Positioning of novel tumor marker NX-PVKA-R in the diagnosis of hepatocellular carcinoma in comparison with PIVKA-II

Background/Aims:To compare the use of protein induced by vitamin K absence or antagonist II( PIVKA-II) measured conventionally with the ratio between PIVKA-II measured using P-11 and P-16 antibodies(NX-PVKA) and PIVKA-II measured conventionally (NX-PVKA-R) in terms of false-positive resultsfor hepatocellular carcinoma( HCC). Methodology:Subjects comprised 318 patients with chronic liver disease,including 8 patients receiving warfarin treatment, which can result in false-positive results for HCC.HCC was present in 65 patients (HCC group) and absent in 253 (non-HCC group). PIVKA-II was measuredconventionally. NX-PVKA-R was calculated as PIVKA-II/NX-PVKA. Results:Both PIVKA-II andNX-PVKA-R were significantly higher in the HCC group than in the non-HCC group (p<0.0001 each).False-positive results were seen in 9.5% of non-HCC patients with PIVKA-II, and in 10.3% with NX-PVKA-R. False-positive results were seen for all 8 patients (100%) on warfarin with PIVKA-II, but for 0%with NX-PVKA-R. Sensitivity, specificity, and accuracy were all lower for NX-PVKA-R than PIVKA-II.Conclusions:NX-PVKA-R is not more useful than PIVKA-II for diagnosing HCC, but is very useful insubpopulations such as patients on warfarin and patients with jaundice. The characteristics of NX-PVKA-Rcan be best exploited by selecting patients in which these factors are present

Measurement of Tissue Stiffness with Virtual Touch Tissue Quantification in Two Cases of Spleen Tumor

We performed non-invasive measurement of tissue stiffness in the spleen for two patients using virtualtouch tissue quantification (VTTQ). Case 1 was an 82-year-old woman with Hodgkin lymphoma. Stiffnessmeasured using VTTQ was lower than normal spleen in tumor areas and higher than normal spleen in nontumorareas. Case 2 was a 66-year-old man with ascites and gastric cancer involving the entire spleen. Stiffnessof the spleen tumor as measured by VTTQ was higher than normal spleen. These cases demonstratedtwo new factors associated with elevated spleen stiffness:compression of healthy spleen tissue by tumorand cancer invasion

Impact of dynamic parameter of trends in vital signs on the prediction of serious events in hospitalized patients -a retrospective observational study

Aim: Although early detection of patients’ deterioration may improve outcomes, most of the detection criteria use on-the-spot values of vital signs. We investigated whether adding trend values over time enhanced the ability to predict adverse events among hospitalized patients. Methods: Patients who experienced adverse events, such as unexpected cardiac arrest or unplanned ICU admission were enrolled in this retrospective study. The association between the events and the combination of vital signs was evaluated at the time of the worst vital signs 0–8 hours before events (near the event) and at 24–48 hours before events (baseline). Multivariable logistic analysis was performed, and the area under the receiver operating characteristic curve (AUC) was used to assess the prediction power for adverse events among various combinations of vital sign parameters. Results: Among 24,509 in-patients, 54 patients experienced adverse events(cases) and 3,116 control patients eligible for data analysis were included. At the timepoint near the event, systolic blood pressure (SBP) was lower, heart rate (HR) and respiratory rate (RR) were higher in the case group, and this tendency was also observed at baseline. The AUC for event occurrence with reference to SBP, HR, and RR was lower when evaluated at baseline than at the timepoint near the event (0.85 [95%CI: 0.79–0.92] vs. 0.93 [0.88–0.97]). When the trend in RR was added to the formula constructed of baseline values of SBP, HR, and RR, the AUC increased to 0.92 [0.87–0.97]. Conclusion: Trends in RR may enhance the accuracy of predicting adverse events in hospitalized patients