In fact, despite how often blue colours are suggested to be apose

In fact, despite how often blue colours are suggested to be aposematic [e.g. nudibranch – Nembrotha kubaryana (Karuso & Scheuer, 2002), blue-tongued lizard – Tiquila scincoides (Wilsdon, 2009), blue ringed octopus – Hapalochlaena maculosa (Williams, 2010), mountain katydid – Acripeza reticulata (Rentz, 1996)], studies have rarely directly tested the hypothesis. Blue may be used to direct predators to attack dispensable parts of the body (e.g. tail autotomy in skinks) (Cooper & Vitt, 1985). Juvenile American five-lined skinks Plestiodon fasciatus have a distinctive

blue tail (Fig. 1), while the adults are cryptically coloured. Clark & Hall (1970) refuted this hypothesis in a study where they conducted behavioural assays and showed that adult male P. fasciatus were less likely to attack a juvenile conspecific if it had a blue tail than if it did not. As such, they suggested that instead of redirecting predators, XL765 purchase the blue tail colour enables aggressive adult males to differentiate between other adult males (potential rivals) and juvenile males (not rivals) thus

redirecting males to real rivals and reducing infanticide (Clark & Hall, 1970). However, this assertion was refuted by Cooper & Vitt (1985) as they found that adult males readily eat hatchlings with blue tails and thus the primary function of the blue may not be important in intraspecifc signalling after all. Juvenile Acanthodactylus find more lizards also sport blue tails. Unlike Clark & Hall (1970), Hawlena (2009) suggested that Acanthodactylus use bright blue colouration to direct the attention of predators ABT-263 cost to their tail. Hawlena (2009) showed that bright blue tail colouration persists in juveniles because their increased activity levels negate any advantages of cryptic colouration, while more sedentary adult Acanthodactylus take advantage of non-blue cryptic colouration. The conflicting results from

these studies highlight the need for more empirical data on bright blue juvenile colouration. Here, crypsis is defined as colouration or morphology that makes detection of an animal more difficult (Stevens & Merilaita, 2009). Crypsis is opposed to mimicry in that mimics actively send deceptive signals (I am a twig, not a phasmid) whereas in crypsis, animals aim to remain undetected (I am not here at all) (Starrett, 1993). There is little evidence for the role of blue colours in crypsis. Macedonia et al. (2009) provide the only evidence of blue colouration being used for crypsis, in Dickerson’s collared lizard Crotaphytus dickersonae. They show that in the coastal species, the blue colour of males is more similar to that of the nearby ocean than that of the blue males in the inland sister species. They concede that serpentine and avian predators may not regularly encounter C.

In fact, despite how often blue colours are suggested to be apose

In fact, despite how often blue colours are suggested to be aposematic [e.g. nudibranch – Nembrotha kubaryana (Karuso & Scheuer, 2002), blue-tongued lizard – Tiquila scincoides (Wilsdon, 2009), blue ringed octopus – Hapalochlaena maculosa (Williams, 2010), mountain katydid – Acripeza reticulata (Rentz, 1996)], studies have rarely directly tested the hypothesis. Blue may be used to direct predators to attack dispensable parts of the body (e.g. tail autotomy in skinks) (Cooper & Vitt, 1985). Juvenile American five-lined skinks Plestiodon fasciatus have a distinctive

blue tail (Fig. 1), while the adults are cryptically coloured. Clark & Hall (1970) refuted this hypothesis in a study where they conducted behavioural assays and showed that adult male P. fasciatus were less likely to attack a juvenile conspecific if it had a blue tail than if it did not. As such, they suggested that instead of redirecting predators, C59 wnt the blue tail colour enables aggressive adult males to differentiate between other adult males (potential rivals) and juvenile males (not rivals) thus

redirecting males to real rivals and reducing infanticide (Clark & Hall, 1970). However, this assertion was refuted by Cooper & Vitt (1985) as they found that adult males readily eat hatchlings with blue tails and thus the primary function of the blue may not be important in intraspecifc signalling after all. Juvenile Acanthodactylus check details lizards also sport blue tails. Unlike Clark & Hall (1970), Hawlena (2009) suggested that Acanthodactylus use bright blue colouration to direct the attention of predators RG7204 cell line to their tail. Hawlena (2009) showed that bright blue tail colouration persists in juveniles because their increased activity levels negate any advantages of cryptic colouration, while more sedentary adult Acanthodactylus take advantage of non-blue cryptic colouration. The conflicting results from

these studies highlight the need for more empirical data on bright blue juvenile colouration. Here, crypsis is defined as colouration or morphology that makes detection of an animal more difficult (Stevens & Merilaita, 2009). Crypsis is opposed to mimicry in that mimics actively send deceptive signals (I am a twig, not a phasmid) whereas in crypsis, animals aim to remain undetected (I am not here at all) (Starrett, 1993). There is little evidence for the role of blue colours in crypsis. Macedonia et al. (2009) provide the only evidence of blue colouration being used for crypsis, in Dickerson’s collared lizard Crotaphytus dickersonae. They show that in the coastal species, the blue colour of males is more similar to that of the nearby ocean than that of the blue males in the inland sister species. They concede that serpentine and avian predators may not regularly encounter C.

Therefore, the terminology for WGC might involve a mixture of tec

Therefore, the terminology for WGC might involve a mixture of technical factors. Another issue is that multiple WGC attempts per se might result in post-ERCP pancreatitis. Most operators who

perform a WGC only once might have a favorable result for the prevention of post-ERCP pancreatitis,11 in contrast to multiple operators, including click here trainees, who perform multiple WGC.12 Therefore, the outcome of a WGC for the prevention of post-ERCP pancreatitis might vary among institutions due to various WGC techniques and involvement by trainees.11,12 In this issue of the Journal of Gastroenterology and Hepatology,13 Nakai et al. suggest that 50 cases might be the learning curve for WGC trainees. Although this study has a retrospective design with methodological flaws, this result might still provide clues for the Roscovitine datasheet above-mentioned conflicting results of WGC. In Nakai et al.’s study, biliary cannulation by WGC had a high success rate, with a median time to cannulation of 3 min for the first 50 cases. The post-ERCP pancreatitis rate was as low as 4% in the first 50 cases, and lower (2%) in the next 200 cases. They suggested that the introduction of WGC was effective in the first 50 cases and did not increase the rate of post-ERCP pancreatitis in biliary therapeutic ERCP. However, this conclusion should be cautiously interpreted

because guidewire manipulation was performed by an assistant endoscopist in this study; it is unclear

whether this learning curve represents trainees as operators or assistant endoscopists. Although WGC might obviate the risk of post-ERCP pancreatitis, multiple attempts at a WGC by trainees might have a chance of post-ERCP pancreatitis, as mentioned. In a previous study by an experienced endoscopist,1 post-ERCP pancreatitis occurred in two patients with suspected find more sphincter of Oddi dysfunction (SOD) and WGC (3 and 4 unintentional pancreatic duct [PD] guidewire passes). Therefore, repeated, unintentional PD guidewire cannulation might develop into post-ERCP pancreatitis in a high-risk group of post-ERCP pancreatitis, such as those with SOD after WGC by an experienced endoscopist or a low-to high-risk group of post-ERCP pancreatitis after WGC by a trainee. Likely mechanisms are mechanical trauma or an increase in hydrostatic pressure by the repeated introduction of a guidewire into the main PD.1 During the training period, therefore, limiting multiple attempts of WGC are essential to prevent post-ERCP pancreatitis. The no-touch technique on the PD is the best way to prevent post-ERCP pancreatitis. If touching is inevitable, limiting it, along with WGC, or putting in a prophylactic pancreatic stent, rather than using a conventional contrast injection, is the best strategy for the prevention of post-ERCP pancreatitis.

Methods: Chinese subjects aged 50 years and above were recruited

Methods: Chinese subjects aged 50 years and above were recruited from gastroenterology clinics of four major public hospitals in Singapore from 2004–2010. Endoscopy surveillance was offered for a minimum of 5 years. Informed consent was obtained from all subjects and the study was approved by the institutional review boards. The main outcome measurement is the number of

subjects who develop high grade dysplasia or gastric adenocarcinoma. Results: 3033 subjects with mean age 59 ± 7 years were recruited. 51% were male, 16% had family history of gastric cancer and 30% had H. pylori infection history based on their medical records. The prevalence of chronic gastritis, current H. this website pylori infection, atrophic gastritis and intestinal metaplasia

at baseline were 81%, 20%, 19% and 44% respectively. The study is in progress, 1,300 have completed 5 years surveillance and the rest will complete by 2015.18 high grade dysplasia or early gastric cancers were detected so far after an average follow up period of 3 years. 12 of those cases were high grade dysplasia or intramucosal carcinoma and 6 were invasive cancers in stage 1A or 1B. The interval between the most recent endoscopy with no abnormal findings and the endoscopy where cancer was diagnosed is 4–25 months. Conclusion: Endoscopic surveillance is effective, and has already Pexidartinib cell line detected high grade dysplasia or early gastric cancer in a high risk Singaporean Chinese population. Key Word(s): 1. gastric caner; 2. endoscopy screening; 3. risk stratification; 4. cohort study; Presenting

Author: IOAN CHIRILA Additional Authors: click here FLORINDUMITRU PETRARIU, VASILELIVIU DRUG Corresponding Author: IOAN CHIRILA Affiliations: University of Medicine and Pharmacy Grigore T. Popa Iasi, National Institute of Public Health, Iasi, Romania; University of Medicine and Pharmacy “Grigore T. Popa” – Iasi; University of Medicine and Pharmacy Grigore T Popa Iasi Objective: The aim of the study was to determine the presence of gastro-esophageal reflux symptoms and the prevalence of gastro-esophageal reflux disease (GERD) in general urban population and to evaluate the type of diet associated with this pathology. Methods: A randomized sample of subjects (n = 300) from a general urban population from Iasi city selected from the family doctors patient lists was invited for interview in the doctor’s office. Selected subjects were evaluated for recent symptoms using Gastrointestinal Symptom Rating Scale (GSRS), for the diagnosis of GERD using Montreal criteria and for their diet using a food frequency questionnaire. Results: In the last 7 days preceding the survey, were present relevant symptoms for gastro-esophageal reflux in 26.4% of investigated subjects and GERD was diagnosed in 31.1% of subjects. People aged over 50 years experienced an increased prevalence of recent symptoms (36.4%, p < 0.001) and GERD (37.

Methods: Chinese subjects aged 50 years and above were recruited

Methods: Chinese subjects aged 50 years and above were recruited from gastroenterology clinics of four major public hospitals in Singapore from 2004–2010. Endoscopy surveillance was offered for a minimum of 5 years. Informed consent was obtained from all subjects and the study was approved by the institutional review boards. The main outcome measurement is the number of

subjects who develop high grade dysplasia or gastric adenocarcinoma. Results: 3033 subjects with mean age 59 ± 7 years were recruited. 51% were male, 16% had family history of gastric cancer and 30% had H. pylori infection history based on their medical records. The prevalence of chronic gastritis, current H. Selleckchem AZD6738 pylori infection, atrophic gastritis and intestinal metaplasia

at baseline were 81%, 20%, 19% and 44% respectively. The study is in progress, 1,300 have completed 5 years surveillance and the rest will complete by 2015.18 high grade dysplasia or early gastric cancers were detected so far after an average follow up period of 3 years. 12 of those cases were high grade dysplasia or intramucosal carcinoma and 6 were invasive cancers in stage 1A or 1B. The interval between the most recent endoscopy with no abnormal findings and the endoscopy where cancer was diagnosed is 4–25 months. Conclusion: Endoscopic surveillance is effective, and has already http://www.selleckchem.com/products/PD-0332991.html detected high grade dysplasia or early gastric cancer in a high risk Singaporean Chinese population. Key Word(s): 1. gastric caner; 2. endoscopy screening; 3. risk stratification; 4. cohort study; Presenting

Author: IOAN CHIRILA Additional Authors: see more FLORINDUMITRU PETRARIU, VASILELIVIU DRUG Corresponding Author: IOAN CHIRILA Affiliations: University of Medicine and Pharmacy Grigore T. Popa Iasi, National Institute of Public Health, Iasi, Romania; University of Medicine and Pharmacy “Grigore T. Popa” – Iasi; University of Medicine and Pharmacy Grigore T Popa Iasi Objective: The aim of the study was to determine the presence of gastro-esophageal reflux symptoms and the prevalence of gastro-esophageal reflux disease (GERD) in general urban population and to evaluate the type of diet associated with this pathology. Methods: A randomized sample of subjects (n = 300) from a general urban population from Iasi city selected from the family doctors patient lists was invited for interview in the doctor’s office. Selected subjects were evaluated for recent symptoms using Gastrointestinal Symptom Rating Scale (GSRS), for the diagnosis of GERD using Montreal criteria and for their diet using a food frequency questionnaire. Results: In the last 7 days preceding the survey, were present relevant symptoms for gastro-esophageal reflux in 26.4% of investigated subjects and GERD was diagnosed in 31.1% of subjects. People aged over 50 years experienced an increased prevalence of recent symptoms (36.4%, p < 0.001) and GERD (37.

For example, fine-needle aspirates in pancreatic cancer are now b

For example, fine-needle aspirates in pancreatic cancer are now being used to assess biomarkers such as S100A2, ribonucleotide reductase subunit N2 and heat shock protein 27 that have been associated with gemcitabine resistance and short survival.29–31 Another potential application of EUS is the screening and surveillance of patients at high risk for pancreatic

cancer such as those with familial pancreatic cancer and hereditary chronic pancreatitis. As EUS can identify and sample lesions as small as 2 mm, it may become the surveillance procedure of choice in this small group of patients.32 In the future, it seems likely that echo-endoscopes will be smaller and lighter and will scan at higher frequencies XL765 purchase with improvements in image quality and reliability.

It may also be possible to design endoscopes with radial and linear imaging in the one instrument as well as 3-dimensional reconstruction of linear EUS. Another potential diagnostic and therapeutic procedure is that of natural orifice transluminal Selinexor cost endoscopic surgery (NOTES). With this procedure, rigid trocars or flexible endoscopes are passed into various parts of the abdominal and thoracic cavities through the esophagus, stomach, colon, vagina or bladder. This topic is discussed in detail elsewhere33 but, at present, it is unclear whether various NOTES procedures will be superior to conventional laparoscopic techniques. There is also the issue of training through gastroenterological or surgical programs although one option is surgical training with additional exposure to therapeutic endoscopy creating the ‘gastrointestinal interventionalist’.34 Impressive progress has been made in endoscopic therapies since the first descriptions of colonic polypectomy and biliary sphincterotomy. Procedures commonly performed by ‘typical’ and specialized

endoscopists are shown in Table 2 along with a short-list of evolving technologies. While most endoscopists are now familiar with hemostatic techniques, variceal ablation and mucosal resection, there is now an emerging group of therapeutic endoscopists with responsibility for insertion of metal stents and for the more challenging areas of submucosal dissection and drainage of pancreatic pseudocysts. This more specialized group is also likely to take responsibility for those procedures in Table 2 that do not, as yet, have an established click here role. Techniques that require EUS guidance include celiac plexus neurolysis, drainage of pancreatic pseudocysts and procedures that involve transgastric or transduodenal puncturing of either the bile duct or main pancreatic duct. One procedure of broad interest is the use of endoscopic techniques for the treatment of early gastrointestinal cancers.35,36 One approach is endoscopic mucosal resection but larger lesions are often removed in pieces, histological assessment is difficult and recurrence rates are significant, at least in some settings.

Methodical details are described in the Supporting Experimental P

Methodical details are described in the Supporting Experimental Procedures. IL-32 mRNA levels were assessed by quantitative RNA Synthesis inhibitor real-time PCR assays using glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and 18S RNA as the housekeeping genes. Details are given in the Supporting Experimental Procedures. For in vitro experiments the human hepatocellular carcinoma cell line Huh-7.5 was used.28 Hep3B hepatoma cells (HB-8064, American Type Culture Collection) were used for confirmation experiments. Isolation of CD14+ monocytes was performed as described.29 Please see Supporting Experimental Procedures for cell culture details. Whole cell lysate was

prepared using M-PER mammalian protein extraction reagent according to the manufacturer’s instructions (Pierce, Rockford, IL). Please see Supporting Experimental Procedures for details. For HCV replication assays, IL-32β (Accession No. NM_001012631) and γ (Accession No. NM_001012635) variants were overexpressed using pTarget

mammalian expression vectors (Promega, Madison, WI). Production of the γ-variant was as described.10 Vector efficiency is demonstrated in Fig. 5A. IL-32 was silenced using specific small interfering RNAs (siRNAs). Silencing capacity is demonstrated in Fig. 5B. The HCV-specific siRNA HCV321 (sequence: AGGUCUCGUA GACCGUGCA) was purchased from MWG.30 Please see Supporting Experimental Procedures for details. The construction of a bicistronic reporter virus carrying a firefly-luciferase reporter gene GDC-0449 supplier (pFK-Luc-Jc1) has been reported.31 Luciferase reporter gene activity was quantified to determine transient HCV RNA replication. Production of cell culture-derived HCV is reported in the Supporting Experimental Procedures. Continuous normally distributed variables are represented graphically as mean ± standard error of the mean (SEM). Age, current or past alcohol consumption are summarized by the median

followed by range find more as indicated. To compare the means between groups, analysis of variance (ANOVA) with post-hoc Bonferroni was performed. To determine differences between groups not normally distributed, medians were compared using Kruskal-Wallis analysis of variance (ANOVA) or the Mann-Whitney U test. The degree of association between variables was assessed using Spearman’s nonparametric correlation. All statistical analyses were carried out using the PASW Statistics 17.0 software package (SPSS, Chicago, IL) and graphical illustrations were prepared using GraphPad Prism v. 5 (http://www.graphpad.com/). The demographic, biochemical, metabolic, and histological characteristics of the 90 study patients with chronic HCV infection used for mRNA studies are summarized in Table 1. The body mass index (BMI) ranged from 18.9 to 40.6 kg/m2. In all, 36% of patients had BMI >25 kg/m2 and 16% had BMI >30 kg/m2.

These findings were probably related to increased plasma VWF leve

These findings were probably related to increased plasma VWF levels, appearance of ultra-large multimers in the circulation and secretion of VWF abluminally from endothelial cells. However, these mechanisms do not explain the shortening of bleeding time observed in patients with BSS who lack glycoprotein Ibα, the receptor of VWF, and raise

the possibility that desmopressin exerts an additional VWF-independent effect on haemostasis. In 1996, Tengborn and Petruson reported a 2-year-old boy with GT in whom find more high dose rFVIIa administration resulted in controlling severe epistaxis [15]. Since then, additional cases, mostly with GT, have been treated for bleeding episodes by rFVIIa with partial Target Selective Inhibitor Library success [16,17]. The mechanism by which rFVIIa arrests bleeding in a fraction of patients with GT has not been rigorously elucidated, but has been attributed to: (i) Increased thrombin generation related to direct activation of factor X by rFVIIa bound to platelet surfaces by a tissue factor-independent mechanism [18]. (ii) Enhanced adhesion of platelets to endothelial extracellular matrix

and collagen under flow conditions by the generated thrombin [19]. (iii) Restoration of platelet aggregation in the presence of factor X, factor II and fibrinogen by polymerizing fibrin formed by the tissue factor-independent thrombin generation [20]. The use

of r-FVIIa in patients with inherited platelet dysfunction selleck chemicals llc has not been examined by randomized controlled studies. The largest experience has been obtained in patients with GT by Poon et al. [16,17,21]. These investigators organized an international survey the objective of which was to examine the efficacy of rFVIIa infusion in GT patients. Fifty-nine patients were enrolled in 49 medical centres and were treated with rFVIIa during 108 bleeding episodes and during 34 surgical procedures. For the bleeding episodes, the success rate was 69/108 (75%), and for the surgical procedures, 29/34 (94%). The regimen used in most patients consisted of at least 80 μG Kg−1 rFVIIa administered intravenously every 2.5 h. The success rate in patients with gastrointestinal bleeding was low 8/17 (47%) and for dental extraction, it was high 9/9 (100%). In another study of seven children with GT (five patients), BSS (one patient) and storage pool disease (one patient), the success rate of rFVIIa infusion alone during bleeding episodes was only 10/28 (36%) [22]. Response was excellent during three bleeding episodes in the patient with BSS and during two bleeding episodes in the patient with storage pool disease. These results are less promising than the results of the international survey and thus further studies are warranted.

1) The characteristics of the HCV-RNA+ve infants and their paren

1). The characteristics of the HCV-RNA+ve infants and their parents are described in Table 1. The rate of HCV-VT was higher for infants born to mothers with high HCV viremia (>600,000 IU/mL) than for infants born to mothers with low HCV viremia (<600,000; Table 2; P = 0.02). Neither gender, nor weight, nor viral genotype (genotype 1 versus genotype non-1), nor type of birth (cesarean versus noncesarean), nor breast-feeding were associated with increased risk of HCV-VT. None of the

infected infants were HCV-RNA-positive at birth and the mean age at the first HCV-RNA-positive result was 3.81 ± 0.91 months. The infected children presented a lower birth weight (nonsignificant) than that of the noninfected children. 37% of the noninfected children Napabucasin in vivo presented ALT levels > 40 U/L whereas 68% of the infected infants had high levels of ALT (>40 U/L, P = 0.016). The study of risk factors for chronic infection was performed in HIV-negative mothers using a stored blood sample (Study Cohort, Fig. 1). Fourteen of the 22 HCV-VT-infected infants (64%) cleared the HCV virus spontaneously (transient viremia group) and eight infants (36%) had persistent infection (chronic group). The rate

of HCV chronic infection was higher among the infants with viral genotype 1 than among those with genotype non-1 (Table 3; P = 0.02). In fact, no chronic infection selleck kinase inhibitor was noted in the infants with genotype non-1 (n = 7, of whom six had genotype 3 and one had genotype 4), whereas only 1/9 infants with genotype non-1 in the general cohort had persistent infection at the end of the study (this infant was a boy whose mother was genotype 3 but HIV-positive). Neither gender, nor weight, nor the mother’s HCV viral load, nor the type of birth (cesarean versus noncesarean), nor breast-feeding were associated with increased selleck inhibitor risk of HCV chronic infection among these infants.

Among the HCV chronic group of infants, the first HCV-RNA-positive result was recorded at a mean age of 2.33 ± 0.3 months, whereas the corresponding value for the transient viremia group was 4.15 ± 1.1 months (nonsignificant). Furthermore, the chronic HCV infants had a lower birth weight than did the transient viremia children (nonsignificant). In all, 50% of the infants with transient viremia presented ALT levels >40 U/L, whereas all the chronic infants presented ALT levels above 40 U/L (P = 0.02). This study was performed among the HIV-negative mothers using a stored blood sample (n = 105, Study Cohort; Fig. 1. In six mothers it was not possible to determine the IL28B polymorphism). Of the 31 mothers with IL28B CC polymorphism, 19 were HCV-RNA-positive (61%), whereas among the 68 mothers with non-CC polymorphism (CT or TT polymorphism), 56 were HCV-RNA-positive (82%). Accordingly, the mothers with non-CC IL28B polymorphism had a greater probability of being HCV-RNA-positive than did those with CC polymorphism (OR = 2.95; 95% CI: 1.1-7.7; P = 0.026).

A variety of scoring systems have been developed to assess NAFLD

A variety of scoring systems have been developed to assess NAFLD on the basis of simple laboratory test results in combination with other parameters. For instance, the fatty liver index predicts US-diagnosed NAFLD based on the combination of body mass index (BMI), waist circumference, and serum TAG and GGT. SteatoTest combines age, sex, and BMI with 10 laboratory determinations (AST, ALT, bilirubin, GGT, α2-macroglobulin,

apolipoprotein AI, haptoglobin, glucose, cholesterol, and TAG) to predict liver steatosis in patients with different causes of chronic liver disease (hepatitis B and C, and alcoholic and nonalcoholic liver disease), showing AUROC curves ranging from 0.72-0.86. Different scoring systems have been developed for staging fibrosis

LY2157299 in patients with NAFLD, based on the combination of age and BMI with simple laboratory measurements (glucose, Romidepsin clinical trial AST, ALT, ferritin, platelet count, and albumin) or with serum cytokines (transforming growth factor-β1, platelet-derived growth factor) and components of the extracellular matrix (collagens, collagenases and their inhibitors, glycoproteins, and polysaccharides). Of these various tests, FIB-4, NAFLD Fibrosis Score (NFS), European Liver Fibrosis (ELF), and FibroTest have been validated more amply. In general, these different scoring systems are more accurate in the detection of cirrhosis than in detecting less advanced stages of fibrosis, which limits their utility in the evaluation of fibrosis in NASH.9 US-based transient elastography (TE) imaging is a technique that can be employed to measure liver stiffness by using a probe that emits a low-frequency this website vibration and calculating the speed of the propagating mechanical wave induced by this vibration.10 In a meta-analysis of the performance of TE in the detection of hepatic fibrosis in patients with cirrhosis, this technique showed sensitivity and specificity values close to 90%. However, the performance of TE decreases in patients with less advanced fibrosis or in obese individuals. Magnetic resonance elastography is an imaging technique related to TE that visualizes, using

MRI, the speed of propagating mechanical waves. As with TE, the detection of cirrhosis by magnetic resonance elastography is highly accurate and performs better than TE in obese patients and individuals with less advanced fibrosis. A scoring system (NashTest) based on all the components of the SteatoTest and FibroTest has been developed to predict liver-diagnosed NASH, and it shows an AUROC curve of 0.79.11 The majority of the existing noninvasive NAFLD tests, such as fatty liver index, SteatoTest, or NashTest, are based on a combination of characteristics unrelated to liver function (age, BMI, sex) with biomarkers reflecting alterations in hepatic function but not directly involved in the initiation and/or progression of the liver disease (i.e., ALT, AST, GGT).