Since HCV-infected female patients on oral hormonal contraceptives (OC) may be treated

with SOF or SOF/LDV fixed dose combination (FDC), this study evaluated a potential for a drug-drug interaction between SOF or LDV and norgestimate/ethinyl estradiol (NGM/EE, Ortho Tri-Cyclen Lo®), a representative hormonal oral contraceptive (OC). Methods This was an open-label, fixed-sequence, Phase 1 study. Subjects not using NGM/EE were enrolled into Part A (lead-in) and received NGM/EE for 1 menstrual cycle before enrolling into Part B (main study). Subjects on NGM/EE could enroll into Part B directly. In Part B, subjects received CT99021 solubility dmso NGM/EE for 3 sequential cycles. NGM/EE was administered alone (1st cycle), followed by coadministration with SOF for 7 days (Days 8-14; 2nd cycle) or with LDV for 14 days (Days 1-14; 3rd cycle). Safety assessments were conducted throughout the study. NGM, norelgestromin (NGMN; active metabolite), norgestrel (NG; active metabolite), EE, SOF and GS-331007 (predominant circulating nucleoside metabolite of SOF), and LDV were analyzed on Day 14 of each

respective cycle. HTS assay Geometric least squares mean ratios (GLSMR) and 90% confidence intervals (CIs) for AUCtau, Cmax and Ctau were estimated using ANOVA with PK alteration bounds of 70-143%. FSH (Day 14) and LH (Day

14), and progesterone (Day 21) were assessed in all cycles. Results All enrolled subjects (N=15) completed Part B. Study treatments were well tolerated. Nausea and headache were the most frequently reported AEs. All treatment-emergent AEs were mild (Grade 1) or moderate (Grade 2). 上海皓元 Small increases in EE Cmax (∼40%) with LDV or NG AUCtau (∼19%) and Ctau (∼23%) with SOF were noted. No other alterations in NGM/EE PK were observed. SOF, GS-331007 and LDV PK were similar to historical data. FSH, LH and progesterone values were similar in all cycles. Conclusion Coadministration of SOF or LDV with NGM/EE was safe and well tolerated. Based on these results, no loss in contraceptive efficacy is expected upon administration of combined oral contraceptives containing ethinyl estradiol and norgestimate with SOF or SOF/LDV FDC. Accordingly, the use of OC with SOF or SOF/LDV FDC is permitted. Disclosures: Polina German – Employment: GIlead Sciences, Inc; Stock Shareholder: GIlead Sciences, Inc Lisa Moorehead – Employment: Gilead Sciences; Stock Shareholder: Gilead Sciences Phil S. Pang – Employment: Gilead Sciences Anita Mathias – Employment: Gilead Sciences Inc.

6, 7), suggesting that the accumulation of neutrophils contributes to the exacerbated liver injury observed in α-Galcer-treated IFN-γ−/− and STAT1−/− mice. IFN-γ−/− mice had lower levels of hepatic expression of IL-4 compared to WT mice after α-Galcer injection (Supporting Fig. 7), suggesting that IFN-γ is required for the production of IL-4. However, this unlikely attributes to IFN-γ prevention

of hepatic neutrophil infiltration because IL-4 promotes hepatic neutrophil accumulation (see above). Our further findings indicate that IFN-γ attenuates hepatic neutrophil accumulation by inducing neutrophil apoptosis after α-Galcer injection, as neutrophil apoptosis was suppressed in IFN-γ−/− mice (Fig. 6).

Mechanistic studies suggest that the proapoptotic effect of IFN-γ is mediated by the induction of several proapoptotic genes by way of a STAT1-dependent mechanism 3-deazaneplanocin A order (Fig. 7F). Collectively, these findings suggest that IFN-γ stimulates the expression of proapoptotic genes in neutrophils by Mdm2 antagonist way of a STAT1-dependent mechanism, thereby playing an important role in preventing hepatic neutrophil accumulation in α-Galcer-induced liver injury. In addition to their opposing roles in the control of hepatic neutrophil accumulation, IL-4 and IFN-γ have been shown to inversely control NKT cell proliferation in vitro.[17] During the course of our studies, we observed the percentage and total number of liver iNKT cells in WT, IL-4−/−, IFN-γ−/−, and IL-4−/−IFN-γ−/− dKO mice MCE公司 were comparable before α-Galcer injection. After α-Galcer injection, liver iNKT cells rapidly disappeared within 24 hours. This disappearance was similar among these four strains of mice (data not shown). These findings suggest that the differences in hepatic neutrophil accumulation 3 hours post-α-Galcer injection

among WT, IL-4−/−, IFN-γ−/−, and IL-4−/−IFN-γ−/− dKO mice were not caused by the changes in iNKT cells at the early timepoints after α-Galcer injection. Additionally, expression of activation markers (CD11b and CD62L) and production of reactive oxygen species (ROS) were comparable in neutrophils from α-Galcer-treated WT, IL-4−/−, and IFN-γ−/− mice (Supporting Fig. 8), suggesting IL-4 and IFN-γ regulate hepatic neutrophil accumulation but not activation. Although IL-4 and IFN-γ mediate many crucial functions of iNKT cells in the liver,[6-8] IL-4−/−IFN-γ−/− dKO mice still had significant liver injury after α-Galcer injection, suggesting that mechanisms other than IL-4 and IFN-γ are involved. It was previously reported that α-Galcer treatment induces TNF-α production by iNKT cells and that inhibition of TNF-α ameliorated α-Galcer-induced liver injury and diminished the aggravating effects of IFN-γ neutralization in this liver injury.[15] These findings suggest that TNF-α likely contributes to the α-Galcer-induced liver injury in IL-4−/−IFN-γ−/− dKO mice.

6, 7), suggesting that the accumulation of neutrophils contributes to the exacerbated liver injury observed in α-Galcer-treated IFN-γ−/− and STAT1−/− mice. IFN-γ−/− mice had lower levels of hepatic expression of IL-4 compared to WT mice after α-Galcer injection (Supporting Fig. 7), suggesting that IFN-γ is required for the production of IL-4. However, this unlikely attributes to IFN-γ prevention

of hepatic neutrophil infiltration because IL-4 promotes hepatic neutrophil accumulation (see above). Our further findings indicate that IFN-γ attenuates hepatic neutrophil accumulation by inducing neutrophil apoptosis after α-Galcer injection, as neutrophil apoptosis was suppressed in IFN-γ−/− mice (Fig. 6).

Mechanistic studies suggest that the proapoptotic effect of IFN-γ is mediated by the induction of several proapoptotic genes by way of a STAT1-dependent mechanism GW 572016 (Fig. 7F). Collectively, these findings suggest that IFN-γ stimulates the expression of proapoptotic genes in neutrophils by Selleck PLX4032 way of a STAT1-dependent mechanism, thereby playing an important role in preventing hepatic neutrophil accumulation in α-Galcer-induced liver injury. In addition to their opposing roles in the control of hepatic neutrophil accumulation, IL-4 and IFN-γ have been shown to inversely control NKT cell proliferation in vitro.[17] During the course of our studies, we observed the percentage and total number of liver iNKT cells in WT, IL-4−/−, IFN-γ−/−, and IL-4−/−IFN-γ−/− dKO mice MCE were comparable before α-Galcer injection. After α-Galcer injection, liver iNKT cells rapidly disappeared within 24 hours. This disappearance was similar among these four strains of mice (data not shown). These findings suggest that the differences in hepatic neutrophil accumulation 3 hours post-α-Galcer injection

among WT, IL-4−/−, IFN-γ−/−, and IL-4−/−IFN-γ−/− dKO mice were not caused by the changes in iNKT cells at the early timepoints after α-Galcer injection. Additionally, expression of activation markers (CD11b and CD62L) and production of reactive oxygen species (ROS) were comparable in neutrophils from α-Galcer-treated WT, IL-4−/−, and IFN-γ−/− mice (Supporting Fig. 8), suggesting IL-4 and IFN-γ regulate hepatic neutrophil accumulation but not activation. Although IL-4 and IFN-γ mediate many crucial functions of iNKT cells in the liver,[6-8] IL-4−/−IFN-γ−/− dKO mice still had significant liver injury after α-Galcer injection, suggesting that mechanisms other than IL-4 and IFN-γ are involved. It was previously reported that α-Galcer treatment induces TNF-α production by iNKT cells and that inhibition of TNF-α ameliorated α-Galcer-induced liver injury and diminished the aggravating effects of IFN-γ neutralization in this liver injury.[15] These findings suggest that TNF-α likely contributes to the α-Galcer-induced liver injury in IL-4−/−IFN-γ−/− dKO mice.

However, AS1411 or modified AS1411 did not induce caspase 9 and 7 activation. Moreover, decrease of cell growth by AS1411 or modified AS1411 was neither prevented by caspase inhibitor nor necrosis inhibitor. Out of many buy DAPT GPC3 aptamers newly synthesized, we found a specific one showing high affinity and specificity in HCC cells as compared to CCA cells. Conclusions: We found that AS 1411

and modified AS1411 can suppress HCC cell growth without inducing cell death. Additionally, we confirmed that GPC3 aptamer may selectively bind to HCC cells with high affinity, implicating the therapeutic potential of aptamer as a novel targeted therapy for HCC. Disclosures: The following people have nothing to disclose: Yun Bin Lee, Jung-Hwan Yoon, Jung Hwan Lee, Eun Ju Cho, Dong Hyeon Lee, Yuri Cho, Su Jong Yu, Jeong-Hoon Lee, Yoon Jun Kim, Hyo-Suk Lee, Chung Yong Kim Background: Biliary intraepithelial neoplasia ABT888 (BilIN) is a precursor lesion of cholangiocarcinoma arising in the hilar region of the liver and the extrahepatic bile duct. BilIN represents the process of multistep cholangiocarcinogenesis, and is a concept of biliary counterpart of pancreatic intraepithelial neoplasia

(PanIN). Previous studies on histopathological characteristics of BilIN and PanIN have been performed individually. Aim: This study was performed to compare the histological characteristics of BilIN to those of PanIN. Methods: Paraffin-embedded tissue sections of surgically resected MCE specimens of cholangiocarcinoma with hepatolithiasis (n = 25) associated with the foci of BilIN and pancreatic ductal adenocarcinoma (n = 22) associated with the foci of PanIN were used. Immunohistochemical staining was performed using the primary antibodies against MUC1, MUC2, MUC5AC, CEA, S1 00P, p53, cyclin D1 and p21. For mucin staining, alcian blue pH2.5 was used. The results were semi-quantitatively graded in consideration of the signal intensity

or the percentage of positive cells in each lesion, and were compared for the foci of BilIN-1, BilIN-2/3, PanIN-1A/1B and PanIN-2/3. Results: Cytoplasmic mucin expression tended to be abundant in PanIN rather than BilIN, and PanIN-1A/1B showed significantly increased mucin expression compared to that of BilIN-1. Approximately 20% of the foci of BilIN-1 and BilIN-2/3 showed MUC2 expression, while it was almost negative in PanIN. The nuclear and cysto-plasmic expression of S100P was frequently observed in BilIN and PanIN, and its expression was significantly high in PanIN-1 A/1 B compared to that of BilIN-1. The expression of p53 was negative in BilIN-1 and PanIN-1A/1B. Twenty % of the foci of BilIN-2/3 and 64% of PanIN-2/3 foci showed positive immunohistochemical expression of p53, in which a significant difference was observed between them.

He was treated for ITP using prednisolone, the unexpected sudden interruption of which caused severe deterioration of eosinophilic cholangitis Y-27632 mouse and acute cholecystitis. Cholecystectomy and choledochojejunostomy were performed, and the addition of treatment by prednisolone resulted in a good clinical course. This is the first report on eosinophilic cholangitis coexisting with ITP. “
“Esophageal and gastric manifestations in systemic and cutaneous diseases

vary a great deal. Some patients have debilitating symptoms, while others may be minimal symptoms with impaired physiologic function. Some patients may be asymptomatic but at risk for developing cancer. In this chapter, the esophageal and gastric manifestations of the connective tissue, endocrine, inflammatory, neuromuscular, and cutaneous diseases are reviewed. “
“Recent genome-wide association studies showed that four single-nucleotide polymorphisms (SNPs) in human leukocyte antigen (HLA)-DP (rs3077and rs9277535) and HLA-DQ (rs2856718 and rs7453920) were associated with chronic hepatitis B virus (HBV) infection in Japanese populations. More than 75% of hepatocellular carcinoma (HCC) patients are attributable to persistent Ibrutinib nmr infection of hepatitis B virus (HBV), especially in China. We genotyped these four SNPs in 1,300 HBV-positive HCC patients, 1,344 persistent HBV carriers, and 1,344 persons with HBV natural clearance from Southeast China to further test the associations

of HLA-DP/DQ variants and with risk of both HBV

clearance and HCC development. Logistic regression analyses showed that HLA-DQ rs2856718 significantly decreased host HCC risk, whereas three SNPs were associated MCE公司 with HBV clearance (HLA-DP rs9277535 as well as HLA-DQ rs7453920 and rs2856718). In addition, HLA-DP rs3077 showed an approaching significant effect on susceptibility to HBV persistent infection and HCC development when considering multiple testing adjustments. Taken together, we report, for the first time, that genetic variants in the HLA-DP and HLA-DQ loci may be marker SNPs for risk of both HBV clearance and HCC development. (HEPATOLOGY 2011) Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, with a particularly high prevalence in East and Southeast Asia and sub-Saharan Africa, whereas China alone accounts for more than 50% of all cases.1 Among the major risk factors for HCC, chronic infection with hepatitis B virus (HBV) is of particular interest for its coherent distribution with the HCC prevalence. It is estimated that 75%-85% of HCC patients are attributable to persistent infection of HBV, especially in developing countries.1 Persistent HBV infection or HBV clearance is influenced by complex factors of viral infection, host age, environmental factors, and genetic makeup, with most studies that identified susceptibility loci at the human leukocyte antigen (HLA) class II region at 6p21.2-6 Recently, Koichi et al.

A simulated class I partially edentulous mandible was prepared with two screw-type 3.75×12 mm implants in the first molar regions and 2 metal-ceramic crowns on distal abutments.

Fifteen bilateral distal extension frameworks were conventionally fabricated in three clasp designs (suprabulge, infrabulge, no clasp). Locator attachments were connected to the 15 denture bases with autopolymerized resin. Each specimen was subject to four types of retention pulls (main, anterior, posterior, unilateral pull) five times with a universal testing machine. Locator attachments were replaced www.selleckchem.com/Wnt.html with O-ring attachments, and the same procedure was performed. Therefore, the study groups included: IRPD with Locator attachment and suprabulge clasp (group 1), IRPD with Locator attachment and infrabulge clasp (group

2), IRPD with Locator attachment and no clasp (group 3), IRPD with O-ring attachment and suprabulge clasp (group 4), IRPD with O-ring attachment and infrabulge clasp (group 5), IRPD with O-ring attachment and no clasp (group 6). Data were analyzed using one-way ANOVA, two-way ANOVA, and Tukey tests. The highest mean value was 22.99 lb for prostheses with a Locator attachment and suprabulge clasp. The lowest retentive values were recorded for IARPDs with O-ring attachments. The results of this in vitro study suggest that the precise selection of attachments with or without clasp selleck chemicals llc assemblies may affect the clinical success of mandibular IARPDs. “
“This article describes a method of converting an interim maxillary removable complete denture to an interim implant-supported fixed complete denture. The advantages of this method are that it provides the opportunity to evaluate the patient’s function and esthetics, and helps the accurate transfer of the maxillomandibular relationship to the laboratory. Consequently, the fabrication of the definitive prostheses is accurate, and the final result is predictable. “
“American Equilibration medchemexpress Society 59th Scientific Meeting, Chicago, IL http://www.aes-tmj.org American Prosthodontic Society 86th Annual Meeting, Chicago, IL http://www.prostho.org/ American Academy of Fixed Prosthodontics

2014 Scientific Session, Chicago, IL http://www.fixedprosthodontics.org/ Academy of Osseointegration Annual Meeting, Seattle, WA www.osseo.org ADEA Annual Session, San Antonio, TX [email protected] AADR General Session, Charlotte, NC www.iadr.com Thomas P. Hinman Dental Meeting Atlanta, GA Contact: Ms. Sylvia Ratchford, 404–231–1663 [email protected] Southeastern Academy of Prosthodontics Annual Meeting, Olmstead, NC http://www.seaop.com/Annual_meeting.html American Academy of Cosmetic Dentistry Annual Scientific Session, Orlando, FL http://www.aacd.com Northeastern Gnathological Society Spring Meeting New York, NY Contact: Ms. Carol Bensky [email protected] Academy of Prosthodontics Annual Meeting, Bern, Switzerland http://www.academyofprosthodontics.

1%, n= 8). Osteopenia, as measured by DEXA, was more severe in OS patients (21.7%, n=13), p=0.01. Liver stiffness (FibroscanR) was higher in patients with OS (median 28.4; IQR 17.3 – 43; p<0.001). Patients of OS predominantly presented with cirrhosis 72.5% (n= 58) as compared to AIH 64.9% (n=113); p = 0.08. At first presentation, 56.3% of OS patients had decompensation in contrast with 37.9% of AIH patients; p−0.03. Overall, patients with OS carried poorer prognosis, as 8.8% died as compared to 5.2% of AIH; p=0.18. The presence of ASMA in the titre of 1:40 or 1:20 was associated with higher incidence of decompensation among patient in

both the groups (p=0.04). Crizotinib supplier The presence of ANA in the titre of 1:40 or 1:80 was negatively associated with decompensation in patients of AIH, but not in case of OS (p = 0.05). CONCLUSIONS: AIH and OS are not uncommon as chronic liver disease in the Indian continent. Patients with OS are older and present more often as cirrhosis with decompensation with a poor prognosis. Decompensation is more likely in patients who harbour ASMA (p= 0.04). We propose that high suspicion in diagnosis and lower threshold in performing liver biopsy in seemingly non-classical AIH would yield early diagnosis and could improve survival benefit in this group. Disclosures: The following people have nothing to disclose: Lovkesh Anand, Cyriac

A. Philips, Varsha Bhat, Chhagan Bihari, Ajeet S. Bhadoria, Shiv

K. Sarin Background/Aim: Autoimmune hepatitis (AIH) type 1, often occurs in middle age females, is a progressive autoimmune liver Sorafenib price disease of unknown pathogenesis. 上海皓元医药股份有限公司 Under the prednisolone (PSL) treatment, the progression of disease is mild in almost patients. However, some patients resist the PSL treatment, and some patients who achieved the remission by the PSL treatment recurrent easily without the PSL treatment. Thus, we analyzed the dynamics of gene expression by PSL treatment including messengerRNA (mRNA), long intergenic non-codingRNA (lin-cRNA), and microRNA (miRNA) in CD4+ T cells to reveal the mechanisms of PSL treatment for AIH. Methods: Clinically and pathologically diagnosed 2 naïve AIHs, 7 AIHs in remission, and 7 healthy controls, who agreed to provide samples with written informed consent, were enrolled in this study. This study was approved by the institutional review board. Total RNA was extracted from CD4+ T cells purified from peripheral blood. The comprehensive analysis of the genes were undergone using microarray with statistics (ANOVA). The data were classified by hierarchical clustering and were analyzed for the function bioinformatically using Gene ontology (GO) analysis and pathway analysis. Results: Microarray study showed that 2,957 mRNAs (p<0.05, fold change>1.5), 574 lincRNAs (p<0.05, fold change>1.5), and 17 miRNAs (p<0.05, fold change>1.2) were differentially expressed among 3 groups.

44 [95% CI, 1.12-1.87]) and migraine symptom severity score. Among those who were diagnosed, annual household income was the strongest predictor of currently using guideline-defined appropriate acute treatment (OR = 1.44 [95% CI, 1.07-1.93]) followed by a 10-point change in MIDAS score (OR 1.16 [95% CI, 1.02-1.35]). Conclusions.—

Among persons with migraine in need of medical care (MIDAS Grade II or greater), only one quarter traversed the 3 steps we proposed to be necessary to achieving minimally appropriate care (consulting, diagnosis, and treatment/medication use). Health insurance status was an important predictor of consulting. Among consulters, women were far more likely to be diagnosed than men, suggesting that gender bias in diagnosis may be an important barrier for men. There were economic barriers related to use of appropriate prescription medications. buy Deforolimus Public health efforts should focus on improving consultation rates, particularly in the uninsured and diagnostic rates particularly in males with migraine. “
“(Headache 2011;51:237-245) Objective.— The aim of this study was to investigate the possible microstructural abnormalities of the corpus callosum (CC) in adult patients with migraine without aura complicated with depressive/anxious disorder. Background.— Emotional disorders, especially depression

and anxiety, are KPT-330 cost with relatively higher incidence in migraine population. However, the mechanism of migraine complicated with depressive/anxious disorder remains unclear. Methods.— Diffusion tensor magnetic resonance imaging was carried out in 12 adult patients MCE公司 with simple migraine (without aura and without depressive/anxious disorder) (S-M group), 12 adult patients with complicated migraine (without aura but complicated with depressive/anxious disorder) (Co-M group), and 12 age- and sex-matched healthy subjects (Control group). Fractional anisotropy (FA) and apparent diffusion coefficient were measured at genu, body, and splenium of the CC, respectively. Results.— There were

significant differences in FA values at all locations of the CC among the 3 groups. The FA values from both the SM and Co-M groups were significantly lower than the control (P < .05 and P < .01, respectively). The FA values from Co-M group were significantly lower than the SM group (P < .01). The apparent diffusion coefficient values of the above regions had no significant differences among these groups (P > .05). There were negative correlations between FA value of genu of the CC and disease course as well as FA value of genu and body of the CC and headache frequency (P < .05). Negative correlations were also found between FA values at all locations of the CC and Hamilton anxiety and Hamilton depression scores (both P < .05). Conclusions.

Mice were sacrificed at various time points and peripheral blood and liver were collected for immunohistochemistry, flow cytometry, real-time PCR and microarray analysis. Results: Chronic oral administration of TAA induced two distinct phases

of liver injury (Figure 1). The first phase (0–7 days) induced a rapid peri-central inflammatory infiltrate in association with MCP-1 production and collagen deposition. This inflammatory infiltrate was enriched in non-phagocytic F4/80+ monocytes (Figure 2A,B), which co-localized INCB024360 with activated fibroblasts (αSMA+) and collagen-1 deposits (Figure 2C). Notably, this early phase of fibrosis occurred in the absence of a significant ductular reaction. A second phase of injury, initiated after 4 weeks treatment, was associated with macrophage accumulation and sequestration to peri-central regions and a surge in collagen deposition. In contrast to the early

phase, this second phase had a prominent ductular reaction which initiated in the portal regions and migrated to the site of injury. Strikingly, the activated progenitor cells co-localized with hepatic tissue macrophages. In the late stages of TAA-induced liver injury (6–12 weeks), the DR and collagen formed large fibrous septa resembling cirrhosis. Conclusions: During the initial stages of liver injury, monocytes are recruited to the tissue resulting in early collagen deposition. However, the interaction between the hepatic progenitor cells and tissues macrophages is required during the later stages of injury for the progression of liver fibrosis the KU-60019 clinical trial development of cirrhosis. 1. Friedman SL. Mac the knife? Macrophages- the double-edged sword of hepatic fibrosis. The Journal of clinical investigation 2005;115:29–32. 2. Clouston AD et al. Fibrosis correlates with a ductular reaction in hepatitis C: roles of impaired replication, progenitor cells and steatosis. Hepatology 2005;41:809–818. V KNIGHT, J TCHONGUE, D LOURENSZ, A LIU, P TIPPING, W SIEVERT Centre for Inflammatory Diseases, Monash University, Victoria, Australia Tissue factor (TF) has a well-known function in hemostasis but also plays an important role in angiogenesis, sepsis and inflammation. TF has 3 domains, the

cytoplasmic domain 上海皓元医药股份有限公司 acts as a signaling receptor to promote a proinflammatory phenotype in macrophages (Cunningham 1999). Deletion of the TF cytoplasmic domain reduces the severity of inflammatory arthritis in an experimental murine model (Yang 2004). The aim of this study was to investigate whether deletion of the TF cytoplasmic domain protected against fibrogenesis in a model of hepatic inflammation and fibrosis. Methods: 9 week old wildtype (WT) and C57/BL6 mice with deletion of the TF cytoplasmic domain (TF§CT/§CT) received twice weekly intraperitoneal injections of carbon tetrachloride for 8 weeks. Fibrosis was quantified by computer assisted morphometry of Sirius red stained liver sections. Hydroxyproline assay quantified hepatic collagen content.

Presence of satellites (HR, 2.79; P = 0.003), cirrhosis (HR, 2.3; P = 0.010), and nonanatomic resection (HR, 1.79; P = 0.031) were independently associated with recurrence. Patients with a single HCC ≤2 cm and

platelet count ≥150,000/μL achieved a median survival of 138 months and a 5-year survival rate of 81%, respectively. Conclusion: Resection of HCC ≤2 cm is safe and achieves excellent results in Western centers. Recurrence continues to be a significant problem. Presence of satellites, platelet count, anatomic resection, check details and cirrhosis are associated with outcomes after resection, even among such early tumors. Resection should continue to be considered a primary treatment modality in patients with small HCC and well-preserved liver function. (HEPATOLOGY 2013) See Editorial on Page 1300 Hepatocellular carcinoma

(HCC) ≤2 cm is regarded as a separate and distinct clinical subgroup by both Eastern and Western experts.1, 2 Detection of tumors at such an early stage has traditionally been rare in the West and as a result, clinicians have had to rely on data almost exclusively from the East. However, LY2109761 as a result of the increased awareness of the need for screening in patients with liver disease and validated criteria for accurate noninvasive diagnosis of such small tumors, the number of HCCs being detected at an early stage will likely increase in North America and Europe.3-5 Patients with such early HCC have a good likelihood of cure with resection, transplantation, or ablation.6-11 Although there have been a significant number of recent publications on the indications and outcomes of both transplantation and ablation in the treatment of early HCC, the literature on which the recommendations regarding the role of surgical resection are based is more dated. A review of the data collected by the Liver Cancer Study Group of Japan demonstrated a 5-year survival

rate of 71% for the 1,318 patients with a single HCC ≤2 cm undergoing surgical resection.12 In contrast, examination of the Surveillance, Epidemiology, and End Results Program database identified only 154 patients with HCC ≤2 cm undergoing resection in the United States over an 8-year period with a 5-year survival rate of only 49%.13 Such differing results leave the role of surgical resection for such early tumors unclear. 上海皓元 In addition, such poor results reported by Western series, as well as the lack of well-defined criteria for resection, have led some authors to suggest that radiofrequency ablation may be the treatment of choice for patients with HCC ≤2 cm even when surgical resection is possible.10, 14 The data presented in this study detail the results from two Western centers performing a large volume of HCC resections. It represents the largest Western series to examine the outcomes of patients undergoing resection of a single HCC ≤2 cm. We also provide the results of our exploratory analyses to determine the clinical variables associated with survival and recurrence.