Epidermal Growth Factor Gene Polymorphism and Risk of Hepatocellular Carcinoma: A Meta-Analysis

BACKGROUND: Hepatocarcinogenesis is a complex process that may be influenced by many factors, including polymorphism in the epidermal growth factor (EGF) gene. Previous work suggests an association between the EGF 61*A/G polymorphism (rs4444903) and susceptibility to hepatocellular carcinoma (HCC), but the results have been inconsistent. Therefore, we performed a meta-analysis of several studies covering a large population to address this controversy. METHODS: PubMed, EMBASE, Google Scholar and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to examine the association between EGF 61*A/G polymorphism and susceptibility to HCC. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: Eight studies were chosen in this meta-analysis, involving 1,304 HCC cases (1135 Chinese, 44 Caucasian and 125 mixed) and 2,613 controls (1638 Chinese, 77 Caucasian and 898 mixed). The EGF 61*G allele was significantly associated with increased risk of HCC based on allelic contrast (OR = 1.29, 95% CI = 1.16-1.44, p<0.001), homozygote comparison (OR = 1.79, 95% CI = 1.39-2.29, p<0.001) and a recessive genetic model (OR = 1.34, 95% CI = 1.16-1.54, p<0.001), while patients carrying the EGF 61*A/A genotype had significantly lower risk of HCC than those with the G/A or G/G genotype (A/A vs. G/A+G/G, OR = 0.66, 95% CI = 0.53-0.83, p<0.001). CONCLUSION: The 61*G polymorphism in EGF is a risk factor for hepatocarcinogenesis while the EGF 61*A allele is a protective factor. Further large and well-designed studies are needed to confirm this conclusion

ABO Blood Group and the Risk of Hepatocellular Carcinoma: A Case-Control Study in Patients with Chronic Hepatitis B

BACKGROUND: Studies have observed an association between the ABO blood group and risk of certain malignancies. However, no studies of the association with hepatocellular carcinoma (HCC) risk are available. We conducted this hospital-based case-control study to examine the association with HCC in patients with chronic hepatitis B (CHB). METHODS: From January 2004 to December 2008, a total of 6275 consecutive eligible patients with chronic hepatitis B virus (HBV) infection were recruited. 1105 of them were patients with HBV-related HCC and 5,170 patients were CHB without HCC. Multivariate logistic regression models were used to investigate the association between the ABO blood group and HCC risk. RESULTS: Compared with subjects with blood type O, the adjusted odds ratio (AOR) for the association of those with blood type A and HCC risk was 1.39 [95% confidence interval (CI), 1.05-1.83] after adjusting for age, sex, type 2 diabetes, cirrhosis, hepatitis B e antigen, and HBV DNA. The associations were only statistically significant [AOR (95%CI) = 1.56(1.14-2.13)] for men, for being hepatitis B e antigen positive [AOR (95%CI) = 4.92(2.83-8.57)], for those with cirrhosis [AOR (95%CI), 1.57(1.12-2.20)], and for those with HBV DNA≤10(5)copies/mL [AOR (95%CI), 1.58(1.04-2.42)]. Stratified analysis by sex indicated that compared with those with blood type O, those with blood type B also had a significantly high risk of HCC among men, whereas, those with blood type AB or B had a low risk of HCC among women. CONCLUSIONS: The ABO blood type was associated with the risk of HCC in Chinese patients with CHB. The association was gender-related

Complications of intragastric balloons

The American Society for Gastrointestinal Endoscopy (ASGE) and the American Society for Metabolic and Bariatric Surgery (ASMBS) have defined acceptable thresholds of safety and efficacy for primary endoscopic bariatric therapies (EBTs). Specifically, a given EBT should have an incidence of serious adverse events ≤5% and should result in ≥25% excessive weight loss (EWL) at 12 months, and this EWL should be ≥15% higher than in a control group. In recent decades, several intragastric balloons (IGBs) have demonstrated safety and efficacy, with broad adoption internationally. The U.S. Food and Drug Administration (FDA) has approved the Orbera Intragastric Balloon System (Apollo Endosurgery, Inc., Austin, TX, USA), the ReShape Integrated Dual Balloon System (ReShape Medical, Inc., San Clemente, CA, USA) and, more recently, the Obalon (Obalon Therapeutics, Inc. Carlsbad, CA, USA). The Spatz Adjustable balloon (Spatz Medical, Great Neck, NY, USA) is currently conducting its US pivotal trial. The Elipse Balloon (Allurion Technologies, Natick, MA, USA) has been proven to be a safe and effective device in European clinical studies and the clinical study for FDA approval is still in process. EBTs are mostly represented by intragastric balloons and the balloons we are addressing in this chapter have either been approved or are in the process of being approved by the FDA. The number of adverse events associated with IGB insertion varies across studies. The most commonly reported symptoms after IGBs placement are accommodative in nature, such as abdominal pain, nausea, and vomiting. These generally tend to last only for few days after balloon insertion and are usually self-limiting. Serious adverse events described after IGB placement include dehydration, gastrointestinal ulceration, dislocation of the balloon causing intestinal obstruction, and perforation especially during balloon insertion or removal