A collaborative

study involving the manufacturer and three regulatory authorities, was carried out in which a candidate material, sample B (06/172), Lorlatinib manufacturer was calibrated by assays relative to the manufacturer’s in-house FEIBA standards (C and D). All laboratories used their routine validated methods (16 APTT-assays, 8 ACTIN-FS-assays and 27 DAPTTIN-assays). Intra-laboratory geometric coefficients of variation (GCVs) for candidate B ranged from 3% to 29% (GCVs <9% from majority of labs). Assessment of inter-laboratory variability gave overall GCV values of 6.9% and 4.4% relative to standards C and D, respectively, for all methods. There was good agreement in potency estimation between laboratories using each of the three methods, with the overall potencies by the three methods differing by less than 10% of the overall mean, giving an overall combined potency of 28.0 units per ampoule. All participants agreed that candidate B (06/172) be established as the 1st NIBSC Working Standard for FEIBA with an assigned potency of 28.0 units per ampoule, based on combined results for both methods, relative to either standard C or D. "
“Recombinant factor VIII (rFVIII) concentrates differ due to cell lines, culture conditions, presence of the B domain

and authorized potency assays. This study characterizes three commercially available rFVIII concentrates: a second-generation full length (A), a third-generation full length (B) and a third-generation B domain-deleted (BDD) product Selleck LY2606368 (C). rFVIII concentrates were characterized for FVIII activity (FVIII:C) by one-stage clotting and chromogenic assays, FVIII antigen (FVIII:Ag), thrombin selleck chemical activation profile and FXa-generation assay. The rFVIII concentrates exhibited significant differences with regard to FVIII:C, FVIII:Ag and thrombin activation profile. Product A had significantly greater

FVIII:C and FVIII:Ag relative to the measured values of products B and C. In addition, product A demonstrated faster and more complete activation by thrombin than the two others. BDD product C had the slowest measured thrombin activation rate. Product A exhibited a greater in vitro FXa generation than products B and C. We found no differences in FXa generation among all three products when FXa generation was normalized for FVIII:Ag. The greater FVIII:C and FVIII:Ag values for product A compared with that for products B and C are due to application of different authorized potency assays (one-stage assay for A vs. chromogenic assay for B and C). The variation in thrombin activation profiles may arise from differences in cell line-dependent posttranslational modifications of the various recombinant proteins. “
“Summary.  Youth frequently access health information online, yet little is known about internet use among adolescents with haemophilia (AWH). A youth-centred, age-appropriate online programme is being developed to address the heightened educational needs of AWH as they transit from paediatric to adult care.

Prospective trials are needed to ascertain whether it is useful to predict thrombosis in patients with cirrhosis. HEPATOLOGY 2010 Chronic liver disease is characterized by impaired synthesis of most coagulation see more factors and prolonged conventional coagulation tests such as the prothrombin and activated

partial thromboplastin time.1 Recently, the long and widely used belief that there is a causal relationship between abnormal coagulation tests and the risk of bleeding has been challenged by showing that under appropriate experimental conditions, liver disease patients generate as much thrombin as healthy subjects provided that platelets numbers are sufficient (>60 × 109/L) to support the normal thrombin generation elicited by plasma.2-4 More recently, it has been shown that patients with cirrhosis display a procoagulant imbalance that may be detected by measuring thrombin generation performed with and without thrombomodulin.5 These observations are in keeping with an earlier observation that patients with

chronic liver disease, despite their substantial prolongation of the conventional coagulation times, are not protected from venous thromboembolism (VTE)6 and with those Selleckchem Dactolisib of a recent population-based case-control study showing that patients with chronic liver disease (both cirrhotic and noncirrhotic) have a relative risk of VTE nearly

two-fold higher than that of the general population.7 The detection of the procoagulant versus anticoagulant imbalance might have important practical implications in assessing the risk of VTE, especially in patients with cirrhosis awaiting liver transplantation. Cirrhosis is the main cause of portal vein thrombosis (PVT),8 with a prevalence of 1%9 in compensated cirrhosis, but much higher in advanced cirrhosis learn more or in patients awaiting transplantation (from 8%-25%).10 PVT is a multifactorial process, in which local inflammatory foci and systemic prothrombotic factors concur. Its pathogenetic factors are those recognized for a long time as leading to deep vein thrombosis of the lower limbs: damaged vessel wall, slowing of blood flow, and procoagulant versus anticoagulant imbalance. Thus far, the laboratory method available to detect the procoagulant imbalance in cirrhosis is the thrombin generation test5 which requires expertise and equipment that are not readily available in clinical laboratories. This article reports results on a large series of patients with chronic liver disease investigated for their procoagulant imbalance by means of a standardized, easy-to-run, and commercially available method. ETP, endogenous thrombin potential; PVT, portal vein thrombosis; OD, optical density; PICI, Protac-induced-coagulation inhibition; VTE, venous thromboembolism.

7C,F). As noted in the whole livers, the mRNA expression levels of collagen 1α1, collagen 1α2, and α smooth muscle actin (αSMA) were significantly increased in HSCs from the MCD and HF diet-fed groups compared with the corresponding control diet-fed groups. These increases were significantly enhanced by the increased intake of cholesterol (Fig. 1A,D). The mRNA expression levels of PPARγ1 in HSCs were significantly lower in the MCD and HF diet-fed groups than in the corresponding control diet-fed groups. In addition,

these decreases were significantly enhanced by the increased intake of cholesterol (Fig. 1A,D). Contrarily, the mRNA expression levels of SREBP2 were significantly higher in HSCs BMN 673 mouse from the MCD and HF diet-fed groups than in those from the corresponding control diet-fed groups, and these increases were significantly enhanced by the increased intake of cholesterol (Fig. 1A,D).

The total and nuclear protein levels of PPARγ were lower in HSCs from the MCD and HF diet-fed groups than in those from the corresponding control diet-fed groups and these decreases were significantly enhanced by the increased intake of cholesterol (Fig. 1B,E). Meanwhile, the levels of the nuclear form of SREBP2 were significantly higher in HSCs from the MCD and HF diet-fed groups than in those from the corresponding control diet-fed groups. Furthermore, these increases were significantly enhanced by the increased intake of cholesterol (Fig. 1B,E). Similar to SREBP2 expression, the expression levels of LDLR and miR-33a in HSCs were significantly higher PD0325901 mw in the MCD and HF diet-fed groups than in the corresponding control diet-fed groups. These increases were significantly enhanced by the increased intake of cholesterol (Fig. 1C,F). The total and nuclear forms of PPARγ were abundant in day 1 (quiescent) HSCs but declined in day 3 and 5 (activating) and day 7 (activated) HSCs (Fig. 2A). Meanwhile,

the nuclear form of SREBP2 was scarce in day 1 HSCs, and its expression increased see more at days 3 and 5, and day 7 HSCs (Fig. 2A). Correspondingly, the PPARγ1 and SREBP2 mRNA expression levels were similar to the protein expression levels (Fig. 2A). Furthermore, the expression levels of LDLR and miR-33a in HSCs increased along with their activation (Fig. 2B). PPARγ-siRNA treatment significantly increased the expression levels of SREBP2, LDLR, and miR-33a in quiescent HSCs (Fig. 2C). Similarly, treatment with the PPARγ antagonist significantly increased the expression levels of SREBP2, LDLR, and miR-33a in quiescent HSCs in a dose-dependent manner (Fig. 2D). On the other hand, overexpression (O/E) of PPARγ1 significantly decreased the levels of SREBP2, LDLR, and miR-33a expression in activated HSCs (Fig. 2E). SREBP2-siRNA treatment significantly decreased the mRNA expression level of LDLR (Fig. 2F).

HIF-1α may accommodate the ability of forming vasculogenic mimicry in esophageal squamous cell carcinoma by regulating VE-cadherin, which affects VM formation through EphA2 and LN5γ2. Conclusion: HIF-1α up-regulation of VE-cadherin may be a critical molecular event involved in the vasculogenic mimicry and esophageal squamous cell carcinoma formation. Key Word(s): 1. HIF-1alpha; 2. VE-cadherin; 3. vasculogenic mimicry; 4. esophageal carcinoma; Presenting Author: XIANGMING FANG Corresponding Author: XIANGMING FANG Affiliations: wuhan

puren hospital Objective: To investigate the relationship between cyclin D1 gene polymorphism and susceptibility of gastric cancer and evaluated the combined effect of cyclin D1 gene polymorphism and Helicobacter pylori (Hp) infection on gastric cancer. Methods: By polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), the cyclin D1 (A870G) genotyping was performed among 115 cases with gastric buy Selisistat cancer and 112 controls with chronic gastritis. MG-132 datasheet ELISA was adapted to examine Hp infection of the above people. Results: There was significant difference of cyclin D1 genotypes frequencies between patients with gastric cancer and controls (P < 0.05).

The subjects carrying AA genotype were at an increase risk of gastric cancer compared to subjects carrying A/G and GG genotype with an odds ratio (OR) of 2.60 (95%CI, 1.47∼4.58). In patients Hp infection, the difference of cyclin D1 genotypes frequencies between patients with gastric cancer and controls was statistically significance (P < 0.05). The risk for gastric cancer is higher in AA genotype carriers with Hp infection than in A/G and GG genotype carriers with Hp infection, with OR of 3.82(95%CI, 1.92∼7.61). Conclusion: The cyclin D1 gene polymorphism

is related to the genetic susceptibility of gastric cancer. Individuals click here with cyclin D1 AA genotype show an increased risk for gastric cancer. Association of the cyclin D1 AA genotype with Hp infection could significantly increase gastric cancer risk. Key Word(s): 1. Stomach neoplasms; 2. cyclin D1; 3. Gene polymorphism; 4. Helicobacter pylori; Presenting Author: XIAOMEI ZHANG Additional Authors: YUNSHENG YANG, CHAO YANG, GANG SUN Corresponding Author: YUNSHENG YANG Affiliations: Chinese PLA General Hospital Objective: Therapies for esophageal cancer primarily rely on surgery and radiotherapy. But the prognosis is poor in patients with advanced stage. Previous reports have suggested that treatment with cytokine-induced killer (CIK) cells may benefit patients with various types of tumor. However, CIK-based immunotherapy is rarely used in those patients. In this study, effects of CIK cells against human esophageal squamous cancer were evaluated in vitro and in vivo. Methods: CIK cells were generated routinely from human peripheral blood mononuclear cells (PBMCs) in the presence of CD3, IFN-γ and IL-2 in vitro. The phenotype of CIK cells was analyzed by fluorescence-activated cell sorting.

6A). To examine whether ABT-737 has an antitumor effect in the presence of sorafenib, we administered ABT-737 and

sorafenib together to nude mice bearing SRT1720 molecular weight Huh7 xenograft tumors. Although even sorafenib alone significantly suppressed tumor growth compared with the vehicle alone (Supporting Fig. 3), coadministration of ABT-737 and sorafenib led to significant further suppression of tumor growth compared to administration of sorafenib alone (Fig. 6C). Similar to administration of ABT-737 as a single agent, coadministration of sorafenib and ABT-737 also induced mild thrombocytopenia and ALT elevation (Fig. 6D). However, coadministration did not induce further morbidity or mortality in mice, suggesting that this regimen is safe and effective for controlling HCC progression. Tumor cells have two characteristic features: uncontrolled proliferation and apoptosis resistance. Uncontrolled proliferation, driven by activation of a variety of oncogenes, is directly linked to tumor growth. Apoptosis resistance is believed to be required for the oncogene-induced aberrant proliferation, because without it, tumor cells tend to undergo apoptosis.24 However, the direct link between apoptosis resistance and growth of solid Selleck PXD101 tumors in vivo has not been well studied. Clarifying this point is very important, especially because a very recent study by Weber et al.25 produced the

contradictory finding that aged hepatocyte-specific Mcl-1 knockout mice develop HCC-like lesions, suggesting a link between hepatocarcinogenesis and increased proliferation resulting from increased apoptosis. In the present study, we used conditional expression of Bcl-xL in tumor cells to show that Bcl-xL click here overexpression, which

is frequently found in human HCC, can be directly linked to tumor growth in vivo, although it did not promote significant cell growth in vitro. Our results suggest that tumor cells encounter a variety of cellular stresses and require antiapoptosis to survive in vivo rather than in vitro. Thus, we consider antiapoptosis to be an important mechanism for progression of a solid tumor, even if it may not be the case for tumor development as suggested by Weber et al.25 Our finding also provides proof of the concept that Bcl-xL may be a target for therapy against HCC progression. In the present study, we showed that, unlike hematopoietic malignancy, hepatoma cells are relatively resistant to ABT-737. Although ABT-737 dose-dependently induced apoptosis in hepatoma cells, a relatively high dose of ABT-737 (more than 8 μM) was required to suppress tumor growth in vitro. Importantly, administration of an in vivo effective dose of ABT-737 (50 mg/kg) failed to suppress xenograft tumors. We found increased expression of Mcl-1 in cultured hepatoma cells as well as xenograft tumors upon ABT-737 treatment.

Nevertheless, HBsAg-based response-guided therapy is a valuable tool for optimization of PEG-IFN therapy, and can help with achieving higher response rates for every therapy course completed. Early LY2606368 order identification of nonresponders

may help make this treatment modality more acceptable to patients, physicians, and healthcare policy makers and possibly increase the cost-effectiveness of PEG-IFN in HBeAg-positive CHB. Limitations of the current study are that a subset of patients was treated with a combination of PEG-IFN + LAM. We have therefore performed separate analyses in patients treated with PEG-IFN alone, as shown in Table 4. We enrolled a majority of patients with HBV genotypes B and C compared with A and D, and further confirmation of our findings may therefore be required in the latter groups. Since only a limited group of patients achieved HBsAg loss, further studies may be required to confirm AZD0530 the high NPVs observed for this endpoint, particularly for patients with HBV genotypes

B and D. Previous studies have shown that patients with HBV genotype D respond poorly to PEG-IFN therapy[9] and PEG-IFN may not be an optimal choice for some of these patients given the low rate of response we observed in the current cohort. In conclusion, the current study shows that HBsAg levels can be confidently used to guide therapy decisions in HBeAg-positive patients treated with PEG-IFN. Discontinuation of PEG-IFN treatment is indicated in all patients with HBsAg levels >20,000 IU/mL after 24 weeks of PEG-IFN therapy. Study coordination and design, data collection, data analysis, writing of article, approval of final version: M.S., H.L.Y.C., B.E.H., H.L.A.J. Data collection, critical review of the article, approval of final version: T.P., J.D.J., S.Z., E.G., Y.F.L., Q.X., E.J.H. Statistical analysis, critical review of the article, approval of final version: B.E.H. The authors had complete access to all data, and take

responsibility for its integrity and the accuracy of the analysis. Additional Supporting Information may be found in the online version of this article. “
“Hepatitis B virus (HBV) infection this website is the major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) worldwide, especially in the Asia–Pacific region. Several hepatitis B viral factors predictive of clinical outcomes in HBV carriers have been identified. The Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-HBV (REVEAL-HBV) study from Taiwan illustrated the strong association between HBV-DNA level at study entry and risk of HCC over time. In this community-based cohort study, male gender, older age, high serum alanine aminotransferase level, positive hepatitis B e antigen, higher HBV-DNA level, HBV genotype C infection, and core promoter mutation are independently associated with a higher risk of HCC.

Results: Result 1. LPS induced live injury with increased RG7422 price serum ALT, AST, and TNF levels, high histological injury score, apoptosis of hepatocytes, accumulation of macrophage and neutrophil evidenced with increment of CD68 expression and MPO activity

in liver.2. AICAR or compound C treatment decreased ALT, AST, and TNF levels in serum, reduced histological injury score, CD68 expression, MPO activity, apoptosis cell number in liver of mice with endotoxemia. However, combination of AICAR and compound C treatments failed to exhibit the benefit effect of each single treatment.3. In survival experiments, AICAR or compound C treatment improved survival of endotoxemic mice. Conclusion: ConclusionAICAR or compound C treatment attenuates LPS-induced liver dysfunction, indicating that activation of inhibition AMPK signal can inhibit endotoxemia-induced immune response and liver injury. AMPK signal may provide an alternative to the current clinical treatments for endotoxemia. Key Word(s): 1. Endotoxemia; 2. AMPK; 3. AICAR; 4. liver damage; Presenting Author: HUITING GAO Additional Authors: LISHU

XU, LICHANG GUAN, DONGFENG LI, WEIPING DENG Corresponding Author: LISHU XU Affiliations: Guangdong General MK-2206 Hospital Objective: The aims of the study were to investigate the effect of glucagon-like peptide-1 (GLP-1) on diet induce non-alcoholic fatty liver disease (NAFLD) in rats. Methods: A total of 30 male rats were randomly divided into three groups. Each group contained 10 rats, in which they were fed with normal diet (ND), high-fat diet (HFD), high-fat diet with intraperitoneal injection of liraglutide (HFD+GLP-1, first 12 weeks with HFD, later 4 weeks with liraglutide) for 16 weeks respectively. After 16 weeks’ feeding, the rats were killed ethically and their blood samples and liver tissues were collected. The levels of aminotransferase (ALT), aspartate-aminotransferase (AST), triglyceride (TG), total-cholesterol selleck compound (TC) were detected by biochemistry automatic analyzer. The levels of superoxide dismutase (SOD)

and malondial-dehyde (MAD), tumor necrosis factor-a (TNF-a), JNK-1 and P-JNK1 in liver homogenates were detected by RIA, ELISA and Western blot respectively. Results: The body weight, liver index, serum and liver homogenates levels of TG, TC, ALT and TG, TC, MAD, TNF-a in the HFD group were apparently higher than those in the normal group, while the level of SOD decreased significantly. When compared with the HFD group, the body weight, liver index, serum and liver homogenates levels of TG, TC, ALT and TG, TC, MAD, TNF-a in the HFD+GLP-1 group decreased apparently, while the level of SOD increased. (P < 0.05) Conclusion: Liraglutide (GLP-1) has an anti-inflammatory effect on NAFLD rats, which is conducted by decreasing blood lipid and liver homogenate inflammation index level. Key Word(s): 1. NAFLD; 2. GLP-1; 3.

Additionally, we

investigated reasons for noninclusion and nontreatment buy Dactolisib of patients referred to our tertiary referral center. A0-A3, necroinflammatory activity score; AFP, alpha-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CHC, chronic hepatitis C; CI, confidence interval; DAA, direct-acting antiviral agent; F0-F4, fibrosis stage score; γ-GT, gamma glutamyle transferase; GT, genotype; HCV, hepatitis C virus; ITT, intent to treat; IL, interleukin; IVDA, intravenous drug abuse; peg-IFN, pegylated interferon; RBV, ribavirin; SCR, screening; SD, standard deviation; SOC, standard of care; SVR, sustained virologic response; TPP, treated per protocol; WBC, white blood cell count. Medical records of all 503

treatment-naïve patients with CHC, GT-1, referred to our center from January 1, 2006 to December 31, 2009 were reviewed retrospectively. At referral, patients had a blood test, including HCV GT and viral load, and received an appointment to see a hepatologist. Twenty-two patients had contraindications for peg-IFN/RBV-based therapy; the remaining 481 were evaluated for the feasibility for antiviral therapy. All patients were informed check details about the option to participate in

ongoing studies (DAAs [n = 101]: telaprevir, danoprevir, TMC435, BI201355, mericitabine, balapiravir, and IDX 184; or IFN-based treatments [n = 40]: albIFN alpha-2b or response-guided treatment2). Every patient, for whatever reason, not eligible or willing to be included into a study was offered SOC therapy: 171 patients did neither opt to take part in a study nor had SOC resulting from several reasons (Fig. 1), 169 received SOC, and 141 were treated selleck inhibitor within a study regimen. For analysis of the IL28B GT, patients were either tested at one of the follow-up visits or were recalled for testing. All patients gave informed consent for genetic testing. In 79% of all treated patients, the IL28B rs12979860 GT could be determined. History of intravenous drug abuse (IVDA), alcohol consumption, nicotine abuse, drug-substitution therapy, history of psychiatric disorders, hypertension, diabetes mellitus, coronary artery disease, concomitant medication intake, mode of infection, country of origin, sex, age, and body mass index (BMI; calculated by dividing weight [kg] divided by height2 [m2]) were assessed.

87 ± 72.41% (control group) to (314.23 ± 46.32%, 257.18 ± 26.5%, p < 0.01) respectively. The mRNA expressions of DNMT1, DNMT3a and DNMT3b were down-regulated FG-4592 mouse after ADO alone or combination treatment with HCY. The mRNA expressions of lncRNA-MEG3, P53, caspase-3, caspase-9, cytochrome

C were up-regulated and MDM-2 were down-regulated after ADO alone or combination treatment with HCY. Conclusion: ADO alone or combination treatment with HCY can suppress DNMTs and decreased cellular methylation metabolism. The effects of demethylation may activate lncRNA MEG3 gene, P53 pathway and the mitochondrial pathway and at last led to cell apoptosis. Key Word(s): 1. adenosine; 2. homocysteine; 3. methylation; 4. hepatocellular carcinoma; 5. apoptosis Presenting Author: I-CHEN WU Additional Authors: MING TSANG WU Corresponding Author: I-CHEN WU Affiliations: Kaohsiung Medical University Hosp Objective: This study aims to identify the novel and potential upregulated genes related to secretionary or membranous proteins for the clinical diagnosis and staging of esophageal squamous cell carcinoma (ESCC). Methods: By combining microarray-based screening, which contained at least 25,000 DNA oligonucleotide probes, of esophageal tumors from both N-nitrosomethylbenzylamine- and arecoline-induced F344 rats and

17 human ESCC specimens, we further confirmed the potential candidate

genes by tissue arrays in 243 cancer tissues and 126 LY2157299 manufacturer normal tissues of esophagus from Taiwan, Korea, and USA and by ELISA in 78 serum specimens of ESCC patients from Taiwan. Results: Four candidate genes, including ATP1A1, SPINT2, CMTM8, and AGR2, were chosen by microarray-based screening of 17 paired tissues from 17 ESCC patients. Only ATP1A1 (ATPase Na+/K+ transporting alpha 1 polypeptide) passed validation by RT-PCR and IHC staining in ESCC tissue specimens. check details We found positive ATP1A1 immunostaining in 207 (85%) of the 243 cancer tissues and 88 (70%) of the 126 normal tissues. After adjustment for age and sex, ATP1A1 overexpression had a 3.2-fold (95% CI = 1.8–5.6) to be likely in cancer tissues than in normal tissues. Using the median level of 1,465.0 pg/mL of serum ATP1A1 protein expression as the cut-off point, we found that patients with stage III-IV had a 2.91-fold (1.12–7.36) likely to have high serum ATP1A1 levels than those with stage I-II after adjustment for age and sex. Conclusion: ATP1A1 overexpression may be a potential noninvasive marker of the clinical diagnosis and staging for ESCC patients. Key Word(s): 1. ATPase Na+/K+ transporting alpha 1 polypeptide; 2. microarray-based screening; 3. N-nitrosomethylbenzylamine; 4. arecoline; 5. F344; 6.

For biomarker discovery, the latter was chosen as a control group because the risk of postprocedural pancreatitis or cholangitis ethically bans ERC from application in healthy subjects. However, as the control group consists of patients with choledocholithiasis, proteomic analysis may reflect the difference between a relatively normal PLX4032 mw biliary tree and liver, and an inflamed, cholestatic liver, which can be expected in patients with PSC and patients with a dominant stenosis due to CC. The PSC/CC model was able to distinguish CC and PSC from nonmalignant lesions with an AUC of 0.93 (P = 0.0001), a sensitivity of 93%, and a specificity of

86% as validated in an independent cohort. These findings are of clinical significance,

as in patients with suspected CC or PSC endoscopic procedures will be performed and thus bile becomes accessible. Furthermore, even in the presence of large masses suspicious of CC, a definite diagnosis often cannot be made. The surveillance of patients with PSC is of crucial importance, as those patients have an increased risk to develop CC and curative treatment such as liver transplantation or radical resection can be performed only at an early stage. Therefore, our aim was to distinguish PSC from CC in a second model. This model was established using a training Ponatinib mw set consisting of 18 patients with PSC and 16 with CC. Applied to an independent validation set (18 PSC, 25 CC) it showed an AUC of 0.87, a specificity this website of 78%, and a high sensitivity of 84%. Our findings indicate a possible role of proteomic analysis for surveillance in patients with PSC. Nevertheless, PSC-associated CC may be of different origin than sporadic cholangiocarcinoma. Ten patients within the CC group developed CC in addition to PSC. Eight of those patients were identified positive for CC by proteomic analysis. This proteomic model

reaches a high sensitivity compared to single biochemical markers. Direct comparison with the widely used CA 19-9 tumor marker is impossible, because previous studies used different cutoff values in various study populations, leading to enormous range of sensitivity (53%-92%) and specificity (50%-98%).44 Our proposed model may be of clinical relevance in diagnosing CC in patients with PSC especially if supplementary to other diagnostic methods, as a higher accuracy can be reached by a combination of different diagnostic tools.45 All in all, proteomic analysis of bile as a diagnostic tool for surveillance of patients with PSC alone or in combination with other methods may provide an early and reliable diagnosis of CC. In summary, our data indicate a possible role of proteomic analysis of bile to differentiate CC from PSC and benign lesions.