2012 Aug 1;123(4):225–239 2  Lubel JS ,

2012 Aug 1;123(4):225–239. 2. Lubel JS., Selleckchem JNK inhibitor et al., Angiotensin-(1-7), an alternative metabolite of the renin-angiotensin system, is up-regulated in human liver disease and has antifibrotic activity in the bile-duct-ligated rat. Clin Sci (Lond). 2009 Sep 14;117(11):375–386. 3. Osterreicher CH., et al., Angiotensin-converting-enzyme 2 inhibits liver fibrosis in mice. Hepatology. 2009 Sep;50(3):929–938. G WU, G WILSON, J GEORGE, L QIAO Storr Liver Unit, Westmead Millennium Institute, The University of Sydney, Westmead, NSW, Australia Introduction: Hepatocellular carcinoma

(HCC) is an aggressive disease with poor clinical outcomes. Liver cancer stem cells (LCSCs) are thought to be the major mediators of HCC tumor progression, metastasis and treatment resistance. However, the mechanisms by which these LCSC populations are maintained are not well understood or characterized. Methods: LCSC and non-LCSC populations were generated based on the expression of the stem cell marker Oct4 using an exogenous human

Oct-4 promoter GFP vector. The expression of Notch receptors, Notch ligands, and Notch downstream targets were determined by western blot and quantitative PCR (qPCR). LCSCs (Oct4+) and non-LCSCs (Oct4-) were treated with siRNA targeting Jagged2 and recombinant Jagged2 protein. BrDU cell proliferation assay, Annexin V apoptosis assay, sorafenib resistance assay and tumor sphere assays were undertaken on the cell populations with Stem Cells inhibitor modulated Jagged2 activity. Results: Notch signaling components Jagged2 and Notch1 were found to be upregulated in the LCSC (Oct4+) population. Treatment of these LCSCs with siRNA targeting Jagged2 resulted in the inhibition of Notch signaling, reduced cell proliferation and increased apoptosis. Jagged2 knockdown also sensitized these LCSCs to sorafenib treatment. Conversely, activation of the Notch pathway with recombinant Jagged2 in the non-LCSC (Oct4-) population increased tumor sphere formation and increased the expression of SOX-2,

a major transcription factor which OSBPL9 induces stem-like characteristics and is also a novel predictor of poor prognosis in HCC. Conclusions: Jagged 2 is a critical mediator of Notch signaling in LCSCs. Jagged2 mediated Notch signaling is critical for the maintenance and treatment resistance of LCSCs in HCC and can increase stem-like characteristics of differentiated cells. Given these findings we believe Jagged2 is a potential therapeutic target for the treatment of HCC. LT GAN,1 DM VAN ROOYEN,1 M COOPER,2 A ROBERTSON,2 S MASTERS,3 N TEOH,1 G FARRELL1 1Liver Research Group, ANU Medical School at The Canberra Hospital, Garran, ACT, 2Institute of Molecular Biology, University of Queensland, QLD, 3Walter and Eliza Hall Institute, Parkville, VIC Introduction: Increasing evidence implicates free cholesterol (FC) in pathogenesis of non-alcoholic steatohepatitis (NASH).

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However, anaemia is aggravated by the myelosuppressive effects of

However, anaemia is aggravated by the myelosuppressive effects of pegylated interferon and the effect of ITPA polymorphisms on interferon-free treatments is unknown. We examined the effect of two ITPA SNPs on events associated with anaemia in patients treated with faldaprevir, BI 207127 and ribavirin in the SOUND-C2 study in which PLX4032 up to 85% of patients achieved SVR but >10% of patients experienced anaemia and 6% had ribavirin dose reductions. Methods: In this open-label Phase 2b study, 362 treatment-naive patients with genotype 1 HCV were randomised.

Two SNPs within the ITPA gene region, rs1127354 and rs6051702, were genotyped by melting curve analysis in 314 patients. ITPA genotypes were defined as favourable (rs1127354 AA or AC and rs6051702 CC or CA) or unfavourable (rs1127354 CC and rs6051702 AA) in terms

of their association with haemolytic anaemia. Anaemia (haemoglobin <10 g/dL), ribavirin dose reduction and erythropoietin 5-Fluoracil ic50 use were assessed for patients with favourable and unfavourable SNPs. Results: The proportions of patients who experienced an event associated with anaemia based on ITPA SNPs are shown in the Table. ITPA SNP and genotype rs1127354 AA or AC ‘Favourable’ rs1127354 CC ‘Unfavourable’ rs6051702 CC or CA ‘Favourable’ rs6051702 AA ‘Unfavourable’ Unfavourable genotype at both positions (n = 45) (n = 269) (n = 112) (n = 202) (n = 189) *Anaemia as an adverse event as defined by investigators (not a laboratory event) More patients experienced anaemia with unfavourable versus favourable ITPA SNPs, while no significant differences were found for ribavirin dose reductions or erythropoietin

use. The presence of unfavourable variants at both loci did not further increase the risk for anaemia, erythropoietin use or ribavirin dose reduction. Metalloexopeptidase Conclusions: While the overall risk of severe ribavirin-associated anaemia was low in the SOUND-C2 study, this preliminary analysis indicates that ITPA SNPs may be useful in predicting patients susceptible to ribavirin-induced anaemia during interferon-free treatment for HCV. 1. Fellay J, et al. Nature 2010;464(7287):405–408. S ZEUZEM,1 V SORIANO,2 T ASSELAH,3 J-P BRONOWICKI,4 AW LOHSE,5 B MÜLLHAUPT,6 M SCHUCHMANN,7 M BOURLIERE,8 M BUTI,9 S ROBERTS,10 ED GANE,11 J STERN,12 J-P GALLIVAN,13 W BÖCHER,13 F MENSA12 1Klinikum der J. W.

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Of the 48 patients with positive pH/impedance findings, 38 was no

Of the 48 patients with positive pH/impedance findings, 38 was normal on WLI (Figure 1A) except 10 with EE and 37 showed positive AFI manifestations indicating the presence of GERD(Figure 1B). The sensitivity and accuracy of AFI (77% and 67%, respectively) in detecting GERD were higher than those of

WLI (20% and 52%, respectively), although the specificity of AFI (53%) was lower than that of WLI (97%). Inter-observer reliability analysis of AFI findings indicated substantial agreement (Kappa = 0.630, p = 0.000). Multivariate analysis showed that positive AFI findings significantly correlated with pH/impedance results (odds ratio [OR] = 0.242, 95% confidence interval [CI] 0.087–0.673, p = 0.007). Conclusion: AFI can detect esophageal find more mucosal selleck chemicals llc changes related

to acid reflux, invisible on conventional WLI, in patients with NERD, suggesting that AFI endoscopy may be effective in the endoscopic diagnosis of GERD. Key Word(s): 1. Autofluorescence; 2. Endoscopy; 3. GERD; 4. Acid Reflux; Presenting Author: XI HUANG Additional Authors: JIUHONG MA Corresponding Author: XI HUANG Affiliations: The First Affiliated Hospital of Nanchang University Objective: Endoscopy is widely performed in China, but the reprocessing of the endoscope’s still poses many problems, because many units do not strictly adhere with to the endoscope reprocessing standard. To identify the practices used for reprocessing of gastrointestinal endoscopes in China, a survey a was carried out including basic information about the hospital, rinsing, disinfection, storage as well as personnel protection,

etc. Methods: A survey tool with 53 questions was designed for the survey, and 181 endoscope centers were investigated for endoscope reprocessing selleck chemicals by questionnaire. Results: The results indicate that the main method for the reprocessing of endoscope’s in the hospital endoscopy center’s was mainly manual processing (51.4%) with 45.8% of the endoscope centers using a combination of both manual reprocessing and Automated endoscope reprocessing. Only 2.8% of the investigated endoscope centers completely used Automated endoscope reprocessing. A lot of infection risks will emerge inevitably with such a high proportion of manual reprocessing procedures, which will be shown in the following survey results. 68.5% of the investigated hospitals chose glutaraldehyde, 10% chose the ortho-phthalaldehyde, 11.6% chose acidified water, 10% chose Chlorine dioxide and PAA. Conclusion: Although there are many endoscopy procedures carried out in China, there are still lots of issue’s during endoscope reprocessing which have not attracted extensive attention this study hope’s to address some of these issues. Key Word(s): 1. Reprocessing; 2. GI endoscopy; 3. Cleaning; 4.

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“Vitamin D3 improves portal hypertension (PH) through the

“Vitamin D3 improves portal hypertension (PH) through the activation of vitamin D receptor (VDR) and calcium

sensing receptor (CaSR) in cirrhotic rats. Propranolol is a nonselective β–blocker that is recommended for the treatment of PH. The present study aims to investigate the detail systemic and hepatic mechanisms of vitamin D3 and propranolol, alone or in combination, in cirrhotic rats. Common bile duct-ligated (BDL) and thioacetamide (TAA) cirrhotic rats were treated with vehicle, propranolol (30mg.kg-1.day-1), vitamin D3 (0.5μg.100g-1.day-1, twice weekly), or propranolol+ Ponatinib molecular weight vitamin D3, separately. Significantly, propranolol and vitamin D3 produced a similar magnitude of reduction in portal venous pressure (PVP) in cirrhotic rats through different mechanisms: whereas propranolol decreased PVP by reducing splanchnic hyperemia and cardiac index, vitamin D3 decreased PVP by decreasing intrahepatic resistance (IHR). However, propranolol plus vitamin D3 did not further decrease PVP in cirrhotic rats. Notably, a marked decrease in hepatic VDR and CaSR expressions was noted in cirrhotic human/rat livers compared to non-cirrhotic human/rat livers. In cirrhotic rats, vitamin D3 administration decreasing IHR by inhibiting the renin-angiotensin system, hepatic oxidative stress, inflammation/fibrosis,

ANGII production, Enzalutamide CaSR-mediated angiotensin II (ANGII) hyper-responsiveness, ANGII-induced hepatic stellate cells contraction, and correcting hepatic endothelial dysfunction through up-regulation of hepatic VDR, CaSR and eNOS expressions. Chronic vitamin D3 treatment alone results in comparative

portal hypotensive effects as propranolol alone in cirrhotic rats with PH. Taken together, chronic vitamin D3 administration was an ideal alternative strategy to effectively improve PH without unwanted systemic side effects. “
“Chronic hepatitis B (CHB) is a major global health issue. The role of rare genetic variants in CHB has not been elucidated. We aimed to identify rare allelic variants predisposing to CHB. We performed exome sequencing in 50 CHB patients who had no identifiable risk factors for CHB PRKACG and 40 controls who were healthy and hepatitis B surface antibody-positive, but had never received hepatitis B vaccination. We selected six rare variant alleles and followed up their association with disease status by Sanger sequencing in a case-control study comprising 1,728 CHB patients and 1,636 healthy controls. The latter had either not been immunized with hepatitis B vaccine or had uncertain vaccination status. Our results showed that transmembrane protein 2 p.Ser1254Asn, interferon alpha 2 p.Ala120Thr, its regulator NLR family member X1 p.Arg707Cys, and complement component 2 p.Glu318Asp were associated with CHB, with P values of <1.0 × 10−7, 2.76 × 10−5, 5.08 × 10−5, 2.

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“Previous genetic analyses have

demonstrated that

“Previous genetic analyses have

demonstrated that two divergent lineages of Pipistrellus kuhlii are spread over Europe and North Africa, and it has been proposed that Pipistrellus maderensis, a taxon endemic to the Canary Archipelago and Madeira, was its sister species. In this study, we used mitochondrial DNA sequences to investigate the level of endemism achieved by Corsican lineages with regard to their continental selleckchem counterparts and to propose hypotheses about the geographical origin of Corsican bats. Our results suggest that Corsican Kuhl’s pipistrelles are not endemic. Such a lack of genetic endemism in Corsica can result from current gene flow with French and Italian populations and/or recent colonization of this island. Additionally, our results demonstrate Y-27632 cost that Corsica was colonized independently from Europe by two divergent lineages (genetic distance=5.8%) widespread in the western Palaearctic and clearly suggest that North Africa probably does not play any significant role in the colonization of Corsica by the Kuhl’s Pipistrelle. Additional morphometric, acoustic and ecological studies are needed to soundly ascertain the respective taxonomic status of these two divergent lineages and the level of distinctiveness achieved by Corsican bats. “
“Sexual dimorphism is characteristic

of monogonont rotifers, but at present, most investigations on the evolution of morphology within Monogononta have focused exclusively on females, with only minor taxonomic comments on the male structure. Here, we make the first detailed comparison of female and male morphology by examining their muscular organization, with the aim of understanding how factors such as phylogeny, habitat and the structural 17-DMAG (Alvespimycin) HCl rigidity of the body wall determine the muscle arrangement patterns.

We compare the musculature of both females and males in Brachionus manjavacas and Epiphanes senta. Generally, rotifer males have a similar ecology that may be different from the conspecific females. Thus, we analysed muscles of conspecific females and males with different ecology, namely habitat and/or different stiffness of the lorica. Females of B. manjavacas are loricate and planktic, while E. senta females are illoricate, can be found in the plankton, but have a lifestyle much related to a substrate. Males are in both species free swimmers and without a stiff lorica. Visceral muscles are present in the digestive (only in females) and reproductive apparatus (only in males). Somatic musculature comprises inner longitudinal and outer circular muscles. Major differences are discernible among circular muscle states: B. manjavacas has dorsoventral bands, while E. senta possesses muscles that are ventrally incomplete. The same condition occurs in both sexes.

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Another mechanism of the cholesterol-lowering effect of bezafibra

Another mechanism of the cholesterol-lowering effect of bezafibrate may be due to the stimulation of cholesterol efflux from hepatocytes to the bile canaliculi Decitabine ic50 by way of the activation of PPARs. Our experiment using HepaRG cells showed significantly up-regulated expression of ABCG5 and ABCG8 mRNA after bezafibrate but not rifampicin treatment (Fig. 5B). A similar effect of bezafibrate on ABCG5 in human liver has been reported previously.51 Because of the inhibition of bile acid synthesis and presumably the stimulation of cholesterol excretion into bile, bezafibrate significantly increases biliary cholesterol saturation.52 Indeed, increased risk of gallstone formation has been reported in

hyperlipidemic patients treated with another fibrate, fenofibrate.53 However, combination therapy of UDCA and bezafibrate appears to attenuate

the adverse effect of bezafibrate, because UDCA markedly lowers biliary cholesterol saturation and dissolves cholesterol gallstones.2 On the other hand, bezafibrate may augment the anticholestatic and antilithogenic actions of UDCA by inhibiting bile acid synthesis and increasing the proportion of UDCA (Fig. 2C). In addition to anticholestatic effects, activation of PXR54 and the PPARs55 has been reported to suppress inflammation through the inhibition of proinflammatory genes, including nuclear factor-κB (NF-κB), tumor necrosis factor-α, and interleukin-1α. In this study, although we did not evaluate the contribution of the antiinflammatory effects of bezafibrate to the AZD6244 ic50 improvement of biochemical markers, bezafibrate is suggested to be an ideal drug with anticholestatic, hypolipidemic,

and even antiinflammatory actions on PBC by way of the activation of both PXR and PPARs. In summary, bezafibrate exhibited anticholestatic efficacy on PBC patients who showed an incomplete response to UDCA monotherapy. Although UDCA replaces hydrophobic bile acids and activates canalicular BSEP and MDR3 and basolateral MRP4,7 Doxacurium chloride bezafibrate inhibits hepatic synthesis and uptake of bile acids, enhances bile acid detoxification, and stimulates canalicular MDR3, MDR1 and MRP2 activities as a dual PPARs/PXR agonist (Fig. 6). These data lend support to the idea that combination therapy with UDCA and bezafibrate is an excellent method for the treatment of early-stage PBC patients who exhibit an incomplete biochemical response to UDCA monotherapy. Additional Supporting Information may be found in the online version of this article. “
“The aim of this systematic review was to evaluate the efficacy and safety of biological agents (vedolizumab, abatacept, visilizumab, golimumab) in patients with active moderate to severe ulcerative colitis. This paper was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

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Although in general the NAFLD patients considered asymptomatic, t

Although in general the NAFLD patients considered asymptomatic, there has no any research study about the

quality of life and it’s affecting factors on NAFLD patients in Indonesia. To find out the factors affecting the quality of life on NAFLD patients. Methods: This is an analytic-observational research with cross-sectional design. Research participants are NAFLD patients in RSUP Dr. Kariadi Semarang. Data were collected via interview using SF-36 selleck chemicals llc RAND questionnaire. Diagnosis of NAFLD and severity by liver biopsy accordingly NAFLD activity score (NAS). Data were then analyzed using Anova or Independent Sample T test. In non-parametric analysis, Mann-Whitney and Kruskal-Wallis tests were performed. Results: 28 participants were enrolled in this research. SF-36 (RAND) score did not differ by sex (p: 0.632), age (p: 0.993), education Z-IETD-FMK molecular weight (p: 0.383), marital status (p: 0.488) and NAS (NAFLD activity score) (p: 0.834). Conclusion: SF-36 RAND score did not differ by sex, age, education, marital status and NAFLD activity score. Key Word(s): 1. NAFLD activity score; 2. quality of life Presenting Author: MADHUSUDAN SAHA Additional Authors: ABDULLAH AL MAMUN, SIDDHARTHA

PAUL, KHALEDA BEGUM, AVICK HALDER, FARHANA AFROZ, NADIRA DILRUBA HOQUE Corresponding Author: MADHUSUDAN SAHA Affiliations: Dhaka Medical College, North East Medical College, Dhaka Medical College, Jalalabad Ragib Rabeya Medical College, North East Medical College, Dhaka Medical College Objective: To see incidence of depressive illness among

patients presenting with gastrointestinal symptoms in a tertiary care hospital in North East part of Bangladesh Methods: Consecutive adult patients presenting with various gastrointestinal symptoms were included. In addition to clinic-demographic features all of them were assessed for depressive symptoms 3-oxoacyl-(acyl-carrier-protein) reductase using 21 items Hamilton – depression scale. Statistical analysis was done by using SPSS version 16 and chi-square test was performed. P value <0.05 was considered significant. Level of depression was rated taking score 0-7 as normal, 8-13 as mild, 14-18 as moderate, 19-22 as severe and ≥ 23 as very severe. Results: Total 442 patients, age from 18 to 95 years (mean 37.8) with various social, economic and occupational background were included. Among them 281 (63.57%) were male and 161 (36.42%) were female. Mild to very severe depressive illness was found in 276 (63.57%). It was found more common among 25-35 year (68.06%) and >45 years age (67.86%) group. Among them 203 (66.56%) married persons, 109 (67.71%) female, 97 (73%) housewives, 142 (66.99%) and 151 (67.

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Percentage necrosis in explanted tumors was correlated with imagi

Percentage necrosis in explanted tumors was correlated with imaging findings. 100%, 50%-99% and <50% pathological necrosis was observed in 6 (67%), 1 (11%), and 2 (22%) tumors in Group A and 3 (42%), 2 (28%), and 2 (28%) in Group B, respectively (P = 0.81). While ADC (P = 0.46) did not change after treatment, WHO (P = 0.06) and RECIST (P = 0.08) response at 1 month failed to reach significance,

but significant responses by EASL (P < 0.01/0.03) and mRECIST (P < 0.01/0.03) Ceritinib at 1 and 3 months were observed. Response was equivalent by EASL or mRECIST. No difference in response rates was observed between groups A and B at 1 and 3 months by WHO, RECIST, EASL, mRECIST or ADC measurements. Despite failing to reach significance, smaller baseline size was associated with complete pathological necrosis (CPN) (RECIST: P = 0.07; WHO: P = 0.05). However, a cut-off size of 35 mm was predictive of CPN (P = 0.005). CPN could not be predicted by WHO (P = 0.25 and 0.62), RECIST (P = 0.35 and 0.54), EASL (P = 0.49 and 0.46), mRECIST (P = 0.49 and 0.60) or ADC (P = 0.86 and 0.93). Conclusion: The adjunct of Sorafenib did not augment radiological or pathological response to Y90 therapy for HCC. Equivalent significant reduction in enhancement at 1 and 3 months

by EASL/mRECIST was noted. Neither EASL nor mRECIST could reliably predict CPN. (HEPATOLOGY 2013;58:1655–1666) The development of surrogate markers for locoregional therapies (LRTs) in hepatocellular carcinoma (HCC) is learn more desirable to improve treatment planning and accelerate design and endpoints in clinical trials. Before validation, early imaging surrogate markers face different challenges, including methodological considerations, reproducibility, accuracy to detect real treatment response, and, potentially most important, detection of a survival benefit. In comparison with survival, surrogate endpoints (time to progression [TTP] and progression-free survival) offer the advantage of potentially less-confounding effect by concomitant liver (i.e., cirrhosis, fibrosis) or systemic diseases as well as previous or subsequent locoregional or systemic

treatment.[1] The European Association for the Study of the Liver (EASL) guidelines (2011) advocate the use of enhancing tissue to assess imaging response of HCC.[2] Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were stiripentol devised with keeping this concept in mind and are currently being proposed as the standard methodology of radiological response in HCC.[3] However, few radiological-pathological studies support these criteria; our research group has previously highlighted the relevance of these important correlative concepts for both chemo- and radioembolization.[4-6] Uni- and bidimensional measurements of the entire treated tumor (Response Evaluation Criteria in Solid Tumors [RECIST] and World Health Organization [WHO] criteria) are often criticized, given their lack of correlation with viable tumor.

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[13] Overall, however, Old World monkeys have, so far, not been r

[13] Overall, however, Old World monkeys have, so far, not been relevant as animal models in experimental HBV research, and, with the exception of chimpanzees, animal models with robust persistent infection remain unavailable. Human HBV or HBV variants closely related to human HBV have been isolated from greater (orangutan, gorilla, and chimpanzees) and lesser apes (gibbons), as reviewed previously.[14] In this

issue of HEPATOLOGY, an interesting study by Dupinay et al. describes the discovery of human ICG-001 molecular weight HBV in cynomolgus monkeys of the species M. fascicularis on Mauritius Island.[15] This species of Old World monkeys, also called crab-eating or long-tailed macaque, was originally brought from Java to Mauritius Island,

located in the Indian Ocean east of Madagascar, off the South East coast of Africa (Fig. 1). Amazingly, the investigators found that approximately 25% of the tested monkeys were positive for HBV DNA https://www.selleckchem.com/products/abc294640.html in serum; HBsAg expression was detected in hepatocytes. However, many of the animals had what appeared to be occult low-titer HBV infections. More important, persistence of HBV DNA in serum was demonstrated in 6 animals followed for up to 8 months, thus providing evidence of persistent HBV infection. The HBV DNA titers in these particular animals were similar to titers reported in HBV chronically infected chimpanzees.[8] Furthermore, the virus was transmissible to naïve monkeys (M. sylvanus), with the appearance of HBV DNA and HBsAg markers and evidence of acute hepatitis; transmission to M. fascicularis monkeys was apparently not attempted. Finally, sequence analysis of HBV genomes of viruses recovered from M. fascicularis revealed that animals were infected Fenbendazole with human HBV genotype D; genotype D is a

common HBV genotype found worldwide. The recovered viruses did have potentially important mutations, compared with HBV currently circulating in humans, which could perhaps explain permissiveness in Old World monkeys. The major obstacle for translating this novel finding of persistent human HBV infection in macaques into an available animal model is the establishment of persistent experimental infections. This could involve neonatal infections and/or immunosuppression. However, such approaches did not result in persistent experimental infections of Woolly monkey HBV in spider monkeys.[10] It would be relevant to test different Old World monkey species for susceptibility to this human HBV variant. This research could involve the generation of molecular clones representing the exact HBV variant identified in cynomolgus monkeys on Mauritius Island, or cloned human HBV with the insertion of specific identified mutations, such as a unique substitution identified in the pre-S1 domain of the L glycoprotein involved with receptor binding.

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Coronary artery calcium (CAC) scoring has been extensively studie

Coronary artery calcium (CAC) scoring has been extensively studied as a powerful, non-invasive tool for cardiovascular risk assessment in the general population. The aim of this study is to investigate whether CAC scoring could predict obstructive CAD in asymptomatic LT candidates with liver cirrhosis (LC). Methods: This study included 850 consecutive cirrhotic patients who underwent computerized coronary angi-ography with CAC measurement using

the Agaston method as a pre-LT workup. None of these patients had a previous CAD history. Obstructive CAD was Venetoclax defined as ≥50% of lumi-nal narrowing in any artery on computerized angiography. The association between CAC score and obstructive CAD was analyzed using the Pearson correlation method, logistic regression and area under the receiver operating characteristic Proteases inhibitor curve (AUROC) analyses. Results: The mean CAC score of all patients was 90.0 (range, 0-4411.4). The CAC score was 0 for 535 patients (62.9%), 1-100 for 191 (22.5%), 101-400 for 74 (8.7%), and >400 for 50 (5.9%). Obstructive

CAD was identified in 72 patients (8.5%). The mean CAC score significantly differed between patients with and without obstructive CAD (633.6 vs. 39.6; P<0.05). The prevalence of obstructive CAD increased with the CAC score (1.7% for 0, 5.8% for 1-100, 25.7% for 101-400, and 66.0% for >400). The CAC score was significantly correlated with the grade of coronary stenosis (r=0.71; P<0.05). The CAC score showed excellent performance for predicting obstructive CAD with an AUROC value of 0.88. The best cut-off CAC score was 38.8 for

obstructive CAD with a sensitivity of 83% and a specificity of 86%. In multivari-ate ADP ribosylation factor analysis, a CAC score at a cut-off of 38.8 was an independent predictor for obstructive CAD (adjusted odds ratio[OR], 23.9; P<0.05). Older age, male sex, a current smoker, hypertension, diabetes, and alcoholic LC were significantly associated with a CAC score above 38.8 (adjusted OR, 1.07, 3.27, 1.59, 1.54, 1.79, and 2.17; Ps<0.05), as were neither liver function and coagulation parameters nor viral hepatitis affect the score. Conclusion: Our data indicate that the CAC score is an accurate tool for predicting subclinical obstructive CAD in cirrhotic subjects. Traditional cardiovascular risk factors, together with alcoholic LC, were closely associated with higher CAC score.

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