Noninvasive predictors of large esophageal varices: is there an emerging role of aspartate aminotransferase-to-platelet ratio index in hepatocellular carcinoma?

Background and aim Variceal size has been identified to be closely related to variceal bleeding. Repeated endoscopic examinations have a great burden on endoscopic units and cost-implication issues. Our aim was to evaluate the role of AST to platelet ratio index (APRI) in predicting the existence of large esophageal varices (EV) in hepatitis C virus-related liver cirrhotic patients. Patients and methods Seventy four patients with liver cirrhosis were prospectively recruited. Laboratory data, CTP, MELD and APRI, also ultrasonographic and endoscopic findings are performed and investigated whether associated with the size and bleeding of EV. Results Patients were divided into two groups; group 1 with small varices and group 2 with large varices. Group 2 had significantly prolonged prothrombin time, splenomegaly, ascites, higher Child score compared to group 1. CTP was associated with variceal bleeding (P = 0.028). While APRI was a poor predictor both for the presence of LVs and bleeding yet it revealed favorable Results with bleeding EVs in patients with HCC with AUC (0.61). APRI was a good predictor for the presence of HCC and number of focal lesions with AURC (0.651, 0.61 respectively). Conclusion Splenomegaly, CTP, ascites could be used as noninvasive predictors for large EVs. However, at the moment, these tests could not substitute for endoscopy. Although APRI is a poor predictor for the size and bleeding of EV, yet it might have a role in prediction of HCC and number of focal lesions

Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective: To evaluate vascular endothelial growth factor (VEGF) levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and its relation to treatment response. Methods: A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically. Twenty patients were suitable to be treated by TACE, while other 20 patients were treated with PEI. Serum VEGF levels were measured before and 1 month after each procedure by ELISA. Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound. Results: There was no significant difference between TACE and PEI groups with regard to age, sex, tumor size, response to local therapy, or VEGF and alpha-fetoprotein before and after therapy. VEGF levels after TACE were significantly higher than before TACE [(298.1 ± 123.6) pg/mL vs. (205.8 ± 307.3) pg/mL; P = 0.001]. Also, VEGF levels were significantly higher after PEI than before PEI [(333.8 ± 365.6) pg/mL vs. (245.3 ± 301.8) pg/mL; P = 0.000]. Non-responders of both groups had significantly high VEGF levels than responder's, both before [(985.0 ± 113.2) pg/mL vs. (117.1 ± 75.3) pg/mL; P < 0.001] and after therapy [(1330.6 ± 495.7) pg/mL vs. (171.0 ± 94.7) pg/mL; P = 0.000)]. Conclusions: Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients. Higher levels of VEGF before and after therapy were found in non-responders, suggesting that VEGF is a useful marker in predicting treatment response

Liver Specific Serum Micro RNA122 as a Prognostic Marker in Egyptian Patients with Liver Cirrhosis

Introduction: Recent research has shown that microRNAs (miRNA) are emerging as important regulators of cellular differentiation. The miR-122 accounts for approximately 70% of all miRNAs in the liver so its presence in the serum is highly indicative of liver processes.Aim of the work and methods: was to study the role of miR-122 as a prognostic new marker in patients with liver cirrhosis. MiR-122 was detected by quantitative real-time reverse transcription (RT)- PCR&nbsp; technique. Eighty patients with liver cirrhosis were included in our study, we divided them into 4 equal groups according to the complications of liver cirrhosis (1-compensated cirrhotics, 2- cirrhotics with ascites, 3-spontaneous bacterial peritonitis (SBP), and 4- hepatorenal syndrome (HRS) group) to evaluate if the serum level of miR-122 might be a suitable parameter for assessment of disease severity and prognosis in such patients.Results: miR-122 was statistically signifi cantly higher in group 1 “compensated” when compared to both groups 2 “ascites” and 3 “SBP” (P=0.001), while the difference was highly signifi cant when compared to its level in group 4 ‘’HRS’’ (P&lt;0.001). Serum miR-122 levels were positively correlated with serum albumin, PC, and serum Na levels while it was negatively correlated with creatinine, urea, and INR. Also there was strong negative correlation between serum miR-122 level and both MELD and Child score.Conclusion: Lower serum miR-122 levels are associated with ascites, spontaneous bacterial peritonitis and hepatorenal syndrome. Therefore, serum miR-122 could be a new potential parameter and a prognostic marker in patients with liver cirrhosis.</p

Periodontitis and Cardiovascular Disease: Floss and Reduce a Potential Risk Factor for CVD (Retracted Article. See vol 62, pg 352, 2011)

There is evidence supporting an association between cardiovascular disease (CVD) and periodontitis. We determined whether patients with chronic periodontitis, who are otherwise healthy individuals, have higher serum concentrations of emerging risk markers of CVD such as C-reactive protein (CRP) and interleukin 6 (IL-6) and investigated the effect of subsequent periodontal treatment on the levels of these markers. A total of 40 individuals were included in the study. Serum levels of CRP and IL-6 were estimated twice, once on the initial visits and the other 3 months after periodontal therapy. The mean CRP and IL-6 levels were significantly higher (P LT .001) in the patients compared with controls and significantly decreased (P LT .001) following periodontal treatment. This study suggests that periodontitis is a potential modifiable risk factor for CVD