGFR-1,bFGF,and Ang-2 Levels,thus inhibiting tumors from malignant progression and enhancing patients’QoL.

Liver stiffness and serum markers for excluding high-risk varices in patients who do not meet Baveno VI criteria

BACKGROUND The Baveno VI criteria for predicting esophageal varices, i.e., liver stiffness measurement (LSM)< 20 kPa and platelet (PLT) count > 150 × 109/L, identify patients who can safely avoid gastroscopy screening. However, they require further refinement. AIM To evaluate the utility of LSM and serum markers of liver fibrosis in ruling out high-risk varices (HRV) in patients who do not meet Baveno VI criteria. METHODS Data from 132 patients with hepatitis B virus (HBV)-related compensated liver cirrhosis who did not meet the Baveno VI criteria were retrospectively reviewed. MedCalc 15.8 was used to calculate receiver operating characteristic (ROC) curves, and the accuracy of LSM, PLT count, aspartate aminotransferase (AST)- to-PLT ratio index, Fibrosis-4, and the Lok index in predicting HRV were evaluated according to the area under each ROC curve (AUROC). The utility of LSM, PLT, and serum markers of liver fibrosis stratified by alanine transaminase (ALT) and total bilirubin (TBil) levels was evaluated for ruling out HRV. RESULTS In all patients who did not meet the Baveno VI criteria, the independent risk factors for HRV were LSM and ALT. Only the AUROC of Lok index was above 0.7 for predicting HRV, and at a cutoff value of 0.4531 it could further spare 24.2% of gastroscopies without missing HRVs. The prevalence of HRV was significantly lower in patients with ALT or TBil ≥ 2 upper limit of normal (ULN)(14.3%) than in patients with both ALT and TBil < 2 ULN (34.1%)(P = 0.018). In the 41 patients with ALT and TBil < 2 ULN, LSM had an AUROC for predicting HRV of 0.821. LSM < 20.6 kPa spared 39.0% of gastroscopies without missing HRVs. In the 91 patients with ALT or TBiL ≥ 2 ULN, the Lok index and PLT had AUROCs of 0.814 and 0.741, respectively. Lok index ≤ 0.5596 or PLT > 100 × 109/L further spared 39.6% and 43.9% of gastroscopies, respectively, without missing HRVs. CONCLUSION In HBV-related compensated cirrhosis patients who do not meet Baveno VI criteria, the LSM, PLT, or Lok index cutoff stratified by ALT and TBil accurately identifies more patients without HRV.

Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C

AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C virus(HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography(TE) [FibroS can~/ARFI technology(Virtual Touch~)] and SM [FIB-4/aspartate aminotransferase-toplatelet ratio index(APRI)].The diagnostic performance of these tests was assessed using receiver operating characteristic curves.The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2,F ≥ 3 and F = 4.The Kappa index set the concordance analysis.RESULTS Fifty point six percent were female and the median age was 51 years(30-78).Fifty-six patients(70%) weretreatment-na?ve.The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kP a,for acoustic radiation force impulse(ARFI) 1.22 m/s,for APRI 0.75 and for FIB-4 1.47.For F ≥ 3 TE was 8.9 kP a,ARFI was 1.48 m/s,APRI was 0.75,and FIB-4 was 2.For F = 4,TE was 12.2 kP a,ARFI was 1.77 m/s,APRI was 1.46,and FIB-4 was 3.91.The APRI could not distinguish between F2 and F3,P = 0.92.The negative predictive value for F = 4 for TE and ARFI was 100%.Kappa index values for F ≥ 3 METAVIR score for TE,ARFI and FIB-4 were 0.687,0.606 and 0.654,respectively.This demonstrates strong concordance between all three screening methods,and moderate to strong concordance between them and APRI(Kappa index = 0.507).CONCLUSION Given the costs and accessibility of LSM methods,and the similarity with the outcomes of SM,we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis.This is of particular importance to developing countries.

Chronic hepatitis C virus infection:Serum biomarkers inpredicting liver damage

Currently, a major clinical challenge in the management of the increasing number of hepatitis C virus(HCV) infected patients is determining the best means for evaluating liver impairment. Prognosis and treatment of chronic hepatitis C(CHC) are partly dependent on the assessment of histological activity, namely cell necrosis and inflammation, and the degree of liver fibrosis. These parameters can be provided by liver biopsy; however, in addition to the risks related to an invasive procedure, liver biopsy has been associated with sampling error mostly due to suboptimal biopsy size. To avoid these pitfalls, several markers have been proposed as non-invasive alternatives for the diagnosis of liver damage. Distinct approaches among the currently available non-invasive methods are(1) the physical ones based on imaging techniques; and(2) the biological ones based on serum biomarkers. In this review, we discuss these approaches with special focus on currently available non-invasive serum markers. We will discuss:(1) class?Ⅰ?serum biomarkers individually and as combined panels, particularly those that mirror the metabolism of liver extracellular matrix turnover and/or fibrogenic cell changes;(2) class Ⅱ biomarkers that are indirect serum markers and are based on the evaluation of common functional alterations in the liver; and(3) biomarkers of liver cell death, since hepatocyte apoptosis plays a significant role in the pathogenesis of HCV infection. We highlight in this review the evidence behind the use of these markers and assess the diagnostic accuracy as well as advantages, limitations, and application in clinical practice of each test for predicting liver damage in CHC.

Serum tumor markers for detection of hepatocellular carcinoma

肝细胞癌(HCC ) 是最经常的恶性瘤之一并且是在中国的癌症死亡的第二个很普通的原因。因此，在它的更早的时期检测这疾病和复发是很重要的。作为为很长时间检测肝细胞癌的有效方法，浆液肿瘤标记能被划分成 4 个范畴：oncofetal 抗原和糖蛋白抗原；酶和 isoenzymes；基因；并且 cytokines。浆液高山哈 fetoprotein (法新社) 是在与肝细胞癌检测病人的最广泛地使用的肿瘤标记，并且被证明了有预示的能力预后。然而， AFP-L3 和 DCP 在把肝细胞癌区分开来与非恶意的肝病并且检测小肝细胞癌胜过法新社，这被显示了。一些肿瘤标记例如人的颈的癌症 oncogene 和人的 telomerase 颠倒 transcriptase mRNA，也被显示了比法新社有更高的精确性。而且，一些另外的肿瘤标记例如 glypican-3， gamma-glutamyl 转移酶 II， alpha-l-fucosidase，转变生长 factor-beta1，肿瘤特定的生长因素，被显示了是到在察觉的法新社的可得到的 supplementaries。法新社 mRNA 被显示了与 HCC 的转移和复发相关，并且预示可以是最有用的标记预后。一些另外的标记例如 gamma-glutamyl 转移酶 mRNA，脉管的内皮生长因素，和 interleukin-8，能也被用作可得到的预示的指示物，和法新社的同时的决心，这些标记可以在它的更早的时期检测 HCC 的复发。

Using SELDI-TOF-MS technology for screening serum markers of hepatic carcinoma in rats

Objective： To identify potential serum markers of hepatic carcinoma in rats through Surface-Enhanced Laser Desorption Ionization-Time of Flight-Mass Spectrometry（SELDI-TOF-MS） Technology. Methods： A rat model of hepatic carcinoma was established. The serum samples of hepatic carcinoma and normal rats were analyzed via SELDI-TOF-MS Technology. The changes of the serum protein fingerprint patterns were observed between the experimental group of hepatic carcinoma and the controls. The analysis was conducted by statistical software-Biomarker Wizard. Results： Fifty-six protein peaks in the serums were found. Within m/z 0-20 000, the protein peaks of rrdz 1158, 8 835 and 15 302 of hepatic carcinoma serums were obviously higher in the rat models compared with those in the controls（P 〈 0.01）. Conclusion： Three peaks were considered as potential biomarkers according to the serum protein fingerprint patterns of the hepatic carcinoma group and the control group.

Real time shear wave elastography in chronic liver diseases:Accuracy for predicting liver fibrosis,in comparison with serum markers

AIM:To evaluate the correlation between liver stiffness measurement(LSM)by real-time shear wave elastography(SWE)and liver fibrosis stage and the accuracy of LSM for predicting significant and advanced fibrosis,in comparison with serum markers.METHODS:We consecutively analyzed 70 patients with various chronic liver diseases.Liver fibrosis was staged from F0 to F4 according to the Batts and Ludwig scoring system.Significant and advanced fibrosis was defined as stage F≥2 and F≥3,respectively.The accuracy of prediction for fibrosis was analyzed using receiver operating characteristic curves.RESULTS:Seventy patients,15 were belonged to F0-F1 stage,20 F2,13 F3 and 22 F4.LSM was increased with progression of fibrosis stage(F0-F1:6.77±1.72,F2:9.98±3.99,F3:15.80±7.73,and F4:22.09±10.09,P<0.001).Diagnostic accuracies of LSM for prediction of F≥2 and F≥3 were 0.915(95%CI:0.824-0.968,P<0.001)and 0.913(95%CI:0.821-0.967,P<0.001),respectively.The cut-off values of LSM for prediction of F≥2 and F≥3 were 8.6kPa with 78.2%sensitivity and 93.3%specificity and10.46 kPa with 88.6%sensitivity and 80.0%specificity,respectively.However,there were no significant differences between LSM and serum hyaluronic acid and typeⅣcollagen in diagnostic accuracy.CONCLUSION:SWE showed a significant correlation with the severity of liver fibrosis and was useful and accurate to predict significant and advanced fibrosis,comparable with serum markers.

Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis

AIM:To investigate impairment and clinical significance of exocrine and endocrine pancreatic function in patients after acute pancreatitis(AP).METHODS:Patients with AP were invited to participate in the study.Severity of AP was determined by the Atlanta classification and definitions revised in2012.Pancreatic exocrine insufficiency(PEI)was diagnosed by the concentration of fecal elastase-1.An additional work-up,including laboratory testing of serum nutritional markers for determination ofmalnutrition,was offered to all patients with low levels of fecal elastase-1 FE.Hemoglobin A1c or oral glucose tolerance tests were also performed in patients without prior diabetes mellitus,and type 3c diabetes mellitus(T3c DM)was diagnosed according to American Diabetes Association criteria.RESULTS:One hundred patients were included in the study:75%(75/100)of patients had one attack of AP and 25%(25/100)had two or more attacks.The most common etiology was alcohol.Mild,moderately severe and severe AP were present in 67,15 and 18%of patients,respectively.The mean time from attack of AP to inclusion in the study was 2.7 years.PEI was diagnosed in 21%(21/100)of patients and T3c DM in14%(14/100)of patients.In all patients with PEI,at least one serologic nutritional marker was below the lower limit of normal.T3c DM was more frequently present in patients with severe AP(P=0.031),but was also present in some patients with mild and moderately severe AP.PEI was present in all degrees of severity of AP.There were no statistically significantly differences according to gender,etiology and number of AP attacks.CONCLUSION:As exocrine and endocrine pancreatic insufficiency can develop after AP,routine follow-up of patients is necessary,for which serum nutritional panel measurements can be useful.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Relationship of serum GDF11 levels with bone mineral density and bone turnover markers in postmenopausal Chinese women

Growth differentiation factor 11 （GDF11） is an important circulating factor that regulates aging. However, the role of GDF11 in bone metabolism remains unclear. The present study was undertaken to investigate the relationship between serum GDF11 level, bone mass, and bone turnover markers in postmenopausal Chinese women. Serum GDF11 level, bone turnover biochemical markers, and bone mineral density （BMD） were determined in 169 postmenopausal Chinese women （47-78 years old）. GDF11 serum levels increased with aging. There were negative correlations between GDF11 and BMD at the various skeletal sites. After adjusting for age and body mass index （BMI）, the correlations remained statistically significant. In the multiple linear stepwise regression analysis, age or years since menopause, BMI, GDF11, and estradiol were independent predictors of BMD. A significant negative correlation between GDF11 and bone alkaline phosphatase （BAP） was identified and remained significant after adjusting for age and BMI. No significant correlation was noted between cross-linked N-telopeptides of type I collagen （NTX） and GDF11. In conclusion, GDF11 is an independent negative predictor of BMD and correlates with a biomarker of bone formation, BAP, in postmenopausal Chinese women. GDF11 potentially exerts a negative effect on bone mass by regulating bone formation.

Matrix-derived serum markers in monitoring liver fibrosis in children with chronic hepatitis B treated with interferon alpha

瞄准：为了有希望地评估， 4 选择了浆液纤维变性标记(tenascin， hyaluronan，骨胶原 VI， TIMP-1 ) 以前，在期间并且在有长期的肝炎 B 的孩子的 IFN 治疗以后的 12 瞬间。方法：有长期的肝炎 B 的 47 个连续病人(范围 4-16 年，平均数 8 年) 经历了 IFN 治疗(为 20 wk 的 3 亩 tiw ) 。纤维变性舞台和发炎等级以前以一种使失明的方式被估计并且在治疗的结束以后的 12 瞬间。浆液纤维变性标记用自动化试金被决定。结果：IFN 治疗改进了组织学的发炎但是没在整个组或在亚群改变纤维变性。仅仅 hyaluronan 与组织学的纤维变性显著地相关(r = 0.3383， P = 0.021 ) 。基础纤维变性标记没在应答者(42.5%) 之间并且非不同应答者(57.5%) 。在 IFN 治疗期间，仅仅浆液 tenascin 在整个组并且在显著地减少了非应答者。预告的处理价值什么时候与相比，在治疗以后珍视 12 瞬间， TIMP-1 在所有病人并且在增加了非，应答者，和 hyaluronan 在所有病人并且在应答者减少了。结论：Tenascin 反映与长期的肝炎 B 在孩子的 IFN 治疗期间减少的肝的纤维发生和发炎。TIMP-1 相互关联与非有组织学的纤维变性的反应和 hyaluronan。

Validation of serum tumor biomarkers in predicting advanced cystic mucinous neoplasm of the pancreas

BACKGROUND Early detection of advanced cystic mucinous neoplasms[(A-cMNs),defined as high-grade dysplasia or malignancy]of the pancreas is of great significance.As a simple and feasible detection method,serum tumor markers(STMs)may be used to predict advanced intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms(MCNs).However,there are few studies on the usefulness of STMs other than carbohydrate antigen(CA)19-9 for early detection of A-cMNs.AIM To study the ability of five STMs-CA19-9,carcinoembryonic antigen(CEA),CA125,CA724,and CA242 to predict A-cMNs and distinguish IPMNs and MCNs.METHODS We mainly measured the levels of each STM in patients pathologically diagnosed with cMNs.The mean levels of STMs and the number of A-cMN subjects with a higher STM level than the cutoff were compared respectively to identify the ability of STMs to predict A-cMNs and distinguish MCNs from IPMNs.A receiver operating characteristic curve with the area under curve(AUC)was also created to identify the performance of the five STMs.RESULTS A total of 187 patients with cMNs were identified and 72 of them showed AcMNs.We found that CA19-9 exhibited the highest sensitivity(SE)(54.2%)and accuracy(76.5%)and a moderate ability(AUC=0.766)to predict A-cMNs.In predicting high-grade dysplasia IPMNs,the SE of CA19-9 decreased to 38.5%.The ability of CEA,CA125,and CA724 to predict A-cMNs was low(AUC=0.651,0.583,and 0.618,respectively).The predictive ability of CA242 was not identified.The combination of STMs improved the SE to 62.5%.CA125 may be specific to the diagnosis of advanced MCNs.CONCLUSION CA19-9 has a moderate ability,and CEA,CA125,and CA724 have a low ability to predict A-cMNs.The combination of STM testing could improve SE in predicting A-cMNs.

Elevated soluble 4-1BB is associated with serum markers of hepatitis B virus in patients with chronic hepatitis B

BACKGROUND Previous studies have suggested that the costimulatory molecule 4-1BB plays pivotal roles in regulating immunity during chronic viral infection.However,up to now,there are few studies about 4-1BB in chronic hepatitis B(CHB).AIM To clarify this issue,we report our comprehensive study results on the expression levels of 4-1BB in patients with CHB.METHODS From September 2018 to June 2019,a total of 64 patients with CHB were recruited from the Department of Hepatology,The First Hospital of Jilin University.Peripheral blood samples were collected from 52 treatment-naïve and 12 entecavir-treated patients with CHB as well as 37 healthy donors(including 24 healthy adults and 13 healthy children).The levels of soluble 4-1BB(s4-1BB)in plasma were measured by ELISA.4-1BB mRNA expression in peripheral blood mononuclear cells was detected by real-time quantitative PCR.RESULTS The s4-1BB levels in the plasma of patients with CHB were significantly higher than those in healthy adults(94.390±7.393 ng/mL vs 8.875±0.914 ng/mL,P<0.001).In addition,the s4-1BB level in plasma was significantly increased in patients with a higher viral load and a disease flare up.However,there were no significant differences between treatment-naïve and entecavir-treated patients.Interestingly,among treatment-naïve patients with CHB,the levels of s4-1BB in plasma had a significant positive correlation with hepatitis B surface antigen,hepatitis B virus DNA,hepatitis B e antigen,and triglyceride levels(r=0.748,P<0.001;r=0.406,P=0.004;r=0.356,P=0.019 and r=-0.469,P=0.007,respectively).The 4-1BB mRNA expression was higher in the peripheral blood mononuclear cells of patients with CHB than in the peripheral blood mononuclear cells of healthy adults,but the difference was not statistically significant.CONCLUSION These results suggest that the levels of s4-1BB may be associated with pathogenesis of hepatitis B virus and therefore may be a promising biomarker for disease progression.

Value of serum tumor markers and cytokines detection in elderly patients with breast cancer

Objective:To study the value of serum tumor markers CA125, CA153, CEA, -hCG, CA199, CYFRA21-1, beta and TPS cytokines IL-6, TNF- alpha, IL-8 and GDF-3 levels in the diagnosis of breast cancer, and provide reference for clinical diagnosis and treatment. Methods:A total of 293 cases of breast cancer patients admitted to our hospital from November 2015 to November 2017 were selected as the observation group. Besides, 125 patients with benign breast disease and 125 healthy people who came to our hospital for physical examination were also selected as benign breast disease group and control group, respectively. Serum tumor markers and cytokine changes were detected by using multiple tumor markers protein chip detection system and enzyme-linked immunosorbent assay (ELISA) among three groups.Results: Serum tumor markers and cytokine levels of observation group were higher than those in control group and benign breast disease group, the differences were statistically significant;through comparing different groups at different breast disease stages, serum tumor markers increase with the elevated stage, the highest in stage IV breast cancer. The difference was statistically significant;When benign breast disease group was compared with the control group, there was no significant difference in each index.Conclusion: The serum tumor markers CA125, CA153, CEA, -hCG, CA199, CYFRA21-1, beta and TPS cytokines IL-6, TNF- alpha, IL-8, GDF-3 show higher expression level in breast cancer and increase with the elevated stage. Therefore, it is worthy of attention.

Effects of concurrent chemoradiotherapy on serum tumor markers, MMP-9, VEGF and inflammatory factors in patients with endometrial carcinoma after operation

Objective:To investigate effects of concurrent chemoradiotherapy on serum tumor markers, vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and inflammatory factors in patients with endometrial carcinoma after operation.Methods: A total of 86 patients with endometrial carcinoma treated by surgery were selected as objects of study, according to random data table they were divided into control group (n=42) and observation group (n=44), patients of two groups were all underwent hysterectomy and bilateral adnexectomy treatment, on this basis, the control group was given radiotherapy treatment, observation group patients received concurrent chemotherapy treatment, the levels of serum tumor markers, VEGF, MMP-9 and inflammatory factor of the two groups before and after treatment were compared.Results: Before treatment, there was no significant difference in CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 levels between the observation group and the control group;After treatment, the levels of CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 in the two groups were significantly lower than those in the group before treatment, and the difference was statistically significant;After treatment, the levels of CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 in the observation group were significantly lower than those in the control group, the difference was statistically significant.Conclusion:The concurrent radiotherapy and chemotherapy can effectively reduce the levels of serum tumor markers, VEGF and MMP-9, and effectively decrease the inflammatory stress response in patients with endometrial carcinoma after operation, with critical clinical value.

Non-invasive diagnosis of liver fibrosis and cirrhosis

The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this "gold-standard" is imperfect; even according to its proponents, it is only "the best" among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.

Non-invasive assessment of liver fibrosis:Betweenprediction/prevention of outcomes and cost-effectiveness

The assessment of the fibrotic evolution of chronic hepatitis has always been a challenge for the clinical hepatologist. Over the past decade, various noninvasive methods have been proposed to detect the presence of fibrosis, including the elastometric measure of stiffness, panels of clinical and biochemical parameters, and combinations of both methods. The aim of this review is to analyse the most recent data on non-invasive techniques for the evaluation of hepatic fibrosis with particular attention to costeffectiveness. We searched for relevant studies published in English using the Pub Med database from 2009 to the present. A large number of studies have suggested that elastography and serum markers are useful techniques for diagnosing severe fibrosis and cirrhosis and for excluding significant fibrosis in hepatitis C virus patients. In addition, hepatic stiffness may also help to prognosticate treatment response to antiviral therapy. It has also been shown that magnetic resonance elastography has a high accuracy for staging and differentiating liver fibrosis. Finally, studies have shown that non-invasive methods are becoming increasingly precise in either positively identifying or excluding liver fibrosis, thus reducing the need for liver biopsy. However, both serum markers and transient elastography still have "grey area" values of lower accuracy. In this case, liver biopsy is still required to properly assess liver fibrosis. Recently, the guidelines produced by the World Health Organization have suggested that the AST-to-platelet ratio index or FIB-4 test could be utilised for the evaluation of liver fibrosis rather than other, more expensive non-invasive tests, such as elastography or Fibro Test.

sFRP-4, a potential novel serum marker for chronic hepatitis B-related hepatocellular carcinoma

BACKGROUND：The current methods used for diagnosing hepatocellular carcinoma（HCC）are unsatisfactory.Here,we assessed the serum levels of secreted frizzled related protein 4（s FRP-4）for diagnosing HCC in patients infected with chronic hepatitis B（CHB）.METHODS：In 272 patients with CHB enrolled,142 were pa tients with HCC.Thirty-three healthy subjects were recruited as healthy controls.The CHB patients were assigned to a test group or a validation group based on the time of enrollment. Human antibody arrays were used to screen 15 patients （8 CHB-related HCC patients, 7 CHB patients） for serum mark- ers. Four markers and one candidate marker were assessed in the test group and validation group, respectively. RESULTS： Human antibody assays indicated that the serum levels of sFRP-4 in HCC patients were significantly higher than those in CHB patients （P〈0,05）. Additionally, serum sFRP-4 levels were significantly higher in the HCC patients than those in the non-HCC patients in both test group （79.7 vs 41.3 ng/mL; P〈0.001） and validation group （89.0 vs 39.0 ng/mL; P〈0.001）. Areas under the Receiver Operating Charac- teristic curves （AUCs） for alpha-fetoprotein （AFP） and sFRP-4 were similar in both test group and validation group. In the test group, the combination of sFRP-4 （a sensitivity of 94.4%, a specificity of 60.5% at 46.4 ng/mL） and AFP （a sensitivity of 75.0%, a specificity of 87.2% at 11.3 ng/mL） showed better performance for diagnosing HCC （a sensitivity of 79.2% and a specificity of 95.3%）. The AUC for combined sFRP-4 and AFP increased to 0.941 （95% CI： 0.908-0.975）, and similar results were seen in the validation group. CONCLUSION： sFRP-4 is a candidate serum marker for diagnosing HCC in CHB patients, and the combination of sFRP-4 with AFP may improve the diagnostic accuracy of HCC.