Review: Opportunities and barriers for omics-based biomarker discovery in steatotic liver diseases

The rising prevalence of liver diseases related to obesity and excessive use of alcohol is fuelling an increasing demand for accurate biomarkers aimed at community screening, diagnosis of steatohepatitis and significant fibrosis, monitoring, prognosis and prediction of treatment efficacy. Breakthroughs in omics methodologies and the power of bioinformatics have created an excellent opportunity to combine clinical needs with technological advancements. Omics technologies allow for advanced investigations into biological processes from the genes to transcription and regulation, to circulating protein, metabolite and lipid levels, as well as the microbiome including bacteria, viruses and fungi. We consequently find ourselves in a period of rapid progress in technology and bioinformatics that may allow for development of precision biomarkers for personalised medicine. However, there are important barriers to consider in omics biomarker discovery and validation, including the use of semi-quantitative measurements from untargeted platforms, which may exhibit high analytical, inter- and intra-individual variance. Standardising methods and the need to validate across diverse populations, presents a challenge, partly due to disease complexity and the dynamic nature of biomarker expression in different disease stages. Lack of validity causes lost opportunities when studies fail to provide the knowledge needed for regulatory approvals, all of which contributes to a delayed translation of these discoveries into clinical practice. While no omics-based biomarkers have matured to clinical implementation, the extent of data generated through omics-technologies holds the power of hypothesis-free discovery of a plethora of candidate biomarkers to be further validated. To explore the many opportunities of omics technologies, hepatologists need detailed knowledge of commonalities and differences between the various omics layers, and both the barriers to and advantages of these approaches

Eletrocirurgia: sistemas mono e bipolar em cirurgia videolaparoscópica

O conhecimento das leis físicas e dos mecanismos de funcionamento da eletrocirurgia são de grande importância para o cirurgião. Lesões por eletrocirurgia em laparoscopia têm sido observadas, e estão associadas ao uso do eletrodo monopolar, com freqüência de 1 a 2 lesões a cada 1000 procedimentos.Com relação ao desenvolvimento de lesão, existem vários fatores que influenciam: densidade da corrente; o tipo de onda e de coagulação usadas, com suas respectivas voltagens; as condições de isolamento dos dispositivos; a ocorrência do fenômeno de capacitância; e os riscos oferecidos pelo uso em pacientes com marcapasso. No sistema bipolar, a densidade de corrente encontrada ao redor de seus eletrodos é bem menor, levando a menos lesões e, ainda, elimina vários dos outros mecanismos lesivos, como a placa de retorno e os citados acima. Vários estudos demonstram, em colecistectomias, apendicectomias, polipectomias e outros, que o índice de complicações com o eletrodo bipolar é significativamente menor.<br>the knowledge of the physical laws and of the mechanisms of functioning of electrosurgery are of great importance for the surgeon. Lesions caused by electrosurgery in laparoscopic procedures have been observed, and are associated with the use of monopolar electrode, with the frequency of 1 to 2 lesions in every 1000 procedures. Concerning the development of the lesions, several factors are involved; current density, the waveform and the type of coagulation used, with its respective voltages; the insulation condition of the devices; the occurrence of the phenomenon of capacitance and the risks involved with the use in patients with pacemakers. In bipolar electrosurgery, the current density produced around the electrodes is much lower, causing less tissue damage and, still, eliminating several of the other mechanims of injury, such as the dispersive electrode and those quoted above. Several studies reveal that the incidence of complications with the use of bipolar electrodes in cholecystectomies, appendicectomies, polypectomies and other procedures is significantly lower

On Financial Guarantee Insurance under Stochastic Interest Rates

We extend the financial guarantee insurance literature by modeling, under stochastic interest rates, private financial guarantees when the guarantor potentially defaults. By performing numerical simulations under plausible parameters values, we characterize the differential impact of the incorporation of stochasticity of interest rates on the valuation of both public and private guarantees. The Geneva Papers on Risk and Insurance Theory (1994) 19, 119–137. doi:10.1007/BF01371688