E‐Poster Presentations – B1) Liver

Background/Aims: Paper-and-pencil-based psychometric tests are gold standard for diagnosis of minimal hepatic encephalopathy (MHE). However, it takes time, can be affected by demographic factors like age/education level, and lacks ecological validity. This study explored feasibility and validity of sensory integration test as a new diagnostic approach to assess MHE. Methods: Twenty-one healthy controls and 30 cirrhotic patients were recruited. The sensory integration test presents stimuli from two different sensory modalities (e.g., image and sound) with a short-time lag, and subjects judge, which stimuli appeared first. Repetitive tests reveal the subject’s sensory integration capability. Subjects were compared with each other in their performance of proposed sensory integration test, conventional psychometric tests, and functional near-infrared spectroscopy (fNIRS). Results: Sensory integration capability, the perceptual threshold to discriminate time gap between image and sound stimulus, was significantly impaired in MHE patients compared with healthy controls (P < 0.01) and cirrhotic patients without MHE (P < 0.05). Correlation analysis showed that sensory integration test can also detect psychometric deficits (NCT-A, r = 0.290, P = 0.039; NCT-B, r = 0.395, P = 0.004; DST-B, r = 0.360, P = 0.010; ACPT, r = 0.364, P = 0.009). Conventional psychometric tests were dependent on age and education level, while the sensory integration test was not affected by demographic factors. The sensory integration test, where a cut-off value for the perceptual threshold was 133.1 ms, recognized the patients with MHE at 80 % sensitivity and 81 % specificity. Conclusions: Sensory integration test showed comparable performance to diagnose MHE irrespective of age and education level. Trial identifier: https://cris.nih.go.kr/cris (KCT0000955).

of HCC by calculating the tumor volume doubling time (TVDT) and its impact on survival and recurrence. Methods: A retrospective cohort study of 269 HCC patients who underwent two or more pretreatment imaging studies of computed tomography or magnetic resonance imaging was performed. Tumor growth rate and TVDT were calculated by comparing tumor volumes between imaging studies. The clinical parameters that correlated with tumor growth rate were evaluated. After dividing patients into slow-growing (159 patients with TVDT > 2 months) and rapidgrowing (110 patients with TVDT < 2 months) groups, we compared the groups in terms of their survival and recurrence outcomes. The response to transarterial chemoembolization (TACE) was evaluated according to TVDT. Results: The median tumor growth rate and TVDT were 37.5 %/month (range, 18.1-94.5%/month) and 2.37 months (range, 1.0-4.9 months). In multiple linear regression analyses, poor liver function, initial tumor size, gross vascular invasion, and serum alphafetoprotein level were significantly associated with HCC growth rate (P < 0.05). Patients in the rapid-growing group had lower survival rates and higher recurrence rates (P < 0.05). The response to TACE was worse in the rapid growing group (P < 0.05). Conclusions: HCC growth rate is associated with poor liver function and aggressive tumor biology. HCC patients with shorter TVDTs exhibit worse survival and recurrence outcomes as well as a poor response to TACE.
# P-0021 A case of hepatocellular carcinoma with lung and bone metastasis treated sorafenib therapy who obtained a complete remission Authors: TAKESHI TOMIYAMA; HIDETSUGU NAKAZATO; KOUDAI SHINZATO Affiliation: Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan Introduction: Advanced stage of hepatocellular carcinoma (HCC) has a poor prognosis because of liver dysfunction and a lack of effective treatment. Sorafenib, a multi-targeted tyrosine kinase inhibitor, is a first line systemic treatment for advanced HCC. Sorafenib increases overall survival in patients with advanced HCC;, however, sorafenib rarely induces a complete response. Case Description: A sixty-six66-year-old man was found with liver tumor on abdominal echogram in a health screening. He had been diagnosed with HCC in segment VI (6 cm in diameter), for which he had received liver resection in February 2008. Resected specimen revealed moderately differentiated HCC with cirrhosis. He suffered from right thigh pain in 2011. Bone metastasis of HCC was pointed out. Total hip arthroplasty had been performed in October 2011. Multiple lung metastasis was pointed out in January 2012. The Child-Pugh score was A (5 points) and the patient remained in good conditions (PS = 1). Sorafenib therapy (800 mg/day) was started. After 3 months administration of sorafenib, tumor markers (AFP, PIVKA-II, and AFP-L3) had been within the normal range. After 3 years administration of sorafenib, a complete radiological response had been obtained. Sorafenib dose was reduced and sorafenib therapy was continued. The patient remains in remission without clinical or imaging evidence of disease recurrence. We report an advanced HCC patient with distant metastasis, who has obtained a complete response by sorafenib therapy. Although cases of complete response are uncommon, these cases are characterized by a very rapid response to sorafenib with an early drop of tumor markers and radiological response. If a complete radiological response is obtained, the issue of a discontinuation of sorafenib is still unresolved. Sorafenib is an important treatment option that has been shown to improve prognosis in selected cases of HCC. # P-0030 Nutritional status and hepatic steatosis after direct-acting antiviral therapy for chronic hepatitis C virus infection Authors: MASAAKI SHIMADA; HIROAKI IWASE; NOBORU HIRASHIMA; NOBUMITSU RYUGE; NOBORU URATA; JIN UMESHITA; SATOSHI UNITA; TAKASHI KONDO; DAIKI TANAKA Affiliation: Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan Background: In this retrospective study, we investigated nutritional status and hepatic steatosis after direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection. Methods: Between September 2014 and August 2016, 106 patients with chronic HCV infection underwent HCV-RNA testing 12 weeks after completing DAA therapy. HCV genotype 1 patients received daclatasvir and asunaprevir (DCV/ ASV, n = 35) for 24 weeks, or sofosbuvir and ledipasvir (SOF/LDV, n = 37) for 12 weeks; HCV genotype 2 patients received sofosbuvir and ribavirin (SOF/RBV, n = 34) for 12 weeks. DAA therapy was assessed for virologic response, side effects, and posttreatment alanine transaminase (ALT) and α-fetoprotein (AFP) levels. Liver stiffness (LS) was measured using transient elastography. Nutritional status was evaluated using serum albumin (Alb), triglyceride (TG), total cholesterol (T-cho), and low-density lipoprotein cholesterol (LDL-cho) levels. Controlled attenuation parameter (CAP) values were measured for diagnosis of hepatic steatosis using transient elastography. Results: HCV RNA became undetectable in 32 patients who received DCV/ASV (91.4%), 37 who received SOF/LDV (100%), and 33 who received SOF/RBV (97.1%). Mild anemia was noted with SOF/RBV. ALT decreased from 64.0 ± 68.9 to 16.9 ± 8.3 IU/L, P < 0.001; AFP from 20.0 ± 77.6 to 4.1 ± 5.2 ng/mL, P < 0.001; and LS from 10.4 ± 6.7 to 7.6 ± 5.0 kPa, P < 0.01. Alb increased from 4.1 ± 0.5 to 4.3 ± 0.4 g/dL, P < 0.001; TG from 111 ± 46 to 128 ± 66 mg/dL, P < 0.05; T-cho from 158 ± 30 to 187 ± 35 mg/dL, P < 0.001; and LDL-cho from 82 ± 20 to 105 ± 30 mg/dL, P < 0.001. CAP values increased from 213 ± 60 to 226 ± 55 dB/m (P < 0.01). Conclusion: DAA therapy was useful for chronic HCV infection, and nutritional status improved. However, long-term follow-up is necessary because short-term steatosis was observed. treated by DAA, with at least 12 weeks follow-up after the end of treatment, were enrolled (DCV+ASV 174, SOF/LDV 185, PTV/r/OMV 33, SOF+RBV 165). The 2-year cumulative HCC incidence rate (HIR) was calculated. The correlation between HCC incidence and the factors (age, gender, platelet count, FIB-4, cirrhosis +/À-, history of curative therapy for HCC +/À-, AFP, M2BPGi, achievement of SVR12 +/À-) were was also evaluated. Results: Median age was 67 (23--87), 314 (56%) were male, 202 (36%) had cirrhosis, and 78 (14%) cases were with HCC history. SVR was achieved in 504 (90%). HIR in HCC history group (41%) was significantly higher than that in HCC naïve group (4%) (P < 0.01). In HCC history positive group, HIR was no difference between SVR (47%) and non-SVR group (15%) (P = 0.39). In all cases, HCC history positive (P < 0.01), AFP > 4 ng/dl (P = 0.01), and M2BPGi > 2.3 at 12 weeks after DAA (P = 0.02) were significant risk factors for HCC incidence with multivariate analysis. Also, in 441 cases with HCC naïve and SVR, AFP and M2BPGi were significant risk factors. When AFP and M2BPGi were scored as 1 point for each, HIR in 0, 1, and 2 points were 4%, 9%, and 24%, respectively (P < 0.01), and the risk was well stratified. Conclusions: The recurrence of HCC was observed frequently despite achieving SVR in patients with history of curative therapy for HCC. AFP > 4 and M2BPGi > 2.3 were independent risk factors development of HCC after SVR. The patients satisfied these conditions need more careful observation for incidence of HCC.
# P-0085 A prospective study to assess the role of serum procalcitonin in the diagnosis and follow up of patients with spontaneous bacterial peritonitis Authors: VINEET GUPTA; DEEPAK; RAKESH TANDON Affiliation: Pushpawati Singhania Research Institute for Liver, Renal and Digestive Diseases, New Delhi, India Background: To assess the levels and diagnostic role of serum procalcitonin (PCT) in patients with decompensated cirrhosis with newly diagnosed spontaneous bacterial peritonitis (SBP) and its accuracy in establishing the resolution of SBP after a 5-day course of broad spectrum intravenous antibiotics. Methods: This was a prospective study comprising of 3three groups of 26 patients each: group 1 (SBP group), group 2 (Sterile ascites group), and group 3 (infectious group excluding SBP) with similar baseline characteristics. PCT and ascitic fluid were analyzed within 4 hours of admission in all the 3three groups and were repeated after 5 days of intravenous antibiotic in group 1 only. PCT ≥ 0.5 ng/ml was considered abnormal. Results: Mean PCT was 3.94 ± 3.86 in group 1 and 0.37 ± 0.07 in group2 (P value 0.00). It was also raised in group 3 (3.37 ± 3.38). At a cut-off value of 0.5 ng/ml, PCT had a sensitivity of 92.3%, specificity 50.98%, negative predictive value 92.8%, and positive predictive value 48.97% for the diagnosis of SBP. Significant fall was seen in PCT levels (mean 3.14 ± 3.55) and serum ascitic fluid TLC (mean 3441.30 ± 1319.59) after 5 days of antibiotic therapy in group 1 (P values 0.003 and 0.015, respectively). Positive correlation was seen between proportionate fall in PCT and proportionate fall in ascitic fluid TLC (P value 0.021). This observation indicates that a repeat PCT at the end of antibiotic course can be used as a surrogate marker of resolution of spontaneous SBP. Conclusion: PCT is raised in SBP. A normal PCT may be useful in excluding SBP especially when other infections have been ruled out. In SBP patients, a repeat PCT after 5 days of antibiotic treatment can be used as a helpful noninvasive biomarker for resolution of infection. Background: Terlipressin's efficacy in hepatorenal syndrome (HRS) treatment has been demonstrated in clinical trials, but real world data on adverse events and outcomes is are scarce. We describe our experience of terlipressin use in HRS. Methods: We interrogated our hospital pharmacy database for terlipressin prescriptions between January 2006and June 2012. Patients who received at least one dose of terlipressin and fulfilled the International Ascites Club HRS diagnostic criteria were included. Results: 18 Eighteen patients were identified, with baseline characteristics summarised summarized in Table 1. Ten patients received terlipressin for more than 48 hours, with treatment response (serum creatinine reduction to < 1.5 mg/dL or to baseline) seen in 4 four (40.0%) patients. Of the remaining 8 eight patients, 3 three died within 48 hours of terlipressin commencement, 4 four progressed to hemodialysis, and 1 one developed bowel ischaemia necessitating treatment cessation. Four Four (22.2%) %) patients developed adverse events: bowel ischaemia (n = 1), bowel and myocardial ischaemia (n = 1), limb ischaemia (n = 1), and congestive cardiac failure (CCF) (n = 1). The overall 14-day survival rate was 52.9%, decreasing to 25.0% in patients where terlipressin treatment was delayed (beyond 72 hours post-diagnosis). The 90-day overall survival and transplant-free survival rates were 41.2% and 17.6%, respectively, with 4 four patients having undergone liver transplantation (at 2, 3, 69, and 115 days respectively after terlipressin initiation). Conclusion: Terlipressin should be administered promptly following diagnosis of HRS. For patients on terlipressin, clinicians should be vigilant to adverse events like end-organ ischaemia and CCF. Patients who respond to terlipressin retain an abysmal prognosis short of definitive treatment with liver transplantation. # P-0092 Prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) defined by non-invasive assessment in type 2 diabetes mellitus (T2DM) patients with normal serum aminotransferase (AST/ALT) levels Authors: SIRINA EKPANYAPONG; THANAYA TECHASIRIOANGKUN; CHALERMRAT BUNCHORNTAVAKUL Affiliation: Department of Medicine, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand Background/Aims: NAFLD is more common and more severe in patients with T2DM;, however, the prevalence and severity of NAFLD in T2DM patients with normal AST/ALT is unclear. This study was aimed to evaluate prevalence and risk factors of NAFLD and liver fibrosis in T2DM patients with normal AST/ALT. Methods: T2DM patients with persistently normal AST/ALT (≤ 40 IU/L for ≥ 2 times during ≥ 6 months) were evaluated by controlled attenuation parameter and transient elastography (CAP-TE) by an experienced operator (T. T.) at Rajavithi Hospital, Bangkok, between Nov-2016 and Mar-2017. Exclusion criteria were T1DM, significant alcohol drinking, chronic viral hepatitis, and the use of medications that may affect NAFLD. The cut-offs for steatosis were CAP 215 dB/m for S1 (~10% steatosis) and CAP 252 dB/m for S2 (~33% steatosis), whereas for fibrosis, cut-offs were TE 7.0 kPa for significant fibrosis and TE 10.0 kPa for advanced fibrosis (NAFLD defined by ≥ S1). Results: A total of 105 patients were included; 69.5% were women with median age of 62 (33--80) years. 2) kg/m 2 and 59.0% were obese (BMI ≥ 25). The median duration of T2DM was 10 years (0.25--30) years, and 42.9% have microvascular complications. Prevalence of NAFLD was 81.0% (62.9% were ≥ S2). Prevalence of NAFLD with significant fibrosis and advanced fibrosis was 23.8% and 13.3%, respectively. In the multivariate analysis, independent predictors for NAFLD were female (OR 4.28:95%CI;) and obesity (OR 7.08:95%CI; 1.74--28.9) and for significant fibrosis were obesity (OR 5.47:95%CI;. Other clinical and laboratory parameters, including ALT ≤ 19 in men/≤ 30 in women, NAFLD fibrosis score, FIB-4, BARD, and AST/ALT ratio were not associated with the presence of steatosis and fibrosis. Conclusion: NAFLD and fibrosis were relatively common among T2DM patients with normal AST/ALT. Obesity appeared to be a good predictor for NAFLD/fibrosis in this population.
# P-0094 Follistatin is a useful biomarker predicting the effect of sorafenib for the treatment of hepatocellular carcinoma with extrahepatic spread Authors: TAKUYA ADACHI; KAZUHIRO NOUSO; HIROYUKI OKADA Affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan Background: Follistatin (FST) is a pro-angiogenic cytokine and plays as an important role in tumor growth and metastasis. In case of hepatocellular carcinoma (HCC), we revealed that prognosis of the patients with high serum FST was poor (JGH 2013;28:1391-6). The aim of this study is to examine the usefulness of FST as the prognostic biomarker in patients with metastatic HCC treated with sorafenib, as sub-analysis of prospective sorafenib cohort study (UMIN000009771). Methods: We measured serum FST in 48 HCC patients with extrahepatic spread who were treated with sorafenib at several time points, and evaluated the effects of FST on progression-free survival (PFS), overall survival (OS), and post progression survival (PPS). Results: No correlation was observed between FST before the treatment and OS; however, the increase of FST Other aetiologies include: autoimmune hepatitis / cholangitis (n=2), non-alcoholic steatohepatitis (n=1), drug-induced liver disease (n=1).
E-Poster Presentations -B1) Liver after 2 weeks indicated short OS (HR = 9.25, 95%CI = 1.74--170, P = 0.005). Poor performance status, HBsAg+, large tumor number (≧ 5), high des-gamma-carboxyprothrombin (> 100 mAU/mL), and no hand foot syndrome within 30 days were also predictive markers of short OS. Multivariate analysis with these factors revealed that only the increase of FST after 2 weeks was an independent risk factor for short OS (HR13.6, 95%CI 1.41--464, P = 0.020). Any single FST level was not correlated with PFS; however, FST ratio (FST at 2 weeks/ FST before the treatment) in Long-SD patients (stable disease more than one 1 year) was lower than that in non-Long SD patients (median 0.58 v.s. 1.49, P = 0.019). The increase of FST at progressive disease compared to with FST before the treatment was also a marker of short PPS (HR5.06, 95%CI 1.36--32.7, P = 0.012). Conclusions: The prediction of OS, Long-SD, and PPS was possible by measuring serum FST at appropriate timing. FST might be a key cytokine for predicting the prognosis of HCC patients with extrahepatic spread treated with sorafenib.
# P-0100 Control of hepatic edema by tolvaptan: Ccases with long-term or suspended administration Authors: TAKUYA IWAMOTO; TSUYOSHI ISHIKAWA; ISAO SAKAIDA Affiliation: Department of Gastroenterology and Hepatology, Yamaguchi University, Graduate School of Medicine Background: Tolvaptan is used for control of hepatic edema in our department. This study was performed to examine the efficacy of tolvaptan for this purpose. Methods: The subjects were 62 patients with hepatic edema who received tolvaptan from September 2013 to December 2016. The mean age, Child-Pugh score, serum creatinine level, and rate of HCC complication in the subjects were 71.2 (49--87) years, 9.5 ± 1.7 points, 1.18±0.44 mg/dL, and 66%, respectively. Results: An effective case was defined as a subject who lost ≥ 1.5 kg of weight one 1 week after tolvaptan administration. Using this definition, the effective rate of tolvaptan was 66.1%. After one1-week administration, tolvaptan continued to be administered to 46 subjects on an outpatient basis. The median administration period was 96 (6--992) days. Administration was suspended in 5 five subjects because tolvaptan was ineffective. In another 5 five subjects, administration was suspended due to improvement of ascites, but 3three of these subjects required readministration within 6 months. Among subjects who continued to receive tolvaptan, there were 28 deaths, but 24 of these patients had ascites control and required no paracentesis for ascites removal until death. In multivariate analysis of potential prognostic factors, efficacy, HCC complication, and continuous administration of tolvaptan were identified as independent factors. Conclusion: Tolvaptan may be an effective and safe drug that can be continuously administered to patients with hepatic edema. In subjects who discontinued tolvaptan, readministration was required at high rates. Continuous administration of tolvaptan may prevent reduction of QOL due to ascites retention until death. Tolvaptan may also improve the prognosis of patients with hepatic edema, and long-term administration is likely to be appropriate. # P-0104 Diabetic retinopathy as a risk factor associated with development of hepatocellular carcinoma in non-alcoholic fatty liver disease Authors Background: It is very important to develop the more effective surveillance to diagnosis the hepatocellular carcinoma (HCC) derived from non-alcoholic fatty liver disease (NAFLD) at early tumor stage. But the risk factors associated with the development of HCC from patients with NAFLD, are not fully understood. The aims of the present study were to identify the risk factors associated with the development of HCC from patients with NAFLD. Methods: Between April 2000 and December 2016, a total of 182 patients with NAFLD were enrolled in this study. At the enrolment, 22 patients had HCC, and 160 were not. To identify risk factor, univariate and multivariate analyses were performed, and to identify risk factor other than degree of fibrosis, propensity matched analysis adjusted by NAFLD fibrosis score (NFS) were carried out in 42 patients. Multivariate analysis and Kaplan-Meier analysis were also performed in the patients with HCC. Results: Multivariate analysis indicated that diabetic retinopathy (odds ratio = 9.753; P < 0.001) and NFS (odds ratio = 2.107; P < 0.001) were independent factors that were significantly associated with development of HCC. After adjustment for NFS, multivariate analysis indicated that diabetic retinopathy (odds ratio = 16.195; P < 0.001) and hypertension (odds ratio = 5.382; P = 0.013) were identified as independent factors that significantly associated with the development of HCC. In the patients with HCC, multivariate analysis indicated that NFS were significantly associated with diabetic retinopathy. The cumulative survival rates were no significant difference between the HCC patients with and without diabetic retinopathy (log-rank test: P = 0.438 Introduction: Budd-Chiari syndrome (BCS), a rare and potentially lifethreatening condition, is occasionally associated with hypoproteinemia. Segmental obstruction of the inferior vena cava (IVC) is one of the most common causes of BCS in Eastern countries. Besides many radiological interventions, endovascular stenting has been approved as a promising option for recanalization of IVC occlusion. Case Description: A 32-yearold female patient presented with massive ascites and leg edema. She had had history of abdominal distention for 2 months. She had no prior medical history and no oral contraceptives usage. Liver and spleen were slightly enlarged with no tenderness. No other abnormal findings were found. Laboratory data on admission: Hemoglobin 16.1 g/dl, hematocrit 48.7%, normal white blood cell and platelet count, serum albumin level 2.4 g/dl, total proteinemia 4 g/dl, total bilirubin 1.4 mg/dl, normal transaminase level. The serum ascitic albumin gradient was 1.9 g/dl and ascitic protein was 1.1 g/dl. Urinary protein was negative. Upper gastrointestinal endoscopy, colonoscopy, echocardiogram, and bone marrow biopsy results were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. Abdominal magnetic resonance imaging showed significant stenosis of the inferior vena cava without thrombus. On cavogram, the segmental obstruction of the intrahepatic IVC was 3-cm long with no thrombus and extensive collateral veins ( Figure 1). Stent Protégé was deployed to IVC through right femoral vein. Leg edema and ascites were completely resolved only 3 days after stenting and during 6-month follow-up. Background: Easier to comply and with proven efficacy, modified alternate-day calorie restriction (MACR) involves alternate day of 70% calorie restriction and habitual energy intake. The aim of study was to assess efficacy of 8-week MACR in reduction of steatosis, fibrosis, and biochemical parameters in non-alcoholic fatty liver disease (NAFLD). Methods: Consecutive participants with NAFLD but without other liver diseases were consented. After 2-week period of stable eating and activity habits, participants begun their 8-week MACR through advice of a dietitian. Besides diary, participants received phone-calls and 2-weekly dietitian appointment to ensure adherence. At baseline and 8 th 8 weeks after intervention, BMI, bloods (lipid profiles, glucose, and liver enzymes), and ultrasound (SuperSonic Imagine Aixplorer, France) to assess liver steatosis grading (mild, moderate, severe) and shear-wave elastography (SWE) were measured. Results: A total of 105 patients were screened, 41 consented but 11 withdrew, and 30 participants (mean age 43.9 years and BMI 31.5 kg/m 2 , males 70%, diabetes 53%) completed the study. With 8-week MACR, significant reductions were observed of grading of liver steatosis (40% reduction in those with moderate steatosis, P = 0.001), SWE (mean difference 0.9, P = 0.001), BMI (mean difference 0.6 kg/m 2 , P = 0.003), glucose (median difference 0.3 mmol/L P = 0.01), ALT (median difference 20.5 U/L, P = 0.001), and AST (median difference 9 U/L, P = 0.002 Background: Entecavir (ETV) and tenofovir (TDF) are most commonly used anti-viral agents for the treatment of chronic B hepatitis (CHB). We evaluated renal safety between two antiviral agents. Methods: Of 549 patients who received ETV or TDF as a first-line treatment, 285 patients (ETV, n = 139 vs. TDF, n = 146) were analyzed retrospectively. We compared the frequency of renal impairment, defined by creatinine increase (≥ 0.3 mg/dL), or GFR reduction (≥ 15%) and GFR change at 2 years. Results: The frequency of creatinine increase was 0.8% and 9.2% in ETV and TDF groups, respectively (P = 0.002). The frequency of GFR reduction (≥ 15%) was higher in TDF group (14.2%) than in ETV group (6.8%) (P = 0.048). The frequency of renal impairment at 2 years was higher in TDF group compared with ETV groups (17.0% vs. 6.8%, P = 0.01). TDF treatment, baseline albumin, GFR, and diabetes mellitus were independent risk factors for renal impairment. The GFR decreased from 76.6 ml/min/1.73 m 2 to 74.0 ml/min/1.73 m 2 in ETV group (P < 0.0001) and from 76.2 ml/min/1.73 m 2 to 72.0 ml/min/1.73 m 2 in TDF group (P < 0.0001). GFR change between two groups was not different at 2 years. (P = 0.16). In subgroups with high GFR (≥ 76 ml/min/1.73 m 2 ), GFR change was not different between two groups at 2 years. (P = 0.97). However, in patients with low GFR (< 76 ml/min/1.73 m 2 ), GFR was higher in ETV groups than in TDF groups.
(P = 0.005) at 2 years. Conclusions: TDF treatment might be associated with renal function deterioration. Therefore, before choosing antiviral agents, efficacy and risk factors for renal impairment should and should be considered. Background: We assessed the real-world experience for efficacy and safety of direct-acting antivirals (DAAs) for patients with HCV infection.
Methods: This retrospective study analyzed 127 patients with HCV infection (genotype 1b, n = 77; genotype 1a, n = 1; mixed with genotype 1a/1b, n = 1; genotype 2, n = 48) who were treated with DAAs. In patients with genotype 1b without NS5A RAV (n = 64), daclatasvir and asunaprevir (DCV+ASV) therapy was introduced. In patients with genotype 1Ib harbouring NS5A RAV (n = 12) or decompensated liver cirrhosis (n = 1), and a patients whose NS5A RAV was not available, genotype 1a, mixed with genotype 1a/1b were treated with sofosbuvir and ledipasvir (SOF+LDV). Genotype 2 patients (n = 48) were treated with sofosbuvir and rivabirin (SOF +RBV In genotype 1 patients treated with DCV+ASV, 2 two patients early stopped the treatment because of economic problem (n = 1) and virolgic breakthrough (n = 1). In genotype 2 patients, 3 three patients (SVR12, n = 1;, no SVR12, n = 2), all were over 70 years old, stopped the medication due to gastrointestinal trouble (n = 2) or pruritus (n = 1). During or after DAA treatment, hepatocellular carcinoma developed in 2 two patients (1 one in DCV+ASV group and 1 one in SOF +RBV group) whose ages were over 75 years. Introduction: Portal hypertension is the major complication of cirrhosis and leads to the development of esophageal varices. Bleeding from ruptured EV is the most severe complication of patients with cirrhosis, and the mortality rate of the first variceal bleeding is about 20-58%. Current guidelines recommend screening of all cirrhotic patients for varices at diagnosis and every 3-3 years with EGD. These recommendations are considered a burden on endoscopy unites with relative high costs, which force the patients to perform an unpleasant invasive procedure; on the other hand, many patients refuse repeated endoscopies because of discomfort and fear of transmission of infection. Aim of the Study: The aim of this work is to assess presence of EV by non-invasive markers in patients with liver cirrhosis using some clinical, laboratory, and sonographic parameters. Patients and Method: This study was carried on 120 patients with liver cirrhosis whom underwent EGD in the endoscopy unit of Menofia University Hospital, Egypt, after exclusion of patients with previous interventions for portal hypertension, HCC, and portal vein thrombosis and other malignancies. Patients are classified into 3three groups: 1 Cirrhotic with EV and history of bleeding (40) 2 Cirrhotic with EV and no history of bleeding (40) 3 Cirrhotic without EV (40) Patients were subjected to thorough history taking, clinical examination and lLaboratory investigations, abdominal UUltrasound, and EGD. The following parameters were calculated: Child-Pugh, APRI score, NICE Index, Platelet count / spleen diameter ratio (PC/SD), right lobe liver / Albumin ratio, right lobe liver / Prothrombin ratio, and FIB-4 score. Also, varices were graded according to 3three size classifications and the presence of risky signs. Results: Serum albumin (< 3.65 gm%), platelet count (< 99 × X10 3 /cmm), PC/SD (< 919.6), APRI score (> 1.14), spleen Background/Aim: Activation of WNT/β-catenin pathway has been implicated as a mechanism of oncogenesis of hepatocellular carcinoma (HCC). CTNNB1 mutation, which encodes for β-catenin, has been found to be the commonest underlying genetic alteration. In this study, we evaluated the frequency of aberrant β-catenin expression in our cohort of HCC cases and explored its correlation with clinicopathologic features. Methods: Fifty-three cases of histologically proven HCC were included in the study. Nuclear expression (with or without cytoplasmic staining) in > 5% tumor cells was regarded as positive for β-catenin. Comparison with clinicopathologic features of β-catenin negative HCC cases (controls) was also undertaken. Results: Nuclear β-catenin positivity was seen in 20 (38%) of HCC cases. Median age was 60.5 years and male to female ratio was 5.7:1. Alpha-fetoprotein levels were normal in two-third patients (P = 0.04). About 36.8% of HBV-related, 50% of HCV-related, and 35% of viralmarker negative HCC were positive for β-catenin. Median tumor size was 8.7 cm. Majority (53%) of the β-catenin positive HCCs were unicentric, and a significant proportion (65%) displayed a welldifferentiated histology (P = 0.12). No specific histological type was associated with β-catenin positivity. Although not statistically significant, more patients (57%) with β-cateninpositive HCCs developed recurrence or progressive disease than β-catenin negative cases (35%). Discussion and Conclusion: Aberrant WNT signaling/β-catenin was observed in a substantial proportion of our HCC cases. β-cateninpositive HCC were associated with normal AFP levels, unicentric tumors, well-differentiated histology, and an unfavorable outcome. Background: Acute liver failure (ALF) in the young is rare, yielding limited known data in its pathophysiology and management. Introduction: ALF refers to sudden massive hepatic necrosis with encephalopathy and impaired synthetic function without pre-existing cirrhosis. Chronicity is based on interval between jaundice and encephalopathy onset as hyperacute (< 7 days), acute (7-28 days), and subacute (4-26 26 weeks). Case Description: A previously healthy 24-year year-old female with a history of lacrimal gland tumor on chronic oral prednisone (40 mg) for a year was admitted for acute decreased sensorium, generalized jaundice, tea-colored urine, anorexia, and undocumented fever. . Results: In the 22 cases of CP classification A, 6six cases improved their CP score one year after BRTO, 12 cases did not change, and 4four cases deteriorated. 2Two cases of the 22 cases were dead. The cumulative survival rates after 1, 3, and 5 years after BRTO were 100%, 95%, and 89%, respectively. In the 13 cases of CP-B, 5five cases improved the score one year after treatment, 4four cases did not change, and 4four cases deteriorated. 4Four cases of these 13 cases were dead. The cumulative survival rates of 1, 3, and 5 years after BRTO were 100%, 64%, and 64%, respectively. Conclusion: BRTO for gastric varices inhibited the recurrence of varices for a prolonged period. Even in CP-B cases, their liver function were was improved or maintained for a long period (3 years over) after BRTO. BRTO has shown great promise in the treatment for gastric varices even in the long term.
therapeutic option for thyroid storm and acute liver failure. Case Description: We report the case of a 32-year-old Filipino female who was admitted for a one 1-week history of abdominal pain, jaundice, and hyperdefacation. She is a known case of Graves" disease and chronic hepatitis B infection. She was managed as a case of thyroid storm and acute liver failure from hyperthyroidism on top of liver cirrhosis from chronic hepatitis B with high infectivity. High transaminases (ALT 627 627 IU/L, AST 741 741 IU/L) and bilirubins prevented continued use of thionamides. The HBV DNA was 4494 4494 mIU/L. Because of hemodynamic instability, a low volume plasma exchange (30 ml/kg) with fresh frozen plasma was done and led to 69% and 62% decrease in ALT and AST, respectively; 86% decline in FT3, 3% decline in FT4, 25% decline in thyroglobulin, and 17 % decline in anti-TPO six 6 hours after the procedure. This was associated with rapid clinical improvement in thyrotoxic symptoms sustained over six 6 days. Hepatitis B infection was simultaneously treated with Tenofovir. Plasmapheresis is a viable treatment option and bridge to definitive treatment in thyroid storm with liver disease and may be life-saving. Low-volume plasma exchange safely achieves a rapid yet temporary decline in liver enzymes and hepatotoxins, thyroid hormones, and antibodies. Among Graves" disease patients with concomitant liver disease, early definitive treatment should be done to avoid hepatic complications from uncontrolled hyperthyroidism as well as to lessen exposure to hepatotoxic anti-thyroid medications. Background: Efficacy and well-tolerability of direct antiviral agents are integral to treatment for chronic hepatitis C. However, controversy exists regarding applicability of clinical trials to real world practice, especially for HCV genotype 6. Aim: We report virologic responses of patients with HCV infection receiving sofosbuvir (SOF) and daclatasvir (DCV) with or without ribavirin (RBV) therapy for 12 weeks. Methods: Approval was obtained from the Bumrungrad Institutional Review Board. Treatment naïve and treatment experienced (TE) HCV all GT patients, during March 2016 through January 2017 who started SOF/DCV-based therapy, were consecutively enrolled by dedicated nurse and analyzed on an intent-to-treat basis. End-of Treatment (EOT) and Sustained Virological Response 12 and 24 (SVR12, SVR24) were defined as HCV RNA less than the lower limit of quantification at completion of therapy, 12 and 24 weeks after completing therapy, respectively. Patients were defined cirrhotic if either: (a) any history of biopsy-proven cirrhosis, (b) clinical manifestation of cirrhosis or transient elastrography defined cirrhosis. Treatment was at clinician discretion. Results: The efficacy population (N=211) infected with HCV GT1 (42%), GT6 (29%), GT3 (19%), GT2 (5%), and GT4 (3% Background: Ascites due to cirrhosis can be mobilized with sodium restriction (88 mEq/day) and diuretics. Patients with non-responder to diuretics may have pre-hepatorenal syndrome and a poor prognosis. Diuretic response can be monitored by measuring 24-hr UNa, which can also be a prognostic marker. The aim of this study was to evaluate the value of 24-hr UNa as a prognostic marker in cirrhotic patient with ascites on diuretics. Methods: This cross-sectional study included 100 patients of cirrhosis on diuretics. 24Twenty-four-hour urine was collected properly and tested accordingly. At the same time, liver and renal function tests were done to calculate MELD and CTP score. Results: Out of 100, 48 (48%) subjects had excreted ≥ 78 mmol/d of sodium and 52 (52%) subjects excreted < 78 mmol/d. 64 Sixty-four subjects belong to CTPS "B" and 36 in CTPS "C" group. Majority of the cases (81.3%) of CTPS "B" group had excreted ≥ 78 mmol sodium/day, and 51.9% patients of the CTPS "C" group had 24-hr urinary sodium < 78 mmol/day. In patients who excreted < 78 mmol/day, MELD score was 17.71 ± 4.51 and it was 14.60 ± 2.98 in patients who excreted ≥ 78 mmol/day of urinary sodium. These differences were statistically significant (P < 0.001 Introduction: Osler-Rendu-Weber disease, also known as Hereditary haemorrhagic telangiectasia, is a genetic autosomal dominant disorder occurring with an estimated incidence of 1-2/100 000. Osler-Rendu-Weber disease is characterized by the classic triad of mucocutaneous telangiectasia, recurrent epistaxis, and familial occurrence. Some cases of hepatocellular carcinoma (HCC) in association with Osler-Rendu-Weber disease have been reported, but are very rare. We report a case that laparoscopic radiofrequency ablation (RFA) was useful for the treatment of HCC with Osler-Rendu-Weber disease. Case report: A 71-year-old man was admitted to our hospital for the treatment of HCC in 2016. He has had a history of Osler-Rendu-Weber disease and was diagnosed with hepatitis C virus infection in 2001. He had been treated with IFN monotherapy, but was discontinued due to side effects. Several angiomas were found on his lip by physical examination. Dynamic computed tomography images showed that a 20-mm tumor was detected as defect on portal phase in hepatic segment IV, and showed dilated and meandering hepatic arteries and several arterioportal shunts. RFA with laparoscopic approach was performed for the curative treatment for HCC, in order to cope with intraperitoneal bleeding. Although hemorrhage occurred from the needle tract, a complete hemostasis was achieved by treating with the coagulation forceps. The patient was discharged without a complication 5 days after the operation. Conclusion: In a Patient with Osler-Rendu-Weber disease, percutaneous RFA for HCC has a relatively high risk of bleeding due to expansion and meandering of intrahepatic vessels. However, hemostasis can be achieved using coagulation forceps under laparoscopic observation in case of any bleeding from the liver with laparoscopic approach.
# P-0324 Analysis of risk factors for postoperative liver insufficiency in patients undergoing liver Introduction: Primary hepatic Hodgkin"s lymphoma (PHHL) is a very rare malignancy, with unknown findings on imaging modalities. Case Description: A case of a 61-year-old woman with PHHL with magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings that were helpful for diagnosis is presented. The patient had been treated for rheumatoid arthritis (RA) with methotrexate for 14 years and infliximab for 6 years. She presented with high fever, and suspicious liver lesions were identified by computed tomography (CT). Contrast-enhanced CT showed rim-enhanced hypodense lesions in the liver. However, the borders were unclear. Multiple liver lesions were detected on MRI; hypointense lesions were observed on T1-weighted images, and hyperintense lesions on T2-weighted images and diffusion-weighted MRI. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced MRI revealed multiple hypodense lesions. PET/CT showed high uptake lesions in the liver and spine. Although the liver lesions were not clearly visible on ultrasound (US), the MRI and PET/CT findings were useful to determine the site for US-guided biopsy for pathological diagnosis. Classical Hodgkin"s lymphoma was diagnosed based on hematoxylin-eosin and immunohistochemical staining. The patient was diagnosed with PHHL. Combination chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) was initiated. After one course, the MRI findings showed improvement. After two courses, no uptake was observed on PET/CT. The patient received six cycles of ABVD and showed a complete response. This case demonstrates that MRI and PET/CT are useful for diagnosis and therapeutic evaluation of PHHL. Furthermore, RA and its treatment might contribute to the pathogenesis of PHHL.
# P-0330 Natural prevalence of NS5A polymorphisms in patients infected with hepatitis C virus genotype 6 and their effects on the antiviral activity of drugs targeting NS5A Background: Hepatitis C virus (HCV) genotype (GT)-6 is predominantly found in Southeast Asia, with prevalence approaching 60% in some countries in the region. Intravenous drug use has resulted in the spread of this GT to neighbouring countries. Most in vitro and clinical studies have focused on patients infected with HCV GT-6a where high response rates have been described. However, there are 24 reported GT-6 subtypes (GT-6a-xa). We explored the diversity of GT-6 sequences and their impact on the in vitro activity of drugs targeting the HCV non-structural protein 5A (NS5A). Methods: Phylogeny and baseline NS5A polymorphisms (at 28, 30, 31, or 93) associated with resistance to drugs targeting NS5A were examined in 24 patient-derived and 105 public database HCV sequences. Susceptibility analyses of HCV GT-6 replicons harbouring NS5A substitutions to different NS5A inhibitors were performed. Results: NS5A position 28 was the most polymorphic; NS5A-T28, a drug-resistant polymorphism, was observed in 2/2 GT-6b and 11/16 GT-6f sequences from Thailand. NS5A-T28 was also linked with other drug-resistant NS5A polymorphisms in these GT-6 subtypes: F28T+L31I (GT-6b; 2/2 sequences) and F28T-R30S (GT-6f; 11/11 sequences). The potency of drugs against consensus HCV GT-6a replicons harbouring these substitutions is shown below (Table). NS5A-H93, associated with NS5A inhibitor resistance in GT-1 and GT-3, was not detected. NS5A polymorphisms in 35 GT-6a sequences from China, Hong Kong, and Vietnam conferred low drug resistance supporting the high SVR rates reported for this subtype. Conclusion: HCV GT-6 response rates to NS5A inhibitors may depend on the GT subtype being treated. Introduction: Sorafenib, an oral multikinase inhibitor, remains the only standard treatment offered for patients with BCLC -C.

18
F-FDG PET has been used to assess glucose metabolic activity of various types of tumor, and also used to evaluate the biological behavior of HCC. The aim of this study is to evaluate the performance of 18 F-FDG PET for predicting the response to sorafenib treatment. Methods: We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergone 18 F-FDG PET/CT scan within 1 month before treatment. Thirtyfive HCC patients fulfilling these criteria were included, who began sorafenib treatment between May 2009 and December 2015. The median duration of sorafenib treatment was 92 days (31-775 days). Treatment response according to SUVmax, recurrence-free survival (RFS), and overall survival (OS) were was studied. Results: Among total patients enrolled, two patients obtained partial remission, and 11 patients showed stable disease after first response evaluation during sorafenib treatment. Patients with SUVmax ≥ 6 (n = 17) had median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with SUVmax < 6 (n = 18) had median of 12.2 months (P < 0.001). For progression-free survival (PFS), patients with SUVmax ≥ 6 had PFS of 1.9 months, whereas patients with SUVmax < 6 had median of 4.7 months (P = 0.023). SUVmax ≥ 6 (HR = 32.901, P < 0.001), high MELD score (MELD > 9) (HR = 6.629, P = 0.015), and poor performance state demonstrated by ECOG score (ECOG = 2) (HR = 6.607, P = 0.018) were poor prognostic factors for OS by multivariate analysis. Regarding PFS, SUVmax ≥ 6 (HR = 3.160, P = 0.023) was the only poor prognostic factor by multivariate analysis. Conclusion: Tumor metabolic activity assessed by 18F-FDG PET/CT is an independent prognostic factor in patients BCLC-C stage HCC after sorafenib treatment. Background: Stereotactic body radiation therapy (SBRT) has become an accepted treatment option for hepatocellular carcinoma (HCC) patients who are not suitable for other locoregional therapies, but its indication and irradiation dose have varied among institutions. In this study, we aimed to investigate its efficacy, safety, and the optimal indication on the basis of our experience. Methods: We conducted a retrospective observational study involving 16 patients who underwent SBRT for HCC from October 2014 to November 2016 at our hospital; 53 to 88 years old (median 78 years) and 12 males and 4 females. All of them were classified as Child-Pugh class A or B. Results: Complete response (CR) and partial response (PR) were achieved in 11 (69%) and 3 patients (19%), respectively. The other 2two patients failed to control their disease. Averse events were grade 1 malaise (n = 1) and liver injury (n = 1). Discussion: In the largest retrospective study reported by Sanuki et al., a single lesion, Child-Pugh Classification A or B, tumors ≤ 5 cm, and dose to the bowels < 25 Gy/5 fractions were the eligibility criteria for SBRT. In our study, CR was achieved in 11 (92%) of 12 patients who met the criteria, whereas of four patients who did not satisfy the criteria, none achieved CR, and the tumor progressed in two patients. Conclusion: SBRT showed favorable efficacy and safety for HCC patients who are not suitable for other locoregional therapies. When patients are appropriately selected, SBRT looks promising option for treatment of HCC. Introduction: The pathophysiology of hepatic encephalopathy is not fully understood. This study was conducted to investigate risk factors in the development of hepatic encephalopathy (HE) among patients with liver cirrhosis (LC) in Taiwan. Methods: A total of 913 patients with incident HE and 3,499 patients without HE (control) were identified from a cohort of liver cirrhosis (n = 14, 428) using the population-based, Longitudinal Health Insurance Database 2000 in 1997À2012. Controls were matched to case patients on age at LC diagnosis (± 2 years), sex, Charlson Comorbid index score, year of LC and follow-up time at 1:1 ratio. A multivariate logistic regression model for HE was developed to explore the relative contribution of various risk factors. A Cox regression model for all-cause mortality was performed. Results: A total of 714 cases of HE and matched to 714 controls were enrolled in the analysis. Infections (adj. OR, 3.41, 95% CI, 2.7-4.31, P < 0.0001) and frequency of infections yearly (≥ 3:adj. OR 11.26, 95%CI, 5.7--22.22; 1-3: adj. OR 2.82, 95%CI, 2.26--3.53) were significantly associated with increased risk of HE. H. Pylori pylori infection and sites of infections such as pneumonia, peritonitis, sepsis, urinary tract infection, biliary tract infection, and cellulitis increased risk for HE. HE (adj. HR, 0.90, 95% CI, 0.76--1.06, P = 0.02) and infections (adj. HR, 1.13, 95% CI 0.93--1.38, P = 0.23) increased hazards of death but did not reach statistical significance. Conclusions: The study provides further evidences that infections are strongly associated with HE development among patients with liver cirrhosis; risks for HE vary by relative frequencies and sites of infections. Introduction: Hepatic angiomyolipoma (HAML) is a rare tumor characterized by the presence of blood vessels, muscle tissue, and adipose tissue with only about 300 reported cases to date, and to the best of our knowledge, this the first case reported on a Filipino patient. Case: A 49-year-old Filipino female presented with a 2-year history of recurrent epigastric pain. Abdominal magnetic resonance imaging revealed a fat-containing lesion in the left liver lobe. Serologic tests were negative for malignancy or infection. The patient underwent left hepatic lateral segmentectomy which that revealed a 7.5 x × 7-cm friable mass involving hepatic segments II and III (Figure 1a and 1b). Histopathology showed mature fat cells with a few thick-walled blood vessels and spindled smooth muscle cells with no atypia (Figure 1c). Homatropine mehtylbromide-45 test showed strong and diffused staining confirming angiomylipoma ( Figure 1d). The patient did not show any recurrence or complications on follow-up. Discussion: HAML is difficult to diagnose because of its rarity and varying composition of adipose and muscle tissue, which resembles other hepatic tumors. Pre-operative diagnosis is only 11% to 50% accurate, where the majority are is misdiagnosed as hepatocellular carcinoma. Although HAML is considered a benign tumor, several cases have reported recurrence or malignancy. Tumor size of 10 cm or greater seems to have greater risk of recurrence. Conclusion: Confirmatory tests should be included in hepatic masses suspected for HAML. Close follow-up is advised particularly among patients with large tumors.  Background: Hepatocellular carcinoma (HCC) is the third commonest cancer death in Hong Kong. Several international liver associations recommended HCC surveillance in high-risk subjects. However, evidence about effectiveness of HCC surveillance in real-life practice in district hospitals is limited. Therefore, we aim to evaluate any survival difference between surveillance and non-surveillance groups of HCC patients and to identify prognostic factors. Subjects and Methods: All HCC patients who were diagnosed between January 2000 and December 2008 in the Department of Medicine and Geriatrics at Caritas Medical Centre were enrolled and followed up until June 2012. All these patients recruited were retrospectively reviewed whether HCC surveillance were done or not. Surveillance method consisted of half-yearly ultrasound abdomen and serum alpha feto-protein. Results: The surveillance and non-surveillance groups consisted of 91 and 127 patients, respectively. The surveillance group had smaller tumor (3.1 cm vs .5.4 cm; P < 0.001), less portal vein invasion (5% vs. 18%; P = 0.002), more unifocal HCC (71% vs .58%; P = 0.05), and early tumor stage (59.3% vs. 17.3%; P < 0.001). More patients in the surveillance group received curative therapy (surgical resection: 35% vs. 22%, P = 0.032; local ablative therapy: 17% vs. 6%, P = 0.009). Median survival was significantly longer in surveillance group than that in nonsurveillance group (29.2 months vs. 14.6 months; P < 0.001) ( Figure 1). Multivariate analysis showed that absence of portal vein thrombosis, Child's A grading, unifocal tumor, having hepatectomy, and early tumor stage were independent favorable prognostic factors. Conclusion: HCC surveillance conducted in a district hospital could detect HCC at early tumor stage that is potentially amenable to curative therapy, thus resulting in longer survival.
# P-0362 The combination of anti-HBc and anti-HBs levels is a useful predictor of the development of chemotherapy-induced reactivation in lymphoma patients with resolved HBV Background/ Aims: Fatal chemotherapy-induced hepatitis B virus reactivation (HBV-R) is a well-described serious complication in lymphoma patients with resolved HBV infection. The aim of this study was to determine the predictive factors of the development of chemotherapyinduced HBV-R. Methods: Seventy-seven consecutive newly diagnosed lymphoma patients with resolved HBV infection who received chemotherapy from 2007 through 2015 were analysed, retrospectively. Significant predictive factors associated with HBV-R development were identified based on the data from these patients. Results: Ten patients developed HBV-R during and after chemotherapy, and two of these 10 patients developed HBV-related hepatitis flares. There was a significant negative correlation between anti-HBc titres prior to chemotherapy and time to HBV-R (P = 0.016, R = À-0.732). Univariate and multivariate logistic regression analysis demonstrated that both anti-HBc and anti-HBs titres at baseline were significant predictive factors for HBV-R. Furthermore, patients with high anti-HBc titres at baseline (above 10 S/CO) were significantly more likely to experience HBV-R than were patients with low anti-HBc and high anti-HBs titres (above 28 mIU/ml) who did not experience complete reactivation (P < 0.0001). Additionally, patients with low anti-HBs titres were significantly more likely to experience HBV-R than were those with high anti-HBs titres (P = 0.031). All HBV-R episodes among the patients with high anti-HBc titres occurred within 3 months after starting chemotherapy. Conclusion: The combination of anti-HBc and anti-HBs titres at baseline in patients with lymphoma could serve as a surrogate marker of the occurrence of HBV-R under the influence of chemotherapy.
# P-0376 Evaluation of partial splenic embolization in cirrhotic patients with hypersplenism by contrast-enhanced ultrasonography Author: TATSURO NISHIMURA Affiliation: Department of Gastroenterology & and Hepatology, Yamaguchi University Graduate School of Medicine, Japan Aims: The present study investigates whether contrast-enhanced ultrasonography (CE-US) using perflubutane can be therapeutically applicable as an evaluation modality of partial splenic embolization (PSE) compared with contrast-enhanced computed tomography (CE-CT). Methods: From January 2013 to January 2017, 30 cirrhotic patients (mean age = 65.4 years; female/male = 16/14; hepatitis B virus/hepatitis C virus/alcohol/others = 2/17/8/3; Child-Pugh class A/B/C = 17/12/1) with hypersplenism were treated by PSE with the aim of increasing platelet count. Wedged hepatic venous pressure (wHVP) was measured immediately before and after the PSE procedure. CE-US, CE-CT, and transient elastography (TE) were performed before and 1 week after PSE. Results: Embolization of splenic artery resulted in a significant decrease in both splenic venous volume (P < 0.01) and portal venous volume (PVV, P < 0.01) ultrasonographically. PSE significantly reduced wHVP (P < 0.01), and values for liver stiffness measured by TE showed a decreasing tendency following PSE (P = 0.09). Meanwhile, platelet count increased significantly from 54.4 x × 10 9 /L before PSE to 125.9 x × 10 9 /L 1 month after PSE (P < 0.01), with mean number and mean rate of increase in platelet count of 69.2 × x10 9 /L and 264.2 %, respectively. The splenic infarction ratio (SIR) measured by CE-US was almost equivalent to that measured by CE-CT, and a statistically significant correlation was observed between them (P < 0.01). In addition, the SIR by CE-US was positively associated with both the number and the rate of increase in platelet count 1 month after PSE [r = 0.56 (P < 0.01) and r = 0.41 (P < 0.05), respectively], compared favorably with that by CE-CT [r = 0.50 (P < 0.01) and r = 0.20 (P = 0.27), respectively]. Conclusions: The USA can evaluate hemodynamic changes in portal-splenic venous system in response to PSE, unlike the CT scan. Moreover, CE-US would be comparable to with CE-CT in terms of SIR measurements after PSE. Consequently, the USA, especially CE-US, will be therapeutically applicable as a less-invasive modality that is useful for the evaluation of PSE.
# P-0379 Health care costs for treating hepatocellular carcinoma among the population with national health insurance program in Taiwan  Backgrounds: Radiotherapy and chemotherapy can be used as a salvage therapy for advanced hepatocellular carcinoma (HCC), however, the responses of the treatments are insufficient due to the resistance. Liver cancer stem cells can be a possible cause of radioresistance and recurrence of HCC. Anti-cancer effects of metformin, the medication for the treatment of diabetes, are recently reported in many types of cancer. The aim of this study is to elucidate the role of liver cancer stem cells in the E-Poster Presentations -B1) Liver resistance to radiation treatment and observe whether metformin can overcome the resistance to the radiation treatment. Methods: We sorted CD34+ cells from human hepatoma cell line using flow cytometric analysis and cell sorting (FACS) method. CD34+ cells were placed on mouse embryonic fibroblasts under our derived culture condition. Then we compared the anti-proliferative effect of metfomin to the CD34+ cells and CD 34À-cells as a single treatment or combination treatment with radiation. Cell viability and growth inhibition were assessed by MTT. We also established multicellular organotypic model of HCC and measured the area of each spheroid after exposure to radiation and treatment of sorafenib, a multi kinase inhibitor and merformin to investigate the response to chemo-radiotherapy. Results: CD34+ cancer stem cells are more radio-resistant than CD34Àcells, possibly due to less DNA damage and better DNA damage repair capacity. Metformin inhibited not only the growth of CD34Àcells but also CD34+ cells. In addition, metformin inhibited organotypic growth of HCC spheroids and showed a synergistic effect with radiation treatment. However, combination of sorafenib with radiation did not show any synergistic inhibition. Introduction: Angiotensin II receptor blocker (ARB) is widely used drug for hypertension patients. There have been several reports for losartaninduced hepatotoxicity, although it is rare (< 0.1%). And there have been several reports of hepatotoxicity due to irbesartan or candesartan, still much rare. To our knowledge, there has been no published report for fimasartan-induced liver injury. Herein, we report a case of hepatotoxicity secondary to fimasartan use. Case Description: A 73-year-old South Korean man with hypertension, referred from the local hospital for elevated liver enzyme. He had been taking fimasartan 60 mg orally every day for 2 months. He did not report any use of alcohol or illicit drugs. Blood work revealed acute liver dysfunction with aspartate aminotransferase, 233 U/L; alanine aminotransferase, 424 U/L. The total bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase levels were 1.22 mg/dL, 1182 U/L, and 118 U/L, respectively. Hepatitis A immunoglobulin M and hepatitis B surface antigen were negative, and hepatitis C RNA levels were undetectable. Anti-smooth muscle, antimitochondrial, and antinuclear antibodies were all negative, and the serum copper, ceruloplasmin, and 24-hour urine copper levels were in the normal ranges. The modified Roussel Uclaf Causality Assessment Method scale score was 9. These findings strongly suggested druginduced liver injury. Percutaneous liver biopsy was performed, and hepatocellular necrosis was seen in zones 3 and 2, with sparing of periportal hepatocytes in the zone 1, suggesting toxic hepatitis. As a result, fimasartan was immediately discontinued. He showed improvement of the clinical and laboratory abnormalities, with aspartate aminotransferase and alanine aminotransferase levels of 44 and 34, respectively, after 3 weeks. Conclusion: This case report describes a 73-year-old man who experienced liver injury after fimasartan administration. To our knowledge, there have been no published case reports about fimasartan hepatotoxicity. Therefore, our case emphasizes that liver function tests should be monitored periodically after administration of fimasartan. Background: Tacrolimus is the key immunosuppressive drug for liver transplantation. Once-daily prolonged-release tacrolimus (TAC-PR) exhibits good drug adherence but has difficulty controlling the trough level in the early phase of liver transplantation. The aim of this study was to compare the feasibility and efficacy of immediately starting oral TAC-PR versus traditional twice-daily tacrolimus (TAC-BID) in de novo liver transplantation recipients. Methods: The study included 28 patients treated with conventional TAC-BID and 60 patients treated with TAC-PR (median follow-up 70.5 months). Short-term and long-term outcomes were compared. This study was approved by institutional review board. Results: Patient characteristics were similar except for the incidence of hepatocellular carcinoma and type of graft. Dose adjustment was more frequently required for TAC-PR than TAC-BID (42.9% versus vs 73.3%, P = 0.006), but trough levels of TAC during the first 3 months after liver transplantation were controlled well in both groups. The rate of acute cellular rejection and long-term renal function were similar in both groups. In both groups, renal function worsened during the first 6 months after transplantation and remained stable until the end of the follow-up period. Bacterial pericarditis is very rare in the modern antibiotics era. It is a rapidly progressive and highly lethal infection with mortality rates reaching 100% if left untreated. It is usually arise from hematogenous dissemination or contiguous spread from an intrathoracic infection. Transdiaphragmatic extension of pyogenic liver abscess is the rarest cause of purulent paricarditis. Herein, we presented the rare case of a purulent pericardial and pleural effusion that was caused by the extension of an infection from subdiaphragmatic pyogenic liver abscess. A 67-year-old man presented to our emergency room after having been prolonged fever and progressive dyspnea lasting for 5 days. Initial chest computed tomographic scan showed moderate amount of left pleural effusion, dependent atelectasis, small amount of pericardial effusion, and 10 × 6 cm sized multiloculated space occupying lesion in left hepatic lobe. After the emergent thoracentesis relieving 300 ml of puslike fluid, his dyspnea symptom was more relieved. Both pleural fluid and blood culture grew Klebsiella pneumoniae. Follow up chest CT showed acute pericarditis with moderate amount of pericardial effusion due to transdiaphragmatic extension of liver abscess and increased size of liver abscess;, therefore, emergent surgical pericadiostomy and laparoscopic surgical drainage of liver abscess was performed. After surgical drainage and intravenous antibiotics, the patient recovered and discharged. In conclusion, purulent pericardial effusion is a rare but fatal complication of left lobe liver abscess, and a high suspicion index is needed in patients who complaint of cardiac symptoms. Early diagnosis and immediate treatment such as pericardiocentesis and abscess drainage combined with intravenous antibiotics can avoid patient death. Background: It has been reported that HCV-related chronic liver disorders, especially cirrhosis, are associated with sleep disturbance. In this study, we examined the effect for sleep disturbance of sustained virologic response by direct acting antivirals in the patients with HCV-related chronic liver disorders. Methods: The study population comprised 43 patients with HCV-related chronic liver disorders without neuropsychiatric impairment (37 patients with chronic hepatitis and six patients with liver cirrhosis). All patients were treated by direct acting antivirals (DAA) and achieved the sustained virologic response (SVR). Twenty patients with chronic genotype 2 HCV-related liver disorders were treated with Sofosbuvir and Ribavirin. Nineteen patients with chronic genotype 1 HCV-related liver disorders were treated with Sofosbuvir and Ledipasvir, and four patients with chronic genotype 1 HCV-related liver disorders were treated with Ombitasvir, Paritaprevir, and Ritonavir. Pittsburgh sleep quality index (PSQI) was used to assess sleep quality before and after DAA therapy. The scores were summated to provide the PSQI scores; scores of > 5 identified sleep disturbance. In addition, Self rating Depression scale (SDS) was used to assess the depression. Results: The frequency of sleep disturbance was 25.6% (11/43) in patients with chronic hepatitis C. After the achievement of SVR, 54.5% (6/11) improved in the PSQI scores. However, 18.2% (2/11) exacerbated in the PSQI scores. In the comparison of all patients, PSQI scores, time to sleep onset, and time of sleep were not significant after the achievement of SVR. However, SDS scores significantly improved after the achievement of SVR (P < 0.05). In the comparison of patients with sleep disturbance, PSQI scores tended to improve (P = 0.0687) and the time of sleep was significantly longer (P < 0.01) after the achievement of SVR. Conclusion: Patients with HCV-related liver disorders and sleep disturbance showed the significant increase in the time of sleep after the achievement of SVR.
# P-0467 Parenteral nutrition-Associated associated Liver liver disease (PNALD) ) amongst amongst aAdults dults in in Singapore Background: Previous reports showed that carnitine restore mitochondrial and liver function in various liver diseases. We aimed to assess various metabolic profiles after 3 months carnitine-orotate complex (Godex®) treatment in patients with metabolic disease and elevated alanine aminotransferase levels. Method: We reviewed the records of 544 outpatients who had metabolic derangement and elevated liver enzyme from 31 primary or secondary care clinics from January 2015 to May 2016 in Korea. The key inclusion criteria were such as the following:; (i) participants who were prescribed antidiabetic, antihypertension, or lipid-lowering drugs;, (ii) elevated alanine aminotransferase activity more than 40 IU/L;, and (iii) who were newly prescribed carnitine-orotate complex. Biochemical parameters (liver enzyme, glycated hemoglobin, lipid profile) as well as anthropometric markers were monitored for 3 months.
Results: There was no significant weight change after carnitine-orotate complex treatment (71.55 ± 12.19 kg vs. 71.1 ± 11.8 kg, P = 0.5367). After 3 months of combined treatment with carnitine-orotate complex, the rates of normalization of serum ALT and AST levels were 68.2 % and 63.2%, respectively. Mean change in serum ALT levels from before at 3 months was À-44.07 ± 36.15 IU/L (P < 0.0001) while it was À-33.28 ± 39.46 IU/L in serum AST levels (P < 0.0001). Carnitine-orotate complex showed improvement in HbA1c level with 0.74 % decrease (P < 0.0001) in diabetes. Serum triglyceride level significantly decreased 54.22 mg/dl compared to with baseline in dyslipidemic subjects (P < 0.0001). Systolic and diastolic blood pressure also significantly decreased in hypertensive subjects (À-6.84 mmHg vs. À-3.86 mmHg, respectively, P < 0.0001). Conclusion: Three months of treatment with carnitineorotate complex decreased not only liver enzyme but also improved metabolic parameters. Background: NASH is epidemic in western world and increasing in prevalence across Asia. So far, LM is the only known intervention to be effective. Liraglutide has shown to induce weight loss and reduction of insulin resistance in obese individuals. Treatment with Liraglutide for 20 weeks leads to weight loss in obese patient with/without diabetes. There is little information of its effect on NASH. We, therefore, aim to compare Liraglutide's efficacy, safety, and effect on NASH severity as compared to LM. Methods: We conducted RCT with aim to recruit 15 patients in each arm. This interim analysis includes 21 patients, recruited based on body mass index > 27.5, waist circumference > 90 cm in males, 80 cm in females, with NASH, assessed on liver functions, hepatic ultrasound and after excluding other etiologies of liver disease. Parameters were evaluated at week 0 (W0) and week 26 (W26). Results: Both groups were similar in baseline characteristics except triglyceride (TG), which was higher in LM group. (Table 1.1). Significant reductions in weight, BMI, waist circumference, glucose, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Insulin, minimum/ maximum liver fat fractions was were seen in both groups comparing W0 to with W26. (Table 1.2). Percentage change (W0--W24/W0) in none of the compared parameters differed significantly between LM versus.
LG (Table 1.3). Conclusion: Both interventions were equally effective in reducing weight, liver enzymes, and liver fat fraction. Liraglutide is a potential alternative to lifestyle modification for treatment of NASH. . 59.9% were above the age of 40 (230/ 384), 6% admitted to intercourse with multiple partners (23/384), 1.8% were intravenous drug users (7/384), 12% had surgery (46/384), and 6% had blood transfusions (23/384). There was no significant difference in those who tested positive for Hepatitis B compared to with those who tested negative with a 95% CI. Only 0.23% tested positive for anti-HCV, 71.42% were intravenous drug users (5/7), and 28.57% had surgery and blood transfusions (2/7). When analyzing the laboratories, only 10.6% had an SGPT greater than 2 times the upper limit of normal, 20.8% had abnormal albumin, 15.6% had abnormal ultrasound findings, 2% were cirrhotic, and 1.3% had an HBV DNA > 2000 IU/ml. Conclusion: The prevalence was of Hepatitis B and C was lower in Seamen than the national average, possibly attributed to better education and higher socioeconomic status. There was no significant difference in risks among those who tested positive and negative indicating vertical transmission was the likely mode of transmission. Most patients had chronic hepatitis B Background: Ascites due to cirrhosis can be mobilized with sodium restriction (88 mEq/day) and diuretics. Patients with non-responder to diuretics may have pre-hepatorenal syndrome and a poor prognosis. Diuretic response can be monitored by measuring 24-hr UNa, which can also be a prognostic marker. The aim of this study was to evaluate the value of 24-hr UNa as a prognostic marker in cirrhotic patient with ascites on diuretics. Methods: This cross-sectional study included 100 patients of cirrhosis on diuretics. 24-hour urine was collected properly and tested accordingly. At the same time, liver and renal function tests were done to calculate MELD and CTP score. Results: Out of 100, 48 (48%) subjects had excreted ≥ 78 mmol/day of sodium and 52 (52%) subjects excreted < 78 mmol/day. 64 Sixty-four subjects belong to CTPS "B" and 36 in CTPS "C" group. Majority of the cases (81.3%) of CTPS "B" group had excreted ≥ 78 mmol sodium/day and 51.9% patients of the CTPS "C" group had 24-hr urinary sodium < 78 mmol/day. In patients who excreted < 78 mmol/day, MELD score was 17.71 ± 4.51, and it was 14.60 ± 2.98 in patients who excreted ≥ 78 mmol/day of urinary sodium. These differences were statistically significant (P < 0.001).
Conclusion: This study showed that advanced cirrhosis have relatively lower natriuresis in response to diuretics. So, 24-hr UNa can be considered as a prognostic indicator. But multicentered studies are needed for further recommendation. Aims: It has been reported that poorly differentiated hepatocellular carcinomas (HCC) are visualized more frequently than well or moderately differentiated HCCs on 18 F-fluorodeoxyglucose positron emission tomography (FDG PET). The present study aimed to evaluate whether the signal intensity of small hypervascular HCC on the FDG PET is related to the treatment outcome of radiofrequency ablation (RFA). Methods: In total, 121 consecutive patients with initial hypervascular HCC (≤ 3 tumors and ≤ 3 cm in diameter) without vascular invasion on imaging were examined by FDG PET before RFA. FDG uptake in HCC on the FDG PET were visually compared with the surrounding liver and categorized as positive and negative. Metastatic recurrence was defined as more than three intrahepatic recurrences, recurrence with vascular invasion, seeding, dissemination, and/or extrahepatic metastasis. Results: The median follow up was 1267 days. The 121 HCCs were evaluated as 110 negative and 11 positive tumors on the FDG PET. Tumor size, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), and Des-gamma-carboxyprothrombin (DCP) were higher in the positive group than the negative group on the FDG PET significantly. The cumulative 1-year recurrence rates of the negative and positive group on the FDG PET were 30% and 64% (P = 0.017), respectively, with cumulative 1-year metastatic recurrence rates of 6% and 36% (P < 0.001), respectively. The cumulative 5-year survival related to HCC rates were 88% and 22% (P < 0.001), respectively. On multivariate analysis, positive on the FDG PET was the strongest independent factor related to metastatic recurrence and survival after RFA. Conclusions: During CCRT, infusion of 5-fluorouracil (FU) was infused during the first and last five 5 days of external beam radiation therapy for 5 weeks. After CCRT, repeated HAIC with cisplatin and 5FU was performed monthly. Nineteen patients (50%) underwent additional TACE between repeated HAICs. Factors related to overall survival and time to progression were analyzed. Results: The mean age of patients was 55 years (male: female, 33:5). Underlying liver diseases were hepatitis B, hepatitis C, and non-B/C in 29, 1, and 8 patients, respectively. The objective response rate after CCRT was 36.8%. The median time to progression was 8.1 (range, 1.8À-32.1) months. The median overall survival was 11.6 (range 2.8--65.7) months. Partial response after CCRT (hazard ratio (HR), 0.074; P < 0.001) and additional TACE (HR, 0.237, P = 0.002) were independent significant factors related to overall survival. Overall survivals of patients with partial response (PR) after CCRT (median 44.2 vs. 6.6 months, P < 0.001) and additional TACE (median 19.8 vs. 9.1 months, P = 0.001) were significantly better than those without PR after CCRT or additional TACE. Conclusion: Patients who underwent additional TACE between repeated HAIC after achieving partial response following CCRT showed better survival at advanced stage of HCC with portal invasion. Further prospective study to confirm the positive effect of TACE after CCRT is warranted. Background/Aims: Hepatitis A virus (HAV) infection is associated with morbidity and mortality in northeast India. With a background of a detrimental role played by chemokine RANTES and chemokine receptor 5 (CCR5) in viral disease pathogenesis, and lacunae on their role in hepatitis A virus (HAV) mediated liver disease,; the present study targeted to ascertain their role in the susceptibility and severity of HAV infected liver disease using in silico, in vitro, and in vivo approaches. Methods: In-silico interaction was studied using ClusPro and contact map analysis. Role of RANTES in HAV infection was evaluated using in silico analysis, followed by in vitro analysis using HepG2 cell line and HAV serum/attenuated virus-based vaccine stimulation. Macrophage modulation and activation was estimated by MUSE-based flowcytometry approach. Differential downstream cytokine expression was studied by ELISA. In vivo patient-based analysis for the role of RANTES and CCR5 in HAV disease pathogenesis was studied in clinically proven HAV cases ([AVH = 73; FHF = 28)] compared to with healthy controls (N = 81). Results: In-silico, CCR5 was found to bind with the VP3 region of HAV capsid with more affinity and amino acid clusters than its established receptor, HAVCR1. In-silico analysis suggested that RANTES is competitive to HAV for CCR5 binding; and in vitro analysis proved that RANTES supplementation was able to effectively regulate the magnitude of immune response through controlled modulation of CCR5 expression, TNF-alpha and IFN-gamma expression, and macrophage levels and activation. Patientbased analysis showed that: (i) RANTES expression was downregulated in a gradient pattern viz., controls>HAV-AVH>HAV-FHF;, (ii) CCR5 was upregulated in a gradient pattern viz., controls<HAV-AVH<HAV-FHF; and, (iii) RANTES expression inversely correlated with TNF-alpha levels and HAV viral load statistically. Discussion and Conclusion: CCR5 might be a potent receptor for HAV, and the RANTES-CCR5 interaction axis and resulting regulated immunomodulation holds key to HAV susceptibility and severity. RANTES stimulation holds promise for HAV disease therapeutics. Background: The peginterferon plus ribavirin therapy for the patients of chronic hepatitis C is effective for decreasing liver complications. We aimed to investigate the characteristics of the patients who failed in therapy with developing liver complications. Methods: From November 2009 to December 2016, the patients who failed in peginterferon therapy without further treatment were enrolled. The cases included the patients who received treatment without SVR, stopped therapy due to no EVR, and discontinued therapy due to intolerable side effects. The demographic characteristics, pre-treatment laboratory data, and sonographic findings were analyzed. Results: Overall, 182 patients with failure in antiviral treatment. Sixty-nine patients received either 24 or 48-week of therapy had no SVR (68% with genotype 1 infection). Among the patients with discontinued therapy, 56 patients had no EVR (77% with genotype 1 infection) and 57 patients had side effects. The age were 61 ± 12-year-old (range: 31--86), 45% man, and 35% had liver cirrhosis. During the follow-up after therapy, 26 patients (14%) developed the complications, included hepatoma, variceal bleeding, hepatic encephalopathy, ascites with/without spontaneous peritonitis. For the patients with complication had more liver cirrhosis (84.6% vs 26.2%, P < 0.001), splenomegaly (50.0% vs 24.4%, P = 0.007), older age (67.7 ± 10.3 vs 59.4 ± 11.7, P = 0.001), low platelet count (136 ± 60 vs 164 ± 61x × 10 3 /μL, P = 0.033), body weight (60.1 ± 10.6 vs, 66.4 ± 13.5 kg, P = 0.026), and BMI (23.5 ± 2.7 vs 25.8 ± 4.3, P = 0.011). Using logistic regression model, liver cirrhosis, and low BMI were independent factors of developing hepatic complications. Conclusion: Among the patients of chronic hepatitis C with failure in peginterferon therapy, the patients with liver cirrhosis or low BMI could be further progressed to hepatic complications. Future study of using new antiviral agents for these patients in prevention of disease progression is warranted.
Introduction: Schwannoma is a benign nerve sheath tumor composed of Schwann cells. They predominantly occur in the extremities, but can be found in head and neck, trunk, pelvis, and retroperitoneum. In very rare occasion, it might be seen at liver and pancreas with less than 1% will have malignant transformation. Hepatic schwannoma is rare and difficult in making definite radiological diagnosis. Surgery is often required in order to reach the diagnosis. We present a case of benign hepatic schwannoma. The tumor was resected surgically and the disease was confirmed pathologically with no recurrence. The associated literature is also reviewed. Background: With the rising prevalence of obesity and metabolic syndrome, there has been a mirrored increase in prevalence of non-alcoholic fatty liver disease (NAFLD). In the United States, NAFLD is poised to become the commonest aetiology for liver transplantation. The Asian NAFLD epidemic trails the Western world but is expected to result in an increase in non-alcoholic steatohepatitis (NASH)/cryptogenic (CC) related liver cirrhosis and hepatocellular carcinoma (HCC). We aim to ascertain the prevalence of NASH/CC-associated HCC and liver transplantation, and difference in survival time compared to with other aetiologies. Methods: A retrospective analysis of data collected from 1989 to 2016 at the National University Hospital was performed. We looked at two cohorts of patients, HCC and liver transplantation patients, across 3three distinct time periods (1989--1998, 1999--2007, and 2008--2016), and analysed analyzed their baseline clinical characteristics and clinical outcomes. Background: Increasing of intestinal permeability in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) is a major pathophysiological feature, which results in pathogens from the gut enter into the portal blood. Kupffer cells (KCs) initiate innate immunity, partially due to the short-chain fatty acids (SCFAs) produced by gut microbiota. We aim to explore the effects of fecal microbiota of IBS-D patients to the rat liver. Methods: The germ-free rats were gavaged with diluted fecal samples from IBS-D patient (GI) and health control (GH). KCs, protein levels of TNF-α, IFN-γ and tryptophan 2,3-dioxygenase (TDO), fecal SCFAs, and serum metabolic profiles were analyzed. Results: Hypertrophy of KCs, TNF-α, and IFN-γ of the liver tissue and fecal SCFAs related to the inhibition of imflammation inflammation present significant differences among the three groups, but there are no obviously different in expression of TDO (see table Background and Aim: Hepatitis C virus (HCV) diminishes health-related quality of life (HRQOL). Currently, there is no published data on assessing of the impact of treatment of chronic hepatitis C with the new antiviral drugs in old-aged patients. The aim is to study the effect of treatment of chronic hepatitis C with the new antiviral drugs in old-aged patients in HRQOL. Methods: About 132 patients with chronic hepatitis C (cirrhotic and non-cirrhotic) were enrolled in the study. Age of patients was sixty 60 years old and older. All patients were treated with sofosbuvir/daclatasvir with or without ribavirin for three 3 months. The HRQOL was assessed with sickness impact profile scoring (SIP) before start of treatment, at end of treatment and after three 3 months of end of treatment. Results: Old chronic hepatitis C patients who were treated achieved primary virological response (end of treatment) with percentage 100% and sustained virological response (SVR) (after 3 months of end of treatment) in about 96% of treated patients. Before treatment, patients with chronic hepatitis C had worse scores especially in work, sleep, rest, and recreation, and pastimes categories. After treatment, patients who received sofosbuvir/daclatasvir with or without ribavirin had significant improvement in work, sleep, rest, and recreation, and pastimes categories with P-value 0.001. Numerical improvement was observed in total score, and physical and psychosocial dimension scores. In patients with SVR, the most improvement was in work and psychosocial dimension scores. There was no significant difference in SIP between scores after end of treatment and after 3 months of end of treatment. Conclusion: Treatment  Introduction and Aim: To investigate the association of adolescent obesity with nonalcoholic fatty liver disease (NAFLD) and related risk factors in Xi 'an, China. Materials and Methods: A total of 4141 adolescents (2061 girls and 2080 boys, mean age: 18.62 ± 0.66 years, age range 15--22 years) were enrolled in this investigation. Anthropometric index was measured,and liver ultrasonography and liver function biochemical tests were performed in all the subjects. T test, Chi-square test, and logistic regression analysis were used for statistical analyses. Results: The total rates of obesity was 7.9%(308/4141). The prevalence rate of NAFLD was 8.1% (335/4141) with a declining trend from obesity, overweight to normal BMI. NAFLD prevalence rate in obese boys was significantly higher than in girls(χ 2 = 56.5, P < 0.01). BMI, body weight, ALT, and AST in NAFLD group were higher than in non-NAFLD group (P < 0.05). The tangent point of ALT was 36 U/L using Youden index in boys, and 33 U/L in girls.

Conclusion:
The prevalence of obesity and NAFLD in adolescents is higher in Xi'an than anticipated. Body weight and BMI may be the associated independent risk factors of NAFLD.
# P-0700 Do same cut-off values for controlled attenuation parameter (CAP) apply for both M probe and XL probe of transient elastography Background: The XL probe generates lower liver stiffness values than the M probe in the same patient, but similar data on controlled attenuation parameter (CAP) as a measurement of hepatic steatosis are scarce. We aim to test the hypothesis that the same CAP cut-offs can be used for both probes. Methods: We included subjects who had a liver biopsy and reliable FibroScan examination using both M and XL probes simultaneously. Hepatic steatosis was graded as S0, < 5%; S1, 5--33%; S2, 33--66%; S3, > 66%. Results: Data for 146 patients were analyzed (mean age 52.4 ± 10.7 years old, 45.9% male, mean BMI 28.5 ± 6.5 kg/m 2 , NAFLD, 82.2%; HBV, 5.5%; HCV, 2.1%; others, 10.3%).The distribution of steatosis grade was S0, 11.0%; S1, 26.0%; S2, 41.1%; S3, 21.9%. There was strong positive correlation (r = 0.75, P < 0.001) between CAP measured by M and XL probes. Mean CAP using the XL probe was significantly higher compared with the M probe in the overall population (319 dB/m vs 306 dB/m, P < 0.001) and for each of the steatosis grades (S0, 232 vs 220 dB/m; S1, 303 vs 295 dB/m; S2, 340 vs 325 dB/m; S3, 341 vs 326 dB/m, P < 0.001 for all comparisons). The M and XL probes had similar diagnostic accuracy for steatosis grade ≥ S1 (good to excellent), ≥ S2 (fair), and S3 (poor), but the optimal cut-off appeared higher for the XL probe compared with the M probe. However, the difference in sensitivity and specificity  A total of 114 consecutive individuals who took hepatitis screening test were enrolled. Thirty-three HBV patients and 38 HCV patients were also enrolled in the hospitals for evaluating accuracy of measuring HBs antigen and anti-HCV in fingertip blood samples. Twenty A total of 20 μl of plasma was successfully obtained from all the participants. The results of HBs antigen and anti-HCV in fingertip blood samples were compared with those in the serum. All the samples with undetectable HBs antigen or anti-HCV in the serum showed undetectable in fingertip blood samples, and significant correlations of the test results were observed between the serum and in fingertip blood samples (P < 0.01). The quantifiable ranges in fingertip blood samples showed in-between 1.0 and 80 cut-off index for anti-HCV and in-between 0.03 and 2000 IU/mL for HBs antigen. Conclusion: Fingertip blood sampling technique with novel blood collecting devices may work adequately for hepatitis virus test with small amount of blood samples.
# P-0710 A study of the effectiveness for improving hepatic fibrogenesis and suppressing hepatocarcinogenesis after SVR in DAA therapies Authors: ISAO HIDAKA; ISAO SAKAIDA Affiliation: Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School, Japan Background: In chronic hepatitis type C, viral clearance by interferon therapy is known to lead to improvement of hepatic fibrogenesis and suppression of hepatocarcinogenesis. Although the emergence of direct acting antivirals (DAA) has allowed the high rate of viral clearance, the effectiveness for improving hepatic fibrogenesis and suppressing hepatocarcinogenesis after DAA therapies has not been shown. Therefore, we conducted DAA therapies to analyze the effectiveness for improving fibrogenesis and suppressing carcinogenesis in patients who achieved a sustained virologic response (SVR). Methods: We analyzed changes in the levels of serum fibrosis markers, P-3-P and M2BPGi, over time. The changes in the liver fibrosis index (LFI) were also analyzed by using real-time tissue elastography. In analyzing the effectiveness for suppressing carcinogenesis, cumulative cancer incidence rates after initiation of DAA therapies were calculated in those with and without a medical history of hepatocellular carcinoma (HCC). Results: The subjects were 174 patients. The subjects included patients with chronic hepatitis (n = 113) and liver cirrhosis (n = 61) including sixteen 16 patients who had a medical history of HCC. P-3-P levels significantly decreased over time (P < 0.01).
The LFI values also significantly decreased over time. M2BPGi (C.O.I.) levels significantly decreased after treatment (P < 0.05). HCC occurred in 7seven patients, and the cumulative cancer incidence rates were 4.1% at 1 year and 7.2% at 2 years. The cumulative cancer incidence rates in patients without a history of HCC were 0.8% at 1 year and 0.8% at 2 years, and, in those with a history of HCC, were 26.6% at 1 year and 47.6% at 2 years. A medical history of HCC was a significant factor for HCC development (P < 0.0001). Conclusion: Successful viral clearance by DAA therapies leads to improvement of hepatic fibrogenesis. In addition, carcinogenesis is suppressed in the case of no medical history of hepatocarcinoma.
# P-0744 Factors predicting short-term mortality in cirrhotic patients with infections other than spontaneous bacterial peritonitis Authors: VARUN TADKALKAR; KRISHNADAS DEVADAS; RAJENDRA GUNJAL; S SREEJAYA Affiliation: Department of Gastroenterology, Government Medical College, Thiruvananthapuram, India Background and Aims: Infections other than SBP represent more than two thirds of the infections in patients with cirrhosis. This study aimed at assessing risk factors for short-term mortality among cirrhotic patients having non-SBP infections. Methods: This cross-sectional study included cirrhotic patients who were admitted with non-SBP infections from August 2015 to February 2017, and data was were analysed analyzed in relation to type of infection , culture positivity, presence of AKI and encephalopathy , hospital mortality, and 30-day mortality. Results: 153 One hundred and fifty-three patients were analysedanalyzed. The main etiology of cirrhosis was alcohol, and 71% of cases were CHILD C. UTI ( 38.6 %) was the most common non-SBP infection followed by Cellulitis and Pneumonia. E. coli was the most common organism isolated in urine culture and blood culture. AKI, type 1 HRS, and ACLF (CANONIC) developed in 44.4 % , 3.9 %, and 24.8 % of patients, respectively. Overall hospital mortality and 30day mortality was 26.8 % and 43.1 %, respectively. Hospital Mortality was higher in patients having Pneumonia (54.4 %), and spontaneous bacteremia (60 %). On univariate analysis, Pneumonia , female sex, Hepatic encephalopathy, ,AKI , Hyponatremia , WBC , BUN , total bilirubin , serum creatinine, INR , CHILD C status, ACLF, and MELD were significantly associated with mortality. Using logistic regression, Hepatic encephalopathy (P = 0.0001) and elevated BUN (0.004) emerged as significant risk factors for hospital mortality, and Pneumonia (P = 0.016) , Hepatic encephalopathy (P = 0.0001), and MELD score (P = 0.003) were significant risk factors for 30-day mortality. Conclusions: Pneumonia has worse prognosis among non-SBP infections. Presence of hepatic encephalopathy and renal dysfunction leads to poor outcome in patients with cirrhosis having infections. Aim: To investigate the diagnostic accuracy of liver fibrosis using liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) in patients with chronic viral hepatitis and to compare the diagnostic performance of SWE with serum liver fibrosis markers. Methods: We consecutively analyzed 92 patients with chronic viral hepatitis (45 with hepatitis B, 46 with hepatitis C and 1 with hepatitis B+C). Liver fibrosis was staged from F0 to F4 according to the Batts and Ludwig scoring system. The accuracy of prediction for liver fibrosis for SWE, hyaluronic acid (HA), type 4 collagen, AST to Platelet Ratio Index (APRI), FIB-4, Forns index and red cell volume distribution width-to-platelet ratio (RPR) was analyzed using receiver operator curve (ROC) analysis. Results: There were 10, 30, 20, and 32 patients at stages F0-1, F2, F3, and F4, respectively. The overall diagnostic accuracies of LSM and serum markers, as de- . LSM was superior to HA (P = 0.029) and Forns index (P = 0.049) for predicting significant fibrosis, and to APRI for predicting advanced fibrosis (P = 0.011) and cirrhosis (P = 0.011). Conclusion: SWE was the most accurate method to predict the degree of liver fibrosis in patients with chronic viral hepatitis. Also, the majority of six liver fibrosis markers were comparable to SWE to assess liver fibrosis. Demographic data, comorbidities, serial creatinine, and other laboratory results were collected. Estimated glomerular filtration rate (eGFR) were determined by the CKD Epidemiology Collaboration equation, and classified into five CKD stages. The impact of ETV and TDF treatment on CKD progression, defined as an increase of at least one CKD stage, were compared. Results: A total of 32, 091 ETV or TDF-treated CHB patients were identified; 29, 599 (92.2%) were first treated by ETV while 2,492 (7.8%) received TDF initially. During a median (interquartile range) follow-up of 22 (8--50) months, 767 TDF-treated patients (30.8%) and 9,816 ETV-treated patients (33.2%) had CKD progression. The annual median (95% confidence interval [CI]) decline in eGFR were 1.66 (1.47 --1.84) and 1.23 (1.18 --1.28) ml/min/1.73 m 2 in the TDF and ETVtreated patients, respectively (P = 0.007). TDF use as compared with ETV treatment (adjusted hazard ratio 1.23, 95% CI 1.14 --1.33; P < 0.001), diabetes mellitus (1.20, 1.14 --1.26; P < 0.001), and hypertension (1.28, 1.22 --1.34; P < 0.001) were associated with increased risk of CKD progression after adjustment of age, sex, and baseline laboratory results. Conclusion: TDF treatment in CHB patients is associated with higher risk of CKD progression than ETV treatment. Background: Pituitary tumor trans-forming gene (PTTG) is a kind of proto-oncogene, and its expression is related to sister chromatid separation, angiogenesis, tumor metastasis and spread, and so on. In the current study, the expression of PTTG1 was investigated in liver tissue of patients with hepatocellular carcinoma (HCC). Methods: The expression of PTTG1 in tumor and paratumor tissues was detected by immunohistochemistry in 60 patients with HCC, and was detected using western blotting and RT-PCR in 15 patients with HCC. The expression of PTTG1 in normal liver tissue of patients with liver hemangioma during the same period was as a control. Statistical data were expressed as median (interquartile range).
Results: Immunohistochemitry showed that PTTG1-positive staining is mainly seen in cytoplasm and can also be seen in nucleus. The staining intensity of PTTG1 in tumor tissues was higher than that of paratumor tissues, while the staining intensity of PTTG1 in paratumor tissues was higher than that of normal liver tissues (both P < 0.001). The result of western blotting revealed that PTTG1 protein level in HCC tumor and paratumor tissues was up-regulated compared with that of normal liver tissues (both P < 0.05). The result of RT --PCR showed that the relative PTTG1 mRNA level was 3.64 ( Background: Pituitary tumor trans-forming gene (PTTG) is a kind of proto-oncogene and is related to tumor development and metastasis. In the current study, the relationship of PTTG1 and tumor progression in patients with hepatocellular carcinoma (HCC) was investigated. Methods: The expression of PTTG1 was detected by immunohistochemical staining in 60 patients with HCC. The relationship between PTTG1 and the clinical data was analyzed. Different PTTG1-positive grades of tumor tissues were used for univariate and multivariate survival analysis to investigate the effect of PTTG1 expression on short-term survival of HCC patients. Results: The PTTG1-positive staining rate in tumor and paratumor tissues were was higher than those of normal liver tissues (both P < 0.001). HCC patients with PTTG1-positive cells ≤ 70% in tumor tissues had higher proportion of spontaneous rupture or intratumoral hemorrhage of the tumor compared with those with PTTG1-positive cells> 70% ( P < 0.05). Compared with high differentiated tumor, the percentage of nuclear PTTG1 expression was higher in poorly differentiated hepatocellular carcinoma (P < 0.05). PTTG1-positive cells < 5% in paracancer tissues had lower serum a-L-fucosidase level, smaller tumor volume, and earlier clinical stage compared with those PTTG1-positive cells ≥ 5% (all P < 0.05). Univariate and multivariate survival analysis revealed that different PTTG1-positive grades of tumor tissues was were not related to the short-term survival rate of HCC patients (all P > 0.05).
Conclusion: Up-regulation of PTTG1 in tumor and paratumor tissue indicates relative severe situation of HCC but is not associated with short-term survival rate in patients with HCC.
# P-0803 Carnitine palmitoyl transferase 1 a (CPT1a) deficiency: A rare cause of severe nonalcoholic fatty liver disease (NAFLD) in an adult patient Author: PRASIT PHOWTHONGKUM Affiliation: Department of Medicine, Chulalongkorn University, Thailand NAFLD becomes a more prevalent cause of liver disease in Asians. Inborn errors of metabolism (IEM) are rare causes of NAFLD and mostly present in infancy or childhood. We report an adult patient with severe NAFLD with CPT1a deficiency, a rare fatty acid oxidation disorder (FAOD). Physicians should be aware that IEM can first be present in adulthood. A 29 years -old woman was healthy until she developed progressive cholestatic jaundice and weight loss at five 5 months of pregnancy when she was 21 years old. She was diagnosed with Grave"s disease and underwent thyroidectomy. Her electrolytes were consistent with renal tubular acidosis (RTA). Her cholestasis was subsided without definite diagnosis. Six years later, she was admitted to the hospital with severe progressive cholestasis. The investigations revealed that she had acute pancreatitis. She had massive hepatosplenomegaly; therefore, she underwent a liver biopsy that showed more than ninety per cents90% macro-vesicular fatty liver. PAS stain was negative. Her jaundice was improved a few months later when it was worsening again co-occurred with E.coli bacteremia. Jaundice and hepatosplenomegaly were completely disappeared at 6six months. Liver disease worsen intermittently with intercurrent illness raised the suspicion of FAOD. Plasma carnitine (C0) and acylcarnitine profile performed with tandem mass spectrometry were sent. Increased C0 of 58.74 μmol/l (5.55--20.88) with markedly low levels of long-chain FA consistent with CPT1a deficiency was found. RTA was a known association with this FAOD. To our knowledge, this is the first adult patient with CPT1a deficiency present with severe NAFLD during sever inter-current illness or high physiologic demand (pregnancy). Molecular diagnosis is pending. Medium chain triglycerides was were instigated as it was shown to ameliorate the liver and kidney problems in patients with CPT1a deficiency. Background: Nonalcoholic steatohepatitis (NASH) is the major cause of chronic liver disease worldwide. Endoplasmic reticulum (ER) stress is considered to be an important pathological characteristic in NASH. A sequence variation (I148M) in the patatin-like phospholipase domain-containing protein 3/adiponutrin (PNPLA3) gene is known to be associated with the development of NASH. However, PNPLA3 deficient has been considered to not be associated with fatty liver disease. To clarify, therefore, the role of PNPLA3 in liver, we established PNPLA3 knockout (KO) mice and investigated the phenotypes and involved factors under ER stress. Methods: ER stress was induced by intra-peritoneally injection with tunicamycin or with saline at 0 and 24 hours in KO and C57BL/6 (WT) mice. At 48 hours after the starting of treatment, blood and liver samples were studied. Results: Hepatic steatosis and triglyceride content were  Background: Primary biliary cholangitis (PBC) is a chronic progressive liver disease predominantly affecting women that damages intrahepatic small bile ducts by autoimmune mechanisms. Some patients with PBC progress to liver cirrhosis, which can become complicated in rare cases with hepatocellular carcinoma (HCC). The predisposition factors for HCC are unclear in the clinical setting, although several reports have implicated the development to cirrhosis in PBC. We herein describe two PBC cases becoming complicated with HCC in a non-cirrhotic stage. Case 1 was a 61-year-old woman who was treated for liver dysfunction and finally diagnosed as having PBC by anti-mitochondrial antibody (AMA) positivity. Despite a response to UDCA, a hypoechoic mass lesion of 20 mm was detected in the right lobe by abdominal ultrasonography at the age of 80 years. Complicating HCC was diagnosed based on elevated levels of tumor markers such as alpha-fetoprotein (33.0 ng/mL) and protein induced by vitamin K absence or antagonist II (45 mAU/mL) along with imaging confirmation by computed tomography (CT). Transcatheter arterial chemo embolization (TACE) therapy did not prevent a recurrence, and she died at 82 years of age. A liver specimen at autopsy revealed Scheuer stage III PBC but multiple dissemination of HCC throughout the liver. (13/0/28), insomnia (0/25/22), and energy fall (0/13/6). Additionally, Gr-D is 50 % of increase of body weight and abdominal fullness is 56% for Gr-O. Conclusion: Gr-O is early vVirus negative-ization. It also has a higher SVR rate than Gr-D, whitch improves HOMA-R. There is a different tendency about side effects in the two groups. Gr-I is not strong in side effects. Therefore, it is easy to be used for outpatients with each crowd, and ALT, AFP, and HOMA-R is are also improved. When taking compliance is also considered, IFN-α is also regarded as one of the choices.
# P-0895 The correlation between triglyceride levels and steatosis degree using controlled attenuation parameter on nonalcoholic fatty liver disease patients Authors: Background: NAFLD presents as the most common cause of elevated liver enzymes and cirrhosis nowadays. Triglyceride, a primary component in steatotic cell, is known to be associated with NAFLD. However, correlation between the triglyceride levels in serum and steatosis degree, has not yet understood. This is the first study in Indonesia using Controlled Attenuation Parameter (CAP) in NAFLD patients. We aim to find correlation between a simple test, triglyceride level, with a quantitative CAP value, and also gain optimal cut-off point of triglyceride for predicting moderate to severe NAFLD.  85, 18.42, 11.42, 11.57, and 10.14 Umol/L at baseline;, 4, 8, and 12 weeks after starting the treatment and 4 weeks post treatment in the treatment naive group in comparison to with 11.22, 13.13, 9.09, 9.45, and 6.63 Umol/lL in the treatment experienced group. However, this elevation is not significantly associated with previous treatment. P-value is 0.046. Direct bilirubin is elevated in advanced liver cirrhosis ( Fibroscan 3 and 4 ). It is significantly increased after 8 weeks of starting the treatment (P-value 0.031). Meanwhile, AST and ALT mean values were gradually decreasing from baseline to 4 weeks post treatment. Conclusion: Total bilirubin was the highest value at base line in both groups. Further increase is observed in the first 8 weeks of treatment;. mMainly in dDirect bilirubin. However, it comes to reduction after the completion of treatment. Background/Aims: The diagnosis of alpha-fetoprotein-negative primary hepatic carcinoma (ANHC) is a big challenge. Aptamers are nucleic acid ligands of biological molecules, which are selected by systematic evolution of ligands by expotenial enrichment (SELEX) and valuable in molecular detection and biomarker discovery. In this study, we selected specific aptamers against ANHC serum, evaluated their diagnostic values, and captured and analyzed their protein targets in serum. Methods: Aptamers against ANHC serum were selected by subtractive-SELEX, and their specificities were evaluated by 12% polyacrymide gel electrophoresis (PAGE), and their diagnostic values were evaluated by aptamer-based single tube triple serum fluorescence detection method. Aptamer targets were captured based on magnetic bead isolation method and analyzed by proteomic approach. This research has been approved by the Ethical Committee of the First Affiliated Hospital of Nanchang University. Results: We successfully isolated 120 ANHC aptamers after 6six rounds of positive selection followed by 2two rounds of negative selection. Some aptamers showed stronger binding bands with sera of ANHC than that of liver cirrhosis (LC), chronic hepatitis (CH), and normal controls (NC) in PAGE. Three apatmers were analyzed in 703 cases of ANHC, LC, CH, and NC, with AUROCs of 0.713~0.933 for diagnosing ANHC. The AUROCs of models established by combining the three aptamers for diagnosing ANHC were higher than 0.95, with sensitivity, specificity, and accuracy all more than 90%. We successfully captured 45 serum target proteins expressed only in ANHC serum by the three aptamers, and proteomic analyses showed that they are mainly extracellular molecules with binding functions and most of them are cancer-related proteins, indicating that some of them may be potential serum biomarkers of ANHC. Conclusion: We successfully selected a group of aptamers against ANHC serum with good diagnostic value, and found that some of their serum target proteins are potential biomarkers of ANHC. Background/Aims: Glypican-3 (GPC3) is specifically expressed in primary hepatic carcinoma (PHC) tissue and could release into blood as a potential biomarker for the diagnosis of PHC. Previously, we selected a group of aptamers against GPC3. The present study was to evaluate their diagnostic value for PHC. Methods: Serum specimens and clinical data were random collected from patients with PHC (n = 144), liver cirrhosis (LC) (n = n=158), chronic hepatitis (CH) (n = n=126), and normal control (NC) (n = n=100) in the First Affiliated Hospital of Nanchang University. Serum fluorescence intensities before and after aptamers incubated with serum were measured by aptamer-based single tube triple serum fluorescence method we developed previously. Serum GPC3 level was detected by ELISA. The areas under the receiver operating characteristic curves (AUROCs) were used to evaluate their diagnostic value for PHC. This research has been approved by the Ethical Committee of the First Affiliated Hospital of Nanchang University. Results: The AUROCs of two aptamers (AP-GPC3-13 and AP-GPC3-27) for differentiating PHC from non-PHC were about 0.75 with single fluorescence indicator and 0.9 with multiple fluorescence indicators. The combination of the two aptamers showed more powerful for diagnosing PHC than that with single aptamer, with AUROC, sensitivity, specificity, and accuracy all more than 0.90. In 55 cases of small PHC (≤ 3 cm), the positive rates of the two aptamers in single and combination analysis were 63.6%, 49.1%, and 74.5%, respectively, higher than that of AFP (43.6%). In 68 cases of AFP-negative PHC, the positive rates of the two aptamers in single and combination analysis were 70.6%, 69.1%, and 83.8%, respectively. However, the AUROC of GPC3 detected by ELISA was 0.575, and other tumor markers (CEA, CA125, CA19-9) were not significant for PHC diagnosis. The serum specimens and clinical data of patients with PHC were collected. The autofluorescence and nucleic acid-related fluorescence (after adding EvaGreen) were measured in each serum specimen. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the value of serum fluorescence and clinical indicators alone and combination (by logistic stepwise regression modeling) for distinguishing the patients with PHC from that without PHC. Results: The average age of LCC group (n = 132) was significantly higher than that of LC group (n = n=330) (54.4 ± +/-11.4 vs. 50.8 ± +/-12.0, P = 0.03). All indicators of autofluorescence and nucleic acid-related fluorescence significantly differed between two groups (P = 0.000~0.036). Single fluorescence indicators were not valuable for differentiating LC from LCC (AUROCs 0.554~0.623), but the combination of 5 five indicators could increase AUROC to 0.766. The AUROC of combination of fluorescence indicators with serum AFP and age was higher than that with single AFP (0.898, 95%CI 0.865--0.930 vs. 0.818, 95%CI 0.771--0.865). The AUROC of combination of fluorescence indicators with liver function tests and age was higher than that with liver function tests alone ( Background & and Objectives: Standard of care for hepatitis C virus (HCV) infection is Sofosbuvir-based therapies. Various drugs used in combination include Peginterferon, Daclatasvir, Ledipasvir, and Ribavirin. Multiple generic brands are available in India. We aimed to assess the outcomes of generic Sofosbuvir -based therapy in a real clinical life scenario. Methods: Consecutive HCV patients treated with sofosbuvirbased regimens were included. Detailed clinical, demographical profile, laboratory parameters, and prior therapies received were noted. The combination and duration of therapy of drugs was as per the AASLD guidelines for management of HCV infection. End of treatment response and sustained virological response (SVR) at 12 weeks were documented. Results: A total of 452 patients, mean age (±SD) 38.6 ± 12.8 years, 263 (58.1%) males, were included. A total of 333(73.7%) had chronic hepatitis, and 119 (26.3%) had cirrhosis-92 (20.3%) compensated and 27 (6.0%) decompensated. Genotype 3 was the most common (72%), followed by genotype 1 (23%). Of the 452 patients, 408(90.3%) were treatment naive and 44(9.7%) were treatment experienced (Peginterferon and Ribavirin). Overall SVR12 was 96.7% (437/452),-naïve 96.3% (393/ 408), and treatment experienced 100% (44/44). Among genotype 3, SVR12 was 97.2% among chronic hepatitis, 97.2% in compensated cirrhosis and 89.2% in decompensated cirrhosis. Among genotype 1, SVR12 was 93.9% among chronic hepatitis, 100% in compensated cirrhosis and 100% in decompensated cirrhosis. Model for end stage liver disease (MELD) score in patients with compensated cirrhosis at baseline was 7.5(6.4-13.8) and at end of treatment was 7.5(6.4--16.3); P value= 0.486. MELD score in patients with decompensated cirrhosis at baseline was 9.0 (6.43-30.3) and 8.8 (6.4 -17.2); P value= 0.856. Conclusions: Generic Generic-based therapies are associated with high SVR rates in patients with HCV infection in a real -life clinical scenario. Drug-induced liver injury is considered as one of the most common adverse drug reactions among patients taking anti-tuberculosis drugs. Several hepatoprotectants have been evaluated in preventing anti-tuberculosis drug-induced liver injury (AT-DILI). Most studies are small and limited, and no drug is proven to significantly prevent AT-DILI. Silymarin, a traditional herbal drug extracted from Silybum marinum, has been used as a hepatoprotectant that has been shown to prevent AT-DILI in several animal studies. Recent treatment trials in humans, have conflicting results. The objective of this study is to evaluate the hepatoprotective effect of Silymarin in preventing drug-induced liver injury in adult patients being treated with anti-tuberculosis drugs. A comprehensive search of Medline (via Pubmed), the Cochrane Library, Science Direct, Biomed Central, and EMBASE was performed for English-language literature about Silymarin and AT-DILI from inception to November 2016. The papers were filtered using pre-defined inclusion and exclusion criteria. Included studies were randomized controlled trials comparing Silymarin to placebo in preventing the development of AT-DILI in adults diagnosed with Tuberculosis who are to receive the standard anti-TB regimen. Three papers were identified and included in this meta-analysis. The sample comprised a pooled total of 494 patients, of which 244 and 250 patients took Silymarin and placebo, respectively. The difference between Silymarin and placebo groups in incidence of AT-DILI in adult patients with tuberculosis was not statistically significant (RR = 1.04; 95%CI = 0.34--3.23; P = 0.03). Results show significant heterogeneity, which were attributed to differences in AT-DILI definitions, frequency, and duration of laboratory monitoring, duration of hepatoprotectant treatment, and small sample sizes. The difference in incidence of other adverse events was also not significant between Silyamarin and placebo groups (RR = 1.07; 95%CI = 0.84--1.37; P = 0.02). While Silymarin has an acceptable safety profile, available evidence from limited studies suggest that it exhibits no significant hepatoprotective effect against anti-Tuberculosis drug-related liver injury.
# P-0983 Association of delta-6-desaturase enzyme activity and FADS gene polymorphisms with non-alcoholic fatty liver disease Background: Polyunsaturated fatty acids (PUFAs) have been documented to have lipid lowering and anti-inflammatory properties. PUFAs are acquired from diet and also endogenously synthesized in the human body in a pathway catalysed catalyzed by delta-6-desaturase (D6D) and delta-5-desaturase enzymes. They are encoded by FADS2 and FADS1 genes, respectively. Single nucleotide polymorphisms (SNPs) in the FADS genes have been significantly correlated with acute coronary syndrome and coronary artery disease, which are commonly associated with the Metabolic Syndrome (MS). Non-alcoholic fatty disease (NAFLD) is considered to be the hepatic manifestation of the MS. FADS gene polymorphisms are known to affect the plasma PUFA levels by modulating the D6D enzyme activity. Thus, this study was aimed at demonstrating an association of D6D activity and FADS gene polymorphisms with NAFLD. Methods: SNPs rs3834458 and rs66698963 of FADS2 gene and plasma PUFAs were analysedanalyzed. 230 Two hundred and thirty subjects (117 NAFLD patients and 113 healthy controls) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In a subgroup of 65 subjects (35 NAFLD and 30 healthy controls), plasma PUFAs were studied with the help of gas chromatography. Results: PCR-RFLP results indicated that T/del, del/del genotypes of rs3834458, and I/D, D/D genotypes of rs6669893 were significantly associated with NAFLD risk (P < 0.05). Genotype T/del of rs3834458 was found to significantly increase the risk of NAFLD 2.04 times (P = 0.05, 95% CI 0.99--4.17), after adjusting for confounders by binary logistic regression analysis. Plasma PUFA levels assessed by gas chromatography demonstrated a significant increase in C20:3 n-6 and product/precursor ratio (C18:3 n-6/C18:2 n-6) in healthy controls as compared to with NAFLD subjects (P < 0.05) indicative of impaired D6D enzyme activity in NAFLD patients. Conclusion: The study demonstrated a positive association of FADS2 gene polymorphisms and D6D enzyme activity with NAFLD.
# P-0990 Uncertain association between Tenofovir and eGFR reduction in patients with chronic hepatitis B Aims: Tenofovir disoproxil fumarate (TDF) is known to be associated with nephrotoxicity in patients with human immunodeficiency virus (HIV). TDF is a potent antiviral agent to treat chronic hepatitis B (CHB) infections, and the prescription has been increased rapidly in worldwide. Intermittently, nephrotoxicities due to TDF in CHB patients were reported in some cases. Therefore, we have been interested in the real-life incidence of renal toxicity in CHB patients treated with TDF. Methods: From January 2012 to December 2014, medical records of patients who had been treated with TDF or entecavir (ETV) in Kosin University Gospel Hospital were reviewed retrospectively, focused on the estimated GFR (eGFR) reduction. Results: A total of 295 patients received TDF or ETV. Twenty-five patients treated for 30 days or less, and 45 patients without follow-up creatinine level were excluded. The following patients were also excluded : baseline eGFR < 60 (ml/min/ 1.73 m 2 ) patients (n = 9), polycystic kidney disease (n = 1), decreased eGFR due to aggravating factor (n = 17). Among 198 patients, 99 received TDF and 99 ETV. In 18 patients, eGFR was reduced by more than 30% compared to with baseline. Half of them treated with TDF and the other half with ETV. Baseline eGFR (P = 0.006) and age (P = 0.015) were significantly correlated with eGFR reduction. The presence of LC (P = 0.684), nNon-selective beta blocker (P = 0.309), type of antiviral agents (P = 0.927), and BMI (P = 0.965) were not associated with the eGFR reduction. Subgroup analysis of CKD stage 2 (60 < eGFR < 90) or older than 60 years did not show any significant association between antiviral agents and eGFR reduction. Conclusions: More than 30% reduction of eGFR was observed in 9% CHB patients receiving antiviral agents. Baseline eGFR and age were significantly correlated with eGFR reduction. There was no significant correlation between the type of antiviral agents (TDF of ETV) and the decrease in renal function. Introduction: Prevalence of chronic hepatitis C (CHC) is significantly higher in patients with end-stage renal disease, particularly those receiving haemodialysis. There are very few studies available to prove the safety and efficacy of sofosbuvir-based regimen for treatment of CHC in patients with ESRD. This is a single centre experience of using sofosbuvir-based therapy in patients with ESRD. Methods: Twenty-five patients with ESRD receiving haemodialysis were given sofosbuvir-based regimens after obtaining informed consent. Sofosbuvir (400 mg on alternate days) and daclatasvir (60 mg once daily) were given irrespective of genotypes. Duration of therapy was 24 weeks for patients with evidence of cirrhosis (n = 5) and 12 weeks for those without cirrhosis. Results: Twenty-five patients (12 males) aged 35 ±+ 22 (mean ±+ SD) years received sofosbuvir-based therapy between December, 2015 and December, 2016. Eighteen patients had genotype 3, six had genotype 1, and one had genotype 4. Baseline RNA level was 6.40 ±+ 0.57 log (mean ±+ SD). Five patients had imaging and endoscopic evidence of cirrhosis. Sixteen (64%) patients achieved sustained virological response (SVR 12 ). Six patients achieved end of therapy response (ETR), and SVR 12 is yet to be evaluated. Two patients were lost to follow up. One patient discontinued therapy due to development of extensive skin rash. Relapse was not seen in any of these patients and echocardiographic monitoring was not done. Conclusion: Sofosbuvir-based regimen found to be safe and effective in this small cohort of patients with ESRD and CHC. Further studies with drug levels measurements along with close monitoring of the side effects are needed for stronger recommendation. Background and Aims: Malnutrition is a quite common but frequently overlooked problem among patients with cirrhosis of liver. Malnourished cirrhotic patients have a higher rate of complications and an overall increased mortality. Subjective global assessment (SGA) has been considered as gold standard for the assessment of malnutrition in these patients. This study used anthropometric methods of assessing malnutrition and correlated with clinical outcome. Methods: This prospective study evaluated malnutrition by SGA, handgrip strength (HG), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC) in outpatients with cirrhosis (n = 175), and healthy control group (n = 508) from January 2016 to August 2016 at Trivandrum Medical College and were followed over 6 months for incidence of major complications such as uncontrolled ascites, variceal bleed, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome, and death. TSF, MAMC, HG below the 5th fifth percentile of healthy controls were considered as abnormal. Severity of cirrhosis was assessed by Child-Pugh score. Results: Among 175 patients with cirrhosis, 89 were Child-Pugh A and 86 were Child-Pugh B. Most common etiology was alcohol (58%). Prevalences of malnutrition were 47.4% by SGA, 19.4% by TSF, 26.3% by MAMC, and 66.3% by HG. HG method has sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 69.9%, 37%, 50%, 57.6%, and 53.5%, respectively. Major complications were seen in 54.3% over 6 months, and the most common complication was variceal bleed. Mortality was 7.5% over 6 months. HG is the only method, which predicted a major complication among malnourished patients (P = 0.024). No significant differences were found by any method regarding mortality. Conclusions: HG was superior TSF, MAMC as well as, and SGA in the assessment of malnutrition in cirrhotic outpatients. HG was the only method which that predicted a significant clinical outcome over 6 months in malnourished cirrhotic patients.
# P-1055 Liver changes on ischemic injury reperfusion due to femoral artery ligation of New Zealand White Rabbit Authors: S MAULANISA; Y MOENADJAT Affiliation: Cipto Mangunkusumo Hospital, Indonesia Objective: To investigate indirect impact of ischemia reperfusion injury of liver due to femoral artery ligation of New Zealand White Rabbit.
Methods: This experimental study was conducted April-to December 2015 using eleven 11 New Zealand White Rabbits, and consist of three control animals and eight experimental animals. In the experimental group, the ligation was done on right communist femoral artery for four 4 hours, and then the ligation was released for eight 8 hours. Then we performed laparotomi, and liver was taken. Liver was divided from the central, midzonal, and peripheral zone for histopathological examination. Biochemical examination was performed using malondialdehyde (MDA) and HIF-1α. For liver function examination, we performed enzyme transaminase and bilirubin examination of blood serum, and the variables were compared with rabbits without ischemic treatment. Statistical significance is found when P < 0.05. Results: Histomorphological changes of liver in the experimental group mostly found are sinusoidal dilatation. There was no statistically significant difference between the three liver zones with in P central = 0.06, P medial = 0.051, and P perifer = 0.160. MDA levels showed a significant increase in the experimental group on liver tissue (P = 0.012), indicating the presence of oxidative stress due to ischemia reperfusion injury. The difference in HIF-1α levels between experimental groups and controls with the largest difference is 0.665 ng / ml. Conclusions: Ischemia-reperfusion injury of the ligation femoral artery causes indirect impact of liver damage such as histomorphological changes and oxidative stress of hepatic cells.
# P-1074 The cost effectiveness of rifaximin in hepatic encephalopathy is strongly influenced by quality of life improvements Authors: JIANYI CALVIN KOH; KIERON LIM; DAN YOCK YOUNG Background and Aim: Hepatic encephalopathy (HE) is a costly complication of chronic liver disease, and its therapy, mostly inpatient derives considerable morbidity and costs for such patients. Rifaxmin has been shown in several studies to be cost-effective in the treatment of hepatic encephalopathy in France but not the United States. Patients with on rifaxmin have reported significant improvements in quality of life (QOL) scores. The aim of this study is to models the cost effectiveness of rifaximin in hepatic encephalopathy, when factoring in QOL gains. Methods: A Markov approach was developed with the base case of rifaximin use concomitantly with lactulose with patients that have experienced 2two previous HE events. 2 Two models were evaluated:, Model 1 where the utility of patients without overt HE in both arms having similar QOL;, and Model 2 patients without HE on rifaximin had better QOL. Results and Discussion: For Model 1, using the base-case analyses and a willingness-to-pay threshold of SGD 65, 000 /QALY, the strategy of lactulose monotherapy is undominated (Table 1).
Adding regular rifaximin to this group of patients, although prevents hepatic encephalopathy and subsequent costs of inpatient hospitalization, does not come out as a cost-effective strategy. For Model 2, adding regular rifaximin to lactulose is a cost-effective strategy with an ICER at SGD 44, 072.71 /QALY. Although in the base case (Model 1), rifaximin is not cost effective, but if its effect on improving the baseline QOL of cirrhotic patients (Model2) is taken into account, it then becomes cost cost-effective. Conclusion: This model suggests that rather than all recurrent HE patients, a targeted approach for patients might be a better use of limited healthcare resources, such as patients with minimal HE where the HE, although mild, poses a significant impact on the patient's functioning and QOL.