Evaluation of alternative serum biomarkers to monitor the progression of chronic HBV and HCV infection.

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most serious health conditions affecting about 600 million people worldwide leading to a number of severe liver diseases. Due to the lack of warning signs or mild symptoms during the early stage of the infection, a molecular signature associated with disease progression would be useful. Based on our recent paper where candidate biomarkers were determined through topological and modularity analysis of protein interaction networks (PINs), this study was focused on the evaluation of MIF, TNFRSF1A, FAS and TMSB4X as diagnostic biomarkers in chronic HBV and HCV infections. The aim was to establish a molecular profile, by combining those markers, that would discriminate the different stages during the progression of chronic hepatitis. One hundred and fifteen patients infected with HBV or HCV categorized into three groups: non-cirrhotic, cirrhotic and with HCC, and 20 healthy subjects were enrolled in this study. Serum levels of the aforementioned factors were measured by ELISA. TNFRSF1A serum levels appeared statistically significantly increased in all patient groups compared to control group with a p-value of <0.05. Furthermore, the combination of TNFRSF1A and TMSB4X serum levels successfully classified 63, 47% of patients indicating an association with HBV and HCV infections. Thus, variations of serum levels of TNFRSF1A and TMSB4X could be associated with the different stages of the disease and may be utilized for further research. On the other hand, we found no contribution of MIF and FAS serum levels for successful classification of patients.

A non-invasive methodology for fetal monitoring during pregnancy.

OBJECTIVES: This paper describes a methodology for the monitoring of the fetal cardiac health status during pregnancy, through the effective and non-invasive monitoring of the abdominal ECG signals (abdECG) of the mother. METHODS: For this purpose, a three-stage methodology has been developed. In the first stage, the fetal heart rate (fHR) is extracted from the abdECG signals, using nonlinear analysis. Also, the eliminated ECG (eECG) is calculated, which is the abdECG after the maternal QRSs elimination. In the second stage, a blind source separation technique is applied to the eECG signals and the fetal ECG (fECG) is obtained. Finally, monitoring of the fetus is implemented using features extracted from the fHR and fECG, such as the T/QRS ratio and the characterization of the fetal ST waveforms. RESULTS: The methodology is evaluated using a dataset of simulated multichannel abdECG signals: 94.79% accuracy for fHR extraction, 92.49% accuracy in T/QRS ratio calculation and 79.87% in ST waveform classification. CONCLUSIONS: The novel non-invasive proposed methodology is advantageous since it offers automated identification of fHR and fECG and automated ST waveform analysis, exhibiting a high diagnostic accuracy.

Diagnostic value of serum tumor markers in asymptomatic individuals.

PURPOSE: Tumor markers, particularly carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), are widely used in oncology, either in monitoring patients with metastatic colorectal cancer (CEA) or surveillance of hepatocellular carcinoma (HCC/AFP). The objective of this study was to determine the diagnostic value of CEA, CA19-9 or AFP in asymptomatic individuals. METHODS: 12 asymptomatic individuals (6 males), with age range 55-82 years, referred to outpatient Gastroenterology- Oncology department for second opinion, with slightly elevated serum CEA (8 persons), CA19-9 (2 persons), and AFP (2 persons). The tumor markers were ordered from the primary practitioner or internist in order to avoid further specific examinations, such as colonoscopy. All individuals were totally asymptomatic. One of them had a known-history of 5-year surgically removed malignant pediculated sigmoid polyp and remained asymptomatic since then. RESULTS: After continuous and repeated meticulous examinations in all individuals, no specific pathology was found to explain the slightly elevated tumor markers. In one male (59 years) and one female (75 years) with slightly elevated CEA levels, 2 small colonic polyps were found, which were endoscopically removed. Repeated CEA levels 3 months later remained borderline high. During follow-up, 3 years after the discovery of slightly elevated tumor markers all individuals remained asymptomatic (positive predictive value / PPV 0%). CONCLUSION: Although further prospective studies are necessary, the preliminary results of this study showed that tumor markers are not useful for primary prevention of gastrointestinal malignancy. Moreover, slightly elevated tumor markers are confusing, leading to unnecessary examinations and stress from the individual's point of view.

Upper gastrointestinal complaints as a consequence of thoracic spinal tumor.

A rare case of a 43-year-old male with chronic epigastric complaints and atypical diffuse osseous pain for two years, which were finally found to be caused by a benign thoracic spinal tumor (lipoma) and was successfully treated by neurosurgical resection, is presented. At three years follow-up postoperatively he remains completely asymptomatic. This report discusses the case and the potential pathophysiology of the patient's symptoms.

Early antiplatelet and antithrombotic therapy in patients with a history of recurrent miscarriages of known and unknown aetiology.

OBJECTIVES: To assess the efficacy of early thromboprophylaxis throughout pregnancy in women with previous history of first trimester recurrent miscarriages of unknown aetiology. METHODS: Low dose aspirin and low molecular weight heparin (LMWH) were administered from the day of detection of the fetal heart up to the 37th week, in two groups of patients of known (Group A, n = 24) and unknown aetiology recurrent miscarriages (Group B, n = 27). RESULTS: The success rate (viable pregnancy >24 weeks) was high and equally effective in both Groups A and B (83.3% and 85.1%, respectively). The complications recorded (pre-eclampsia, IUGR, placenta abruptio, injection site heamatomas and skin reactions) were more prevalent in Group A but of no significant difference. No abnormal bleeding was observed during vaginal delivery or caesarean section. CONCLUSIONS: Our results reaffirm previous reports that the use of LMWH in combination with low dose aspirin throughout pregnancy is safe and effective. It was also shown that the treatment is equally effective against recurrent miscarriages in both groups of patients, of known and unknown aetiology.

A knowledge-based technique for automated detection of ischaemic episodes in long duration electrocardiograms.

A novel method for the detection of ischaemic episodes in long duration ECGs is proposed. It includes noise handling, feature extraction, rule-based beat classification, sliding window classification and ischaemic episode identification, all integrated in a four-stage procedure. It can be executed in real time and is able to provide explanations for the diagnostic decisions obtained. The method was tested on the ESC ST-T database and high scores were obtained for both sensitivity and positive predictive accuracy (93.8% and 78.5% respectively using aggregate gross statistics, and 90.7% and 80.7% using aggregate average statistics).