Evaluation of the capability of oil specific discrimination in detection dogs.

Dogs are used for oil detection to support spill remediation and conservation, but little is known about the effects of weathering and aging of oil odorants on dogs' ability to generalize and discriminate unweathered oil from aged/weathered tar ball oil. Three dogs were trained to detect unweathered oil odorant using a three-alternative choice procedure and automated olfactometers. We evaluated dogs' ability to discriminate unweathered target oil from four different weathered/tar ball samples. All three dogs successfully discriminated the unweathered target oil from the four nontarget weathered oils with an accuracy of 96%, 97%, and 100%. After the oil discrimination test, dogs' ability to discriminate unweathered target oil from novel natural odorants on a beach (plastic bottle lid, bird feathers, and rocks) was tested in a novel discrimination test yielding an accuracy of 95%, 100%, and 100%. These data suggest dogs are successful in discriminating unweathered oil from weathered oil with explicit training.

Part, III: Increasing odor detection performance after training with progressively leaner schedules of odor prevalence.

Prior work has demonstrated canine search behavior and performance declines when challenged with infrequent target odors. The purpose of this study was to evaluate whether performance could be maintained in a low target odor prevalence context by explicitly training dogs through progressively leaner target odor schedules. In Experiment 1, nine control dogs were trained at 90% target prevalence rate. Nine experimental dogs were trained with progressively lower prevalence rates in 10% increments until reaching 20% prevalence with > 85% detection accuracy in the training context. Both groups were tested in the operational context at a 10% target odor prevalence. Experimental dogs had higher accuracy, hit percentage, and shorter search latency in the operational context compared with control dogs. In Experiment 2, twenty-three operational dogs were challenged with a target frequency of 10%, which resulted in 67% accuracy. Control dogs were then trained with 90% target frequency, whereas experimental dogs received a progressively decreasing target rate from 90% to 20%. The dogs were rechallenged with target frequencies of 10, 5, and 0%. Experimental dogs outperformed control dogs (93% vs. 82% accuracy) highlighting the effect of explicit training for infrequent targets.

Explosive odor signature profiling: A review of recent advances in technical analysis and detection.

With the ever-increasing threat of improvised explosive devices (IEDs) and homemade explosives (HME) both domestically and abroad, detection of explosives and explosive related materials is an area of urgent importance for preventing terrorist activities around the globe. Canines are a common biological detector used in explosive detection due to their enhanced olfactory abilities, high mobility, efficient standoff sampling, and optimal identification of vapor sources. While other sensors based on different principles have emerged, an important concept for the rapid field detection of explosives is understanding key volatile organic compounds (VOCs) associated with these materials. Explosive detection technology needs to be on par with a large number of threats including an array of explosive materials as well as novel chemicals used in the manufacture of IEDs. Within this much needed area of research for law enforcement and homeland security applications, several studies have sought to understand the explosive odor profile from a range of materials. This review aims to provide a foundational overview of these studies to provide a summary of instrumental analysis to date on the various types of explosive odor profiles evaluated focusing on the experimental approaches and laboratory techniques utilized in the chemical characterization of explosive vapors and mixtures. By expanding upon these concepts, a greater understanding of the explosive vapor signature can be achieved, providing for enhanced chemical and biological sensing of explosive threats as well as expanding upon existing laboratory-based models for continued sensor development.

A laboratory model of canine search vigilance decrement, I.

Previous studies have found that infrequent targets can reduce dogs' vigilance. The purpose of this study was to develop a laboratory model to evaluate the effects of infrequent targets on dogs' search behavior and performance. Dogs (n = 18) were trained to detect smokeless powder in an automated olfactometer in two distinct rooms ("operational" and "training"). During baseline, the dogs received five daily sessions at a high target odor frequency (90%) in both rooms. Subsequently, the frequency of the target odor was decreased to 10% only in the "operational" room but remained at 90% in the training room. Last, the odor prevalence was returned to 90% in both rooms. All dogs showed a significant decrement in detection performance in the operational room when the target odor frequency was decreased but simultaneusly mantained high performance in the training room. This decrement was largely due to decreases in adequate search behavior. All dogs recovered performance when the odor frequency was increased again to 90%. Trial accuracy was associated with tail position, search score, latency, and duration of environmentally directed behaviors. The data show that low target odor prevalence significantly reduced search behavior and performance and that there are behaviors that can be used by handlers to assess their dog's search state.

Co-Detection of EBV and Human Polyomavirus JCPyV in a Case of AIDS-Related Multifocal Primary Central Nervous System Diffuse Large B-Cell Lymphoma.

The human neurotropic Polyomavirus JCPyV is the widespread opportunistic causative pathogen of the fatal demyelinating disease progressive multifocal leukoencephalopathy; however, it has also been implicated in the oncogenesis of several types of cancers. It causes brain tumors when intracerebrally inoculated into rodents, and genomic sequences of different strains and expression of the viral protein large T-Antigen have been detected in a wide variety of glial brain tumors and CNS lymphomas. Here, we present a case of an AIDS-related multifocal primary CNS lymphoma in which JCPyV genomic sequences of the three regions of JCPyV and expression of T-Antigen were detected by PCR and immunohistochemistry, respectively. No capsid proteins were detected, ruling out active JCPyV replication. Sequencing of the control region revealed that Mad-4 was the strain of JCPyV present in tumor cells. In addition, expression of viral proteins LMP and EBNA-1 from another ubiquitous oncogenic virus, Epstein-Barr, was also detected in the same lymphocytic neoplastic cells, co-localizing with JCPyV T-Antigen, suggesting a potential collaboration between these two viruses in the process of malignant transformation of B-lymphocytes, which are the site of latency and reactivation for both viruses.

Pathogenesis and Mechanisms of SARS-CoV-2 Infection in the Intestine, Liver, and Pancreas.

The novel coronavirus, SARS-CoV-2, rapidly spread worldwide, causing an ongoing global pandemic. While the respiratory system is the most common site of infection, a significant number of reported cases indicate gastrointestinal (GI) involvement. GI symptoms include anorexia, abdominal pain, nausea, vomiting, and diarrhea. Although the mechanisms of GI pathogenesis are still being examined, viral components isolated from stool samples of infected patients suggest a potential fecal-oral transmission route. In addition, viral RNA has been detected in blood samples of infected patients, making hematologic dissemination of the virus a proposed route for GI involvement. Angiotensin-converting enzyme 2 (ACE2) receptors serve as the cellular entry mechanism for the virus, and these receptors are particularly abundant throughout the GI tract, making the intestine, liver, and pancreas potential extrapulmonary sites for infection and reservoirs sites for developing mutations and new variants that contribute to the uncontrolled spread of the disease and resistance to treatments. This transmission mechanism and the dysregulation of the immune system play a significant role in the profound inflammatory and coagulative cascades that contribute to the increased severity and risk of death in several COVID-19 patients. This article reviews various potential mechanisms of gastrointestinal, liver, and pancreatic injury.

Training with varying odor concentrations: implications for odor detection thresholds in canines.

Detection dogs are required to detect trace quantities of substances, many times in the parts per billion or parts per trillion concentration range. Frequently, detection of trace quantities is not explicitly trained but rather assumed when dogs show proficiency at higher concentrations to which they are trained. The aim of this study was to evaluate the effect of the odor concentration of the training sample on the minimum concentration dogs will subsequently detect. We expected that dogs may not spontaneously generalize to trace odor concentration when trained with higher concentrations, but when trained to a range of lower concentrations, dogs will show superior detection to lower untrained concentrations. A total of 11 dogs were randomly assigned to 2 groups and were trained to alert to isoamyl acetate at 0.01% odor dilution (v/v with mineral oil) using a 3-alternative forced choice test. Once reaching proficiency, odor detection threshold was assessed using a 2-down 1-up descending staircase procedure. Next, experimental dogs received training with systematically lower concentrations of isoamyl acetate and threshold re-assessed. Control dogs were yoked to experimental dogs in terms of training time, but only received training to the 0.01% dilution between threshold assessments. Experimental dogs showed significantly improved detection thresholds, outperforming control dogs by detecting an average dilution about 100-fold lower. Results suggest that explicitly training for lower concentrations is critical for generalization for trace odor detection.

Stimulus Control of Odorant Concentration: Pilot Study of Generalization and Discrimination of Odor Concentration in Canines.

Despite dogs' widespread use as detection systems, little is known about how dogs generalize to variations of an odorant's concentration. Further, it is unclear whether dogs can be trained to discriminate between similar concentration variations of an odorant. Four dogs were trained to an odorant (0.01 air dilution of isoamyl acetate) in an air-dilution olfactometer, and we assessed spontaneous generalization to a range of concentrations lower than the training stimulus (Generalization Test 1). Dogs generalized to odors within a 10-fold range of the training odorant. Next, we conducted discrimination training to suppress responses to concentrations lower than a concentration dogs showed initial responding towards in Generalization Test 1 (0.0025 air dilution). Dogs successfully discriminated between 0.0025 and 0.01, exceeding 90% accuracy. However, when a second generalization test was conducted (Generalization Test 2), responding at the 0.0025 concentration immediately recovered and was no different than in Generalization Test 1. Dogs were then tested in another generalization test (Compound Discrimination and Generalization) in which generalization probes were embedded within discrimination trials, and dogs showed suppression of responding to the 0.0025 concentration and lower concentrations in this preparation. These data suggest dogs show limited spontaneous generalization across odor concentration and that dogs can be trained to discriminate between similar concentrations of the same odorant. Stimulus control, however, may depend on the negative stimulus, suggesting olfactory concentration generalization may depend on relative stimulus control. These results highlight the importance of considering odor concentration as a dimension for generalization in canine olfactory research.

Virologic suppression in patients with a documented M184V/I mutation based on the number of active agents in the antiretroviral regimen.

OBJECTIVES: The optimal antiretroviral therapy for patients with the M184V/I mutation is not known. The primary objective of this study was to determine the efficacy of various antiretroviral therapies in patients with HIV and the M184V/I mutation based on the number of active antiretroviral agents. METHODS: A retrospective chart review was conducted of 100 treatment-experienced patients harboring the M184V/I mutation seen at an urban HIV clinic. Efficacy was classified as percentage of patients with viral suppression defined as HIV RNA viral load <200 copies/mL at last measurement on current antiretroviral therapy, stratified by the number of active antiretroviral agents. RESULTS: The primary outcome of viral suppression occurred in 70.6% (12/17) of patients on <2 active agents, 77.2% (44/57) on 2-2.5 active agents, and 69.2% (18/26) on 3 active agents. No significant difference was found between viral suppression and patients on <2 and 2-2.5 antiretroviral agents (odds ratio = 0.71, 95% confidence interval = (0.21, 2.39), p = 0.8) or between patients on 3 and 2-2.5 active agents (odds ratio = 0.66, 95% confidence interval = (0.23, 1.88), p = 0.7). The most commonly prescribed regimen consisted of a boosted protease inhibitor with an integrase strand transfer inhibitor and two nucleoside reverse transcriptase inhibitors, one of which being lamivudine or emtricitabine. CONCLUSION: Similar rates of viral suppression were observed in patients regardless of the number of active antiretroviral agents prescribed. Regimens containing less than 3 active agents may maintain virologic suppression in patients with the M184V/I mutation. Further studies are needed to determine optimal antiretroviral therapy for patients with the M184V/I mutation.

Effect of Handler Knowledge of the Detection Task on Canine Search Behavior and Performance.

Detection dogs are commonly trained and tested under conditions in which the handler or the evaluator knows the true presence or absence of a target odor. Previous research has demonstrated that when handlers are deceived and led to believe that a target odor is present, more false alerts occur. However, many detection teams operate under unknown conditions, and it remains unclear how handler knowledge (or lack thereof) of odor presence/absence influences the dog's behavior. The aim of this study was to evaluate if knowing the number of hides placed influenced detection dog performance in an applied search environment. Professional (n = 20) and sport (n = 39) detection handler-dog teams were asked to search three separate areas (area 1 had one hide, area 2 had one hide, area 3 was blank). Handlers in the Unknown Group were not told any information on the number of hides whereas the Known Group were told there was a total of two hides in the three areas. The sport Unknown Group spent a longer duration (69.04 s) searching in area 3 compared to the sport Known Group (p = 0.004). Further, sport dogs in the Unknown group looked back to the handler more frequently. When a miss did occur, dogs of both sport and professional handlers showed an increase interest in the location of the target odor compared to a comparison location. Critically, however, there was no difference in false alerts between the Known Group and Unknown Group for sport or professional handlers. In a second experiment, fourteen professional, and thirty-nine sport teams from Experiment 1 conducted an additional search double-blind and an additional search single-blind. Both sport and professional-handler dog teams had statistically similar accuracy rate under single and double blind conditions. Overall, when handlers knew the number of hides, it led to significant changes in search behavior of the detection team but did not influence the overall false alert rates.

Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure.

Gout is the most common inflammatory arthritis and is often comorbid with cardiovascular disease (CVD). Hyperuricemia and gout are also independent risk factors for cardiovascular events, worsening heart failure (HF), and death. The recommended treatment modalities for gout have important implications for patients with CVD because of varying degrees of cardiovascular and HF benefit and risk. Therefore, it is critical to both manage hyperuricemia with urate-lowering therapy (ULT) and treat acute gout flares while minimizing the risk of adverse cardiovascular events. In this review, the evidence for the safety of pharmacologic treatment of acute and chronic gout in patients with CVD and/or HF is reviewed. In patients with CVD or HF who present with an acute gout flare, colchicine is considered safe and potentially reduces the risk of myocardial infarction. If patients cannot tolerate colchicine, short durations of low-dose glucocorticoids are efficacious and may be safe. Nonsteroidal anti-inflammatory drugs should be avoided in patients with CVD or HF. The use of canakinumab and anakinra for acute gout flares is limited by the high cost, risk of serious infection, and relatively modest clinical benefit. For long-term ULT, allopurinol, and alternatively probenecid, should be considered first-line treatments in patients with CVD or HF given their safety and potential for reducing cardiovascular outcomes. An increased risk of cardiovascular death and HF hospitalization limit the use of febuxostat and pegloticase as ULT in this population. Ultimately, the selection of agents used for acute gout management and long-term ULT should be individualized according to patient and agent cardiovascular risk factors.

Ex vivo mechanical properties of a 2.5-mm bone anchor for treatment of cranial cruciate ligament rupture in toy breed dogs.

OBJECTIVE: To determine the mechanical pull-out properties of a 2.5-mm bone anchor implanted in ex vivo femurs of toy breed dogs and to determine whether there is a difference between knotted and knotless configurations. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Eight paired harvested femurs. METHODS: Femurs were assigned to knotted or knotless configuration. Equal numbers of right and left femurs were tested. The caudolateral femoral condyle at the distal pole of the lateral fabella (F2 site) was drilled. The assigned configuration with braided suture combined with the bone anchor was implanted into the F2 site. Each configuration was positioned into a mechanical testing machine to measure yield load, load at 3-mm displacement, ultimate load, stiffness, and mode of failure at the beginning of the canine standing phase angle (150°). RESULTS: Mean ultimate load was 100.14 and 88.69 N (P = .798), mean yield load was 59.72 and 55.85 N (P = .708), load at 3-mm displacement was 46.72 and 43.33 N (P = .656), and stiffness was calculated to be 43.06 and 47.09 N/mm (P = .548) for knotted and knotless configurations, respectively. Mode of failure occurred primarily by anchor pull-out. CONCLUSION: The bone anchor withstood deformation at the estimated forces applied on the native cranial cruciate ligament (CCL) of toy breed dogs in both configurations. CLINICAL SIGNIFICANCE: This bone anchor may constitute a useful alternative for stabilization of the CCL deficient stifle in toy breed dogs. However, before it can be recommended for widespread use in dogs, closely monitored clinical trials must be conducted to assess outcome and complications associated with this implant.

Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency.

CASE SERIES SUMMARY: Medical records were reviewed for cats that underwent a perineal urethrostomy performed in dorsal recumbency for the treatment of urethral obstruction. Information, including signalment, reason for presentation, number of previous obstructions, surgery time, and perioperative and postoperative complications, were collected through a review of medical records and owner follow-up. The objective was to evaluate short- and long-term complications in cats that underwent perineal urethrostomy performed in dorsal recumbency for treatment of urethral obstruction. RELEVANCE AND NOVEL INFORMATION: No major or life-threatening complications, such as urethral stricture, re-obstruction, euthanasia due to lower urinary signs or chronic urinary tract infection, were reported. Short-term complications were limited to dysuria in 2/12 (16.7%) cats. Long-term follow-up was available for nine cats. The most common long-term complication seen in this population of cats was a single recurrence of urinary tract infection in 3/9 (33.3%) cats that resolved after a short course of empirical antibiotic therapy. Performing perineal urethrostomy in dorsal recumbency is safe and may have advantages to ventral recumbency due to improved visualization, allowing for more efficient dissection and improved accuracy in tissue apposition during closure. We believe this has been a major contributor to our reported reduced major postoperative complication rate.

An aspirin a day? Clinical utility of aspirin therapy for the primary prevention of cardiovascular disease.

Introduction: Cardiovascular disease remains a leading cause of morbidity and mortality. Since the description of its therapeutic potential, aspirin has been a cornerstone of therapy following vascular events. However, aspirin in the primary prevention setting is controversial and major guideline groups provide inconsistent recommendations. Thus, there is variability in practice as providers are faced with a balance of therapeutic benefit and drug-induced harm. Areas covered: This article provides a critical appraisal of both past and present data for aspirin in the primary prevention setting. PubMed and Cochrane Central Register databases were searched from inception to May 1st, 2019. Expert opinion: The decision to initiate or withdraw aspirin for primary prevention requires an understanding of the equilibrium between efficacy and safety. In adults greater than 70 years of age, low to moderate cardiovascular risk, controlled diabetes, or at high risk of bleeding, initiation of aspirin for primary prevention should generally be avoided. Instead, risk factor modification should be prioritized. The net benefit of aspirin in those at high risk for cardiovascular disease and in those with uncontrolled diabetes is largely unknown. Ultimately, initiation or withdrawal of aspirin therapy must involve discussion of the patient's wishes and treatment expectations.

When the Nose Doesn't Know: Canine Olfactory Function Associated With Health, Management, and Potential Links to Microbiota.

The impact of health, management, and microbiota on olfactory function in canines has not been examined in review. The most important characteristic of the detection canine is its sense of smell. Olfactory receptors are primarily located on the ethmoturbinates of the nasal cavity. The vomeronasal organ is an additional site of odor detection that detects chemical signals that stimulate behavioral and/or physiological changes. Recent advances in the genetics of olfaction suggest that genetic changes, along with the unique anatomy and airflow of the canine nose, are responsible for the macrosmia of the species. Inflammation, alterations in blood flow and hydration, and systemic diseases alter olfaction and may impact working efficiency of detection canines. The scientific literature contains abundant information on the potential impact of pharmaceuticals on olfaction in humans, but only steroids, antibiotics, and anesthetic agents have been studied in the canine. Physical stressors including exercise, lack of conditioning, and high ambient temperature impact olfaction directly or indirectly in the canine. Dietary fat content, amount of food per meal, and timing of meals have been demonstrated to impact olfaction in mice and dogs. Gastrointestinal (GI) microbiota likely impacts olfaction via bidirectional communication between the GI tract and brain, and the microbiota is impacted by exercise, diet, and stress. The objective of this literature review is to discuss the specific effects of health, management, and microbiota shifts on olfactory performance in working canines.

Minimal 10-year results of a tapered cementless femoral component in total hip arthroplasty.

A series of 120 primary total hip arthroplasties with minimal 10-year follow-up, in which a cementless, proximal-to-distal, dual-tapered geometry femoral component was used, was reviewed. At a mean follow-up interval of 12.20 years, a mean Harris hip score improvement of 38 points was calculated. Three (2.5%) femoral components were revised secondary to aseptic loosening, yielding a 97.5% survivorship. Thigh pain was mild or absent in 96.6% of the cases. Distal femoral osteolysis was observed in <2% of cases. The Harris hip score improvement, low incidence of severe thigh pain, high survivorship, and low incidences of significant stress shielding and distal osteolysis suggest excellent long-term results with the use of this uncemented tapered design, adding credence to the design rationale and justifying its continued use.

Short-term results of the M2a-taper metal-on-metal articulation.

A polyethylene-free, metal-on-metal acetabular system (M2a-taper [Biomet, Inc., Warsaw, IN]) was designed in an effort to improve total hip arthroplasty (THA) longevity. Minimum 2-year follow-up results involving 72 polyethylene liner THAs and 78 metal liner THAs from a multicenter, randomized, controlled, investigational device exemption study are reported. Mean Harris hip scores of 95.54 (polyethylene liner group) and 95.23 (metal liner group) were reported at mean follow-up intervals of 3.29 and 3.23 years. Radiographic evaluation revealed no evidence of early failure. No acetabular components have been revised or are pending revision. No statistically significant differences in the data were calculated between liner types except for the immediate postoperative (P=.0415) and minimum 2-year follow-up (P=.0341) angles of inclination. The M2a-taper metal-on-metal articulation may represent a viable alternative for THA in younger, higher demand patients.

Simultaneous bilateral total knee arthroplasties: who decides?

The purpose of the current retrospective review was to compare the results of 1498 patients having 1090 simultaneous bilateral total knee arthroplasties and 958 unilateral total knee arthroplasties in a 3-year period, focusing on perioperative complications, length of hospital stay, and discharge disposition. Gender, age, diagnosis, and weight were similar between the groups. Patients undergoing simultaneous bilateral total knee arthroplasties had statistically significant higher amounts of intraoperative blood loss, with more patients requiring blood transfusion, and a higher average number of units of blood transfused compared with patients undergoing unilateral total knee arthroplasty. Overall, a significantly higher incidence of gastrointestinal complications was reported in patients who had simultaneous bilateral knee arthroplasties compared with patients who had unilateral knee arthroplasty. Comparing age subgroups within the unilateral group revealed significantly higher incidences of pulmonary, neurologic, cardiac, and genitourinary complications among patients 80 years or older versus patients younger than 80 years. Patients having simultaneous bilateral arthroplasties who were 80 years or older had significantly higher incidences of pulmonary, neurologic, and cardiac complications than patients younger than 80 years in that same group. These results suggest that age, not procedure, has a more significant role in the perioperative morbidity of total knee arthroplasty. Based on the results from the current study and previous literature documenting patient preference, patient satisfaction, efficacy, and outcomes comparable with those of patients having unilateral total knee arthroplasty, the authors continue to offer patients the option of simultaneous bilateral total knee arthroplasties.

An algorithm for the posterior cruciate ligament in total knee arthroplasty.

The fate of the posterior cruciate ligament in primary total knee arthroplasty is controversial. An algorithmic approach is presented that is based on pathologic criteria for evaluating and treating patients with primary total knee arthroplasty that will aid in the posterior cruciate ligament decision-making process, producing more predictable procedures and outcomes. A consecutive series of the first 120 patients (171 knees) who had primary posterior cruciate-retaining arthroplasty and the first 120 patients (180 knees) who had primary posterior-stabilized arthroplasty with a minimum 5-year followup in which the Maxim Complete Total Knee System and the algorithmic approach were used were compared. No statistically significant differences in outcome between the groups were observed. Among the patients who had posterior cruciate-retaining arthroplasty, no revisions attributable to aseptic loosening have been reported at an average followup of 6.39 years. The average followup Knee Society total score was 162.16 points, with 91 (54.8%) knees having excellent outcome ratings. No revisions attributable to aseptic loosening have been reported among the patients who had posterior-stabilized arthroplasty at an average followup of 5.98 years. The average followup Knee Society total score was 158.05 points, with excellent outcome ratings reported in 96 (54.9%) knees. The use of a standardized algorithm has streamlined the treatment of patients having primary total knee arthroplasty, consistently providing excellent clinical results when either retaining or sacrificing the posterior cruciate ligament.

AFP-L3: a new generation of tumor marker for hepatocellular carcinoma.

BACKGROUND: Alpha-fetoprotein (AFP) from hepatocellular carcinoma (HCC) displays differential affinity to lectin Lens culinaris agglutinin (LCA) compared to that from chronic hepatitis/liver cirrhosis. According to their binding capability to LCA, total AFP can be separated into three different glycoforms, AFP-L1, AFP-L2, and AFP-L3. AFP-L1 is the non-LCA-bound fraction, which constitutes the major glycoform of AFP in serum of chronic hepatitis and liver cirrhosis. AFP-L3 is the LCA-bound fraction of AFP. It has been reported that malignant liver cells produce AFP-L3, even when HCC is at its early stages, and especially when the tumor mass is supplied by the hepatic artery. Clinical research has determined that AFP-L3 is a highly specific marker for HCC. The AFP-L3 can be detected in the serum of approximately 35% of the patients with small HCC (<2 cm). The AFP-L3-positive HCC has potential for rapid growth and early metastasis. Compared to imaging techniques, it has been shown to have 9-12 months of lead-time in early HCC recognition. Combined sensitivity of AFP-L3 for HCC is 56%, with a specificity of >95%. METHODS: Automated assay for measuring AFP-L3 has been developed and introduced in clinical use. The new automated method for measurement of ALP-L3 is based on liquid phase binding of the AFP-L3 glycoform with LCA and two specific monoclonal antibodies labeled with peroxidase and polysulfated tyrosine peptide, respectively. CONCLUSION: AFP-L3 is a new generation of tumor marker for HCC and yields useful information on HCC for clinical decision making.