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Purpose: Acute kidney injury (AKI) is a severe complication in medical and surgical intensive care units accounting for a high morbidity and mortality. Incidence, risk factors, and prognostic impact of this deleterious condition are well established in this setting. Data concerning the neurocritically ill patients is scarce. Therefore, aim of this study was to determine the incidence of AKI and elucidate risk factors in this special population.
Methods: Patients admitted to a specialized neurocritical care unit between 2005 and 2011 with a length of stay above 48 hours were analyzed retrospectively for incidence, cause, and outcome of AKI (AKI Network-stage ≥2).
Results: The study population comprised 681 neurocritically ill patients from a mixed neurosurgical and neurological intensive care unit. The prevalence of chronic kidney disease (CKD) was 8.4% (57/681). Overall incidence of AKI was 11.6% with 36 (45.6%) patients developing dialysis-requiring AKI. Sepsis was the main cause of AKI in nearly 50% of patients. Acute kidney injury and renal replacement therapy are independent predictors of worse outcome (hazard ratio [HR]: 3.704; 95% confidence interval [CI]: 1.867-7.350; P < .001; and HR: 2.848; CI: 1.301-6.325; P = .009). Chronic kidney disease was the strongest independent risk factor (odds ratio: 12.473; CI: 5.944-26.172; P < .001), whereas surgical intervention or contrast agents were not associated with AKI.
Conclusions: Acute kidney injury in neurocritical care has a high incidence and is a crucial risk factor for mortality independently of the underlying neurocritical condition. Sepsis is the main cause of AKI in this setting. Therefore, careful prevention of infectious complications and considering CKD in treatment decisions may lower the incidence of AKI and hereby improve outcome in neurocritical care.
Artificial intelligence (AI)1, together with big data, is the driving force behind the ever-accelerating digital revolution. AI has what it takes to call into question our fundamental concepts and processes of political, social, economic etc. order (Macron, 2018; Zuboff, 2018), and the law will not be spared. Therefore, all societal actors (inter alia from politics, the economy, legal practice and academia) must take responsibility for the crucial twin tasks of determining the right, balanced relationship between AI and the law, and even to hybridise them. ...
Does economic policy uncertainty affect household stockholding? To answer this question we create a novel measure of household exposure to economic policy uncertainty news by combining survey information on the hours a household spends in reading newspapers and the frequency of such news in the popular press during a household’s pre-interview period. After controlling for household fixed effects, month-year fixed effects and time-varying cognitive skills, we find that households with a higher exposure to economic policy uncertainty news are less likely to invest in stocks held directly or through mutual funds. This effect is independent from the market volatility index and household (first-moment) expectations about the stock market index.
Background: Immigration has a strong impact on the development of health systems, medicine and science worldwide. Therefore, this article provides a descriptive study on the overall research output.
Methods: Utilizing the scientific database Web of Science, data research was performed. The gathered bibliometric data was analyzed using the established platform NewQIS, a benchmarking system to visualize research quantity and quality indices.
Findings: Between 1900 and 2016 a total of 6763 articles on immigration were retrieved and analyzed. 86 different countries participated in the publications. Quantitatively the United States followed by Canada and Spain were prominent regarding the article numbers. On comparing by additionally taking the population size into account, Israel followed by Sweden and Norway showed the highest performance. The main releasing journals are the Public Health Reports, the Journal of Immigrant and Minority Health and Social Science & Medicine. Over the decades, an increasing number of Public, Environmental & Occupational Health articles can be recognized which finally forms the mainly used subject area.
Conclusion: Considerably increasing scientific work on immigration cannot only be explained by the general increase of scientific work but is also owed to the latest development with increased mobility, worldwide crises and the need of flight and migration. Especially countries with a good economic situation are highly affected by immigrants and prominent in their publication output on immigration, since the countries’ publication effort is connected with the appointed expenditures for research and development. Remarkable numbers of immigrants throughout Europe compel medical professionals to consider neglected diseases, requires the public health system to restructure itself and finally promotes science.
Ein Hauptziel dieser Arbeit war die spektroskopische Charakterisierung einer neuartigen photolabilen Schutzgruppe (Photocage). Diese besteht aus dem weitverbreiteten (7-Diethylaminocumarin)methyl (DEACM), welches zusätzlich mit einer Art Antenne (ATTO 390) ausgestattet ist. Letztere soll die Zwei-Photonen-Absorption (2PA) erleichtern, was neben dem Energietransfer von der Antenne zur photolabilen Schutzgruppe sowie die Freisetzungsreaktion eines gebundenen Effektormoleküls untersucht wurde. Der Nachweis der erhöhten 2PA wurde durch Zwei-Photonen-induzierte Fluoreszenz erbracht, welche die Bestimmung des Zwei-Photonen-Einfangquerschnitts ermöglicht. Die 2PA wurde durch Messungen mit variierender Anregungsenergie an Rhodamin B und dem neuartigen Antennen-Photocage-System bestätigt, welche eine fast perfekte quadratische Abhängigkeit der Fluoreszenzintensität nach vorangegangener 2PA widerspiegelten. Die Werte des Zwei-Photonen-Einfangquerschnitts der neuartigen photolabilen Schutzgruppe sind über alle Wellenlängen hinweg größer als die von DEACM-OH. Der Beweis eines intramolekularen Energietransfers von der Antenne zu DEACM erfolgte durch transiente Absorptionsspektroskopie. Hierfür wurde der Photocage mit 365nm angeregt, was überwiegend die Antenne adressiert. Ein intramolekularer Energietransfer konnte mit einer Zeitkonstante von 20 ps beobachtet werden, welcher wahrscheinlich von einem nachgelagerten Ladungstransfer von DEACM auf ATTO 390 begleitet wurde. Die Funktionalität des neuartigen Photocages wurde durch Aufnahme von Absorptionsspektren im IR-Bereich während kontinuierlicher Belichtung bei 365 nm untersucht. Hierbei konnte die Entstehung der intensiven Absorption von Kohlendioxid aufgrund der Photodecarboxylierung detektiert werden. Absorptionsänderungen während kontinuierlicher Belichtung wurden ebenfalls im UV/Vis-Bereich detektiert, in welchen eine hypsochrome Verschiebung der langwelligen Absorptionsbande sowie ein Anstieg der Absorption festgestellt wurden. Hieraus konnte eine Quantenausbeute der Freisetzungsreaktion von 1,5% ermittelt werden. Die Ergebnisse zum Antennen-Photocage-System zeigen auf, dass durch Anbringen einer Antenne die 2PA verbessert werden kann, ohne die Funktionalität des Freisetzungsprozesses negativ zu beeinflussen. In einem nächsten Schritt zielen Verbesserungen des untersuchten Photocages darauf ab, den Ladungstransfer zu unterdrücken. Die Validierung dieses Ansatzes sollte die Einführung anderer Antennen mit erhöhten Zwei-Photonen-Einfangquerschnitten, wie z.B. Quantenpunkte, weiter motivieren. Der zweite Ergebnisteil dieser Arbeit konzentriert sich auf drei verschiedene Photosysteme, die sich durch eine sehr kurzlebige Fluoreszenz auszeichnen, welche mit einem Kerrschalter aufgenommen wurde. Das erste der drei untersuchten Systeme umfasst eine kooperative BODIPY-DTE-Dyade(Bordipyrromethen-Dithienylethen), die einen hocheffizienten photochromen Förster-Resonanzenergietransfer aufweist. Dieser wurde durch verkürzte Lebenszeiten der Differenzsignale im transienten Absorptionsspektrum der Dyade im photostationären Zustand abgeleitet. In diesem stellt BODIPY-DTE eine hochkonjugierte Einheit dar, welches durch die geschlossene Form des photochromen DTEs einen Energietransfer vom photoangeregten BODIPY zum DTE ermöglicht. Bei diesem Prozess wird die Fluoreszenz des Donors um einige Größenordnungen reduziert. Die Ergebnisse der transienten Absorptionsmessung wurde durch ein zeitaufgelöstes Fluoreszenzexperimentbestätigt. Die detektierte Fluoreszenztransiente zerfällt mit einer Zeitkonstante von etwa 15 ps und weist somit sehr hohe Ähnlichkeit mit dem Signal des Grundzustandsbleichens (GSB) aus dem transienten Absorptionsexperiment auf. Des Weiteren wurde die photochrome Ringschlussreaktion eines wasserlöslichen Indolylfulgimids spektroskopisch charakterisiert. Transiente Absorptionsmessungen geben einen direkten Einblick in den Mechanismus der Reaktion, in welcher, nach Photoanregung, die Relaxation aus dem Franck-Condon Bereich und die schnelle biphasische Relaxation des Moleküls über die konische Durchschneidung abgeleitet werden kann. Zusätzlich wurden zeitaufgelöste Fluoreszenzmessungen mit Hilfe des Kerrschalters durchgeführt, da die stimulierte Emission (SE) in transienten Absorptionsmessungen durch die Überlagerung mehrerer Signale nicht vollständig zu erkennen war. Die globale Lebensdaueranalyse der mit dem Kerrschalter aufgenommenen Breitband-Fluoreszenz lieferte drei Zeitkonstanten, welche wesentliche Übereinstimmung mit den Zeitkonstanten aus der globalen Lebensdaueranalyse der transienten Absorptionsmessungen aufweisen. Schlussendlich wurde die Deaktivierung des elektronisch angeregten Zustands des flavinbindenden Dodecins aus Mycobacterium tuberculosis mit Hilfe von unterschiedlichen spektroskopischen Methoden charakterisiert. Stationäre Fluoreszenzmessungen bei unterschiedlichen pH-Werten zeigten bei pH 5 eine im Vergleich zu nahezu physiologischen Bedingungen (pH 7,5)reduzierte Fluoreszenz auf. Auffällig ist, dass diese Beobachtungen durch transiente Absorptionsmessungen nicht bestätigt werden konnten, da diese eine große Ähnlichkeit bezüglich der Dynamik und der spektralen Signatur zueinander besaßen. Ein negatives Signal, hervorgerufen durch die SE, wurde hierbei nicht gefunden. Allerdings konnte in den zerfallsassoziierten Spektren eine spektrale Signatur beobachtet werden, die auf eine SE hindeutete, welche allerdings mit größeren positiven Signalen überlagert ist. Dieser Aspekt wurde in einer Kerrschalter-Messung untersucht, in der eine schwache Emission bei pH 7,5 festgestellt werden konnte. Zusätzlich wies die Zerfallsdynamik der Emission Übereinstimmung mit dem GSB-Signal aus den transienten Absorptionsmessungen auf.
Testing for liver-related autoantibodies should be included in the workup of patients with hepatitis or cholestasis of unknown origin. Although most of these autoantibodies are not disease specific, their determination is a prerequisite to diagnose autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), and they are components of the diagnostic scoring system in these diseases. In primary sclerosing cholangitis (PSC), on the other hand, autoantibodies are frequently present but play a minor role in establishing the diagnosis. In PSC, however, data on antibodies suggest a link between disease pathogenesis and the intestinal microbiota. This review will focus on practical aspects of antibody testing in the three major autoimmune liver diseases AIH, PBC, and PSC.
In AD 79 the town of Herculaneum was suddenly hit and overwhelmed by volcanic ash-avalanches that killed all its remaining residents, as also occurred in Pompeii and other settlements as far as 20 kilometers from Vesuvius. New investigations on the victims' skeletons unearthed from the ash deposit filling 12 waterfront chambers have now revealed widespread preservation of atypical red and black mineral residues encrusting the bones, which also impregnate the ash filling the intracranial cavity and the ash-bed encasing the skeletons. Here we show the unique detection of large amounts of iron and iron oxides from such residues, as revealed by inductively coupled plasma mass spectrometry and Raman microspectroscopy, thought to be the final products of heme iron upon thermal decomposition. The extraordinarily rare preservation of significant putative evidence of hemoprotein thermal degradation from the eruption victims strongly suggests the rapid vaporization of body fluids and soft tissues of people at death due to exposure to extreme heat.
Background: Bacterial meningitis is associated with high mortality and long-term neurological sequelae. Increasing the phagocytic activity of microglia could improve the resistance of the CNS against infections. We studied the influence of activin A, a member of the TGF-β family with known immunoregulatory and neuroprotective effects, on the functions of microglial cells in vitro.
Methods: Primary murine microglial cells were treated with activin A (0.13 ng/ml–13 μg/ml) alone or in combination with agonists of TLR2, 4, and 9. Phagocytosis of Escherichia coli K1 as well as release of TNF-α, IL-6, CXCL1, and NO was assessed.
Results: Activin A dose-dependently enhanced the phagocytosis of Escherichia coli K1 by microglial cells activated by agonists of TLR2, 4, and 9 without further increasing NO and proinflammatory cytokine release. Cell viability of microglial cells was not affected by activin A.
Conclusions: Priming of microglial cells with activin A could increase the elimination of bacteria in bacterial CNS infections. This preventive strategy could improve the resistance of the brain to infections, particularly in elderly and immunocompromised patients.
Lymphangioleiomyomatosis (LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs (pulmonary LAM) and extrapulmonary sites (extrapulmonary LAM). This disease is rare in males. It is hard to distinguish between lung cancer and pulmonary LAM, especially during early stages. Herein, we present a case of a 66-year-old man with a small nodule in the right upper lobe that was first diagnosed as a lung malignancy using a chest CT scan. After a wedge dissection, a pathologist performed a histologic and immunohistochemical examination, and a diagnosis of pulmonary LAM was made. We further performed a 518-gene panel analysis using next-generation sequencing, and only three genes, BARD1, BLM, and BRCA2, were found to have mutations. We also provide a summary of the diagnosis and treatment of this disease.
Cyclin-dependent kinase (CDK) 4/6 inhibitors have shown great results in numerous clinical trials and have improved the clinical outcome for patients with hormone-receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer significantly. To date, three CDK4/6 inhibitors are approved by the US Food and Drug Administration (FDA): palbociclib, ribociclib and abemaciclib; the first two compounds are aproved by the European Medicines Agency (EMA) as well. In combination with endocrine therapy, all of them led to significantly improved progression-free survival compared with endocrine therapy alone. The aim of this article is to give an overview of the efficacy data and to describe the CDK4/6 inhibitor-based treatment-associated adverse events, including hematological and nonhematological adverse events. In addition, it describes the corrrect approach to patient monitoring and adverse event mangement and summarizes the current recommendations for dose reductions and dose interruptions regarding the key adverse events, such as neutropenia, diarrhea, QTc prolongation and hepatobiliary toxicity. Accurate patient monitoring and management of the side effects is crucial, as several clinical trials in early breast cancer are in progress and may lead to an additional approval in the neo-/adjuvant setting.
BACKGROUND: Adjuvant chemotherapy (ACT) for breast cancer improves relapse-free survival (BCRFS) and overall survival. Differences in terms of efficacy and toxicity could partly be explained by the significant interpatient variability in pharmacokinetics which cannot be captured by dosing according to body surface area. Consequently, tailored dosing was prospectively evaluated in the PANTHER trial.
PATIENTS AND METHODS: PANTHER is a multicenter, open-label, randomized phase III trial which compared tailored, dose-dense (DD) epirubicin/cyclophosphamide (E/C) and tailored docetaxel (D) (tDD) with standard interval 5-fluorouracil/E/C and D. The primary end point was BCRFS and the primary efficacy analysis has been previously published. In this secondary analysis, we aimed to retrospectively explore the concept of dose tailoring. Our two hypotheses were that BCRFS would not vary depending on the cumulative administered epirubicin dose; and that dose tailoring would lead to appropriate dosing and improved outcomes for obese patients, who are known to have worse prognosis and increased toxicity after DD ACT.
RESULTS: Patients treated with tDD had similar BCRFS regardless of the cumulative epirubicin dose (P = 0.495), while obese patients in this group [body mass index (BMI) ≥30] had improved BCRFS compared with nonobese ones (BMI <30) [hazard ratio (HR) = 0.51, 95% confidence interval (CI) 0.30-0.89, P = 0.02]. Moreover, tDD was associated with improved BCRFS compared with standard treatment only in obese patients (HR = 0.49, 95% CI 0.26-0.90, P = 0.022) but not in nonobese ones (HR = 0.79, 95% CI 0.60-1.04, P = 0.089). The differences were not formally statistically significant (P for interaction 0.175). There were no differences in terms of toxicity across the epirubicin dose levels or the BMI groups.
CONCLUSIONS: Dose tailoring is a feasible strategy that can potentially improve outcomes in obese patients without increasing toxicity and should be pursued in further clinical studies.
Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.
During a survey of the fishes in the region of the Wonga-Wongué Presidential Reserve, 14 new populations of the subgenus Chromaphyosemion Myers, 1924 were found. These observations extend the previously known distribution range of the subgenus 120 kilometres southward. None of these populations could be related to any described species. Based on the colouration of the males and females, together with a genetic marker (mitochondrial DNA cytochrome b sequences), the populations studied are grouped into six new species which are described in this article, all close to Aphyosemion alpha Huber, 1998 with which they share the presence of a black alpha-shaped mark on the pre- and post-opercular region. The group composed of A. alpha and the six new species is referred to here as the A. alpha species group. All the new species, A. aurantiacum Chirio, Legros & Agnèse sp. nov., A. barakoniense Chirio, Legros & Agnèse sp. nov., A. flammulatum Chirio, Legros & Agnèse sp. nov., A. flavocyaneum Chirio, Legros & Agnèse sp. nov., A. pusillum Chirio, Legros & Agnèse sp. nov. and A. rubrogaster Chirio, Legros & Agnèse sp. nov., are further unambiguously diagnosed by unique combinations of colour patterns, making it possible to generate an identification key for the A. alpha species group. It is likely that the coastal dunes of Wonga-Wongué that form a sandy relief, could have led to the fragmentation and then isolation of the hydrographical networks that flow into the Atlantic Ocean, making possible a significant number of allopatric speciations.
Impaired NO-cGMP signaling has been linked to several neurological disorders. NO-sensitive guanylyl cyclase (NO-GC), of which two isoforms—NO-GC1 and NO-GC2—are known, represents a promising drug target to increase cGMP in the brain. Drug-like small molecules have been discovered that work synergistically with NO to stimulate NO-GC activity. However, the effects of NO-GC stimulators in the brain are not well understood. In the present study, we used Förster/fluorescence resonance energy transfer (FRET)-based real-time imaging of cGMP in acute brain slices and primary neurons of cGMP sensor mice to comparatively assess the activity of two structurally different NO-GC stimulators, IWP-051 and BAY 41-2272, in the cerebellum, striatum and hippocampus. BAY 41-2272 potentiated an elevation of cGMP induced by the NO donor DEA/NO in all tested brain regions. Interestingly, IWP-051 potentiated DEA/NO-induced cGMP increases in the cerebellum and striatum, but not in the hippocampal CA1 area or primary hippocampal neurons. The brain-region-selective activity of IWP-051 suggested that it might act in a NO-GC isoform-selective manner. Results of mRNA in situ hybridization indicated that the cerebellum and striatum express NO-GC1 and NO-GC2, while the hippocampal CA1 area expresses mainly NO-GC2. IWP-051-potentiated DEA/NO-induced cGMP signals in the striatum of NO-GC2 knockout mice but was ineffective in the striatum of NO-GC1 knockout mice. These results indicate that IWP-051 preferentially stimulates NO-GC1 signaling in brain slices. Interestingly, no evidence for an isoform-specific effect of IWP-051 was observed when the cGMP-forming activity of whole brain homogenates was measured. This apparent discrepancy suggests that the method and conditions of cGMP measurement can influence results with NO-GC stimulators. Nevertheless, it is clear that NO-GC stimulators enhance cGMP signaling in the brain and should be further developed for the treatment of neurological diseases.
The neomycin sensing riboswitch is the smallest biologically functional RNA riboswitch, forming a hairpin capped with a U-turn loop—a well-known RNA motif containing a conserved uracil. It was shown previously that a U→C substitution of the eponymous conserved uracil does not alter the riboswitch structure due to C protonation at N3. Furthermore, cytosine is evolutionary permitted to replace uracil in other U-turns. Here, we use molecular dynamics simulations to study the molecular basis of this substitution in the neomycin sensing riboswitch and show that a structure-stabilizing monovalent cation-binding site in the wild-type RNA is the main reason for its negligible structural effect. We then use NMR spectroscopy to confirm the existence of this cation-binding site and to demonstrate its effects on RNA stability. Lastly, using quantum chemical calculations, we show that the cation-binding site is altering the electronic environment of the wild-type U-turn so that it is more similar to the cytosine mutant. The study reveals an amazingly complex and delicate interplay between various energy contributions shaping up the 3D structure and evolution of nucleic acids.
As adapter molecules to convert the nucleic acid information into the amino acid sequence, tRNAs play a central role in protein synthesis. To fulfill this function in a reliable way, tRNAs exhibit highly conserved structural features common in all organisms and in all cellular compartments active in translation. However, in mitochondria of metazoans, certain dramatic deviations from the consensus tRNA structure are described, where some tRNAs lack the D- or T-arm without losing their function. In Enoplea, this miniaturization comes to an extreme, and functional mitochondrial tRNAs can lack both arms, leading to a considerable size reduction. Here, we investigate the secondary and tertiary structure of two such armless tRNAs from Romanomermis culicivorax. Despite their high AU content, the transcripts fold into a single and surprisingly stable hairpin structure, deviating from standard tRNAs. The three-dimensional form is boomerang-like and diverges from the standard L-shape. These results indicate that such unconventional miniaturized tRNAs can still fold into a tRNA-like shape, although their length and secondary structure are very unusual. They highlight the remarkable flexibility of the protein synthesis apparatus and suggest that the translational machinery of Enoplea mitochondria may show compensatory adaptations to accommodate these armless tRNAs for efficient translation.
The statistical model with exact conservation of baryon number, electric charge, and strangeness – the Canonical Statistical Model (CSM) – is used to analyze the dependence of yields of light nuclei at midrapidity on charged pion multiplicity at the LHC. The CSM calculations are performed assuming baryon-symmetric matter, using the recently developed Thermal-FIST package. The light nuclei-to-proton yield ratios show a monotonic increase with charged pion multiplicity, with a saturation at the corresponding grand-canonical values in the high-multiplicity limit, in good qualitative agreement with the experimental data measured by the ALICE collaboration in pp and Pb–Pb collisions at different centralities and energies. Comparison with experimental data at low multiplicities shows that exact conservation of charges across more than one unit of rapidity and/or a chemical freeze-out temperature which decreases with the charged pion multiplicity improves agreement with the data.
Background: Transient elastography (TE) has been validated as an effective noninvasive tool for the assessment of liver fibrosis. The XL probe is a new probe that was initially designed for use in patients with obesity. A meta-analysis was performed to assess the feasibility and efficacy of TE using the XL probe.
Methods: In September 2016, we systematically searched the PubMed and Science Direct search engines. The feasibility of TE was evaluated based on the failure rate and the results of the unreliable liver stiffness measurement (LSM). The efficacy of TE was measured using sensitivity, specificity, and summary receiver-operating characteristic as measures/indices assessed in different stages of fibrosis. Heterogeneity was measured using the chi-squared test and the Q-statistic. We used the 95% confidence interval (95% CI) as an effect measure.
Results: We included 8 studies in the meta-analysis. When the XL was compared to the M probe, the former showed a lower risk of failure rate [relative risk (RR) 0.24, 95% CI 0.14–0.38]. In patients with a body mass index ≥30 kg/m2, the XL probe showed a statistically significantly lower risk of failure rate (RR 0.16, 95% CI 0.08–0.32) but no significant improvement (RR 0.76, 95% CI 0.50–1.16) in the unreliable LSM result. In patients showing liver fibrosis stage ≥F2, the XL probe showed a sensitivity of 0.56 (95% CI 0.39–0.72), specificity of 0.71 (95% CI 0.61–0.79), and an area under the curve (AUC) of 0.71. The results observed in patients with liver fibrosis stage F4 were more promising with a sensitivity of 0.84 (95% CI 0.76–0.90), specificity of 0.78 (95% CI 0.70–0.84), and an AUC of 0.88.
Conclusion: TE using the XL probe demonstrates significant diagnostic utility in patients with liver fibrosis and is likely to be more reliable than the M probe in patients with obesity. Large prospective multicenter studies are, however, necessary to establish the new cut-off values to be used for the XL probe in patients with obesity.