Thus, in our meta-analysis we initially included a total of 33 studies that catered to the inclusion criteria. Twenty-three studies were preliminarily appropriate to the meta-analysis of IL1B–511 polymorphism, 26 studies to that of IL1B-31 polymorphism, 11 studies to that of IL1B+3954 polymorphism, and 25 studies to that of IL1RN VNTR polymorphism, respectively. The corresponding characteristics

are seen in Appendices 2–5. For brevity and uniformity, if studies deviated Obeticholic Acid from HWE through our calculation they were removed from our meta-analysis in the end. Thus, five studies for IL1B–511,12,17,19,23,42 five studies for IL1B-31,23,35,40,42,44 one study for IL1B+3954,45 and five studies for IL1RN15,22,31,33,35 polymorphisms were finally excluded in our meta-analysis for their deviation from HWE. Thus, 18 studies with a total of 4111 controls and 3295 cases were ultimately eligible for the meta-analysis of IL1B–511 polymorphism, 21 studies with 5883 controls and 3786 cases for IL1B-31 polymorphism, 10 studies with 3610 controls and 1559 cases for IL1B+3954 polymorphism, and 20 studies with 5789 controls and 3418 cases for IL1RN VNTR polymorphism, respectively. For IL1B–511 polymorphism, OR1 (P-value), OR2 (P-value), and OR3 (P-value) were 1.17 (P = 0.198), 1.15 (P = 0.081), and 1.02 SCH727965 clinical trial (P = 0.797), respectively,

suggesting a dominant effect of putative susceptible T allele. Thus, original grouping was collapsed, and TT and CT were combined, in accordance with a dominant mode, clonidine into T carrier group, the latter of which was compared with CC genotype group. For IL1B-31 polymorphism, OR1 (P-value), OR2 (P-value), and OR3 (P-value) were 0.92 (P = 0.259), 1.01 (P = 0.763), and 0.88 (P = 0.009), respectively, suggesting a complete overdominant effect of putative susceptible C allele. Thus, the group of CC plus TT as a whole was compared with the CT genotype group. For minimizing or avoiding probable grouping errors in our analysis, the group of CC plus CT (C

carriers) was also compared with the TT genotype group, in accordance with a dominant model, which was suggested in the other report.46 For IL1B +3954 polymorphism, OR1 (P-value), OR2 (P-value), and OR3 (P-value) were 0.92 (P = 0.563), 1.19 (P = 0.202), and 0.91 (P = 0.526), respectively, weakly suggesting a dominant effect of putative-susceptible T allele. Thus, the group of TT plus CT was compared with CC genotypes. For IL1 RN polymorphism, OR1 (P-value), OR2 (P-value), and OR3 (P-value) were 1.11 (P = 0.677), 1.11 (P = 0.522), and 1.08 (P = 0.735), respectively, suggesting a dominant effect of putative-susceptible *2 allele. Thus, the group of *2/*2 plus *2/L was compared with L/L genotypes. Figures 1–5 present the pooled OR and 95%CI for the associations between IL-1B −511, IL-1B −31, IL-1B +3954, and IL-1B RN genotypes and gastric carcinoma risk, respectively.

Based on different duration of extended consolidation therapy, 96 patients were divided into 3 groups (Group1: extended 1–12 mon, 54 patients; Group2: extended12–24 mon, 23 patients; Group3: extended 24–36 mon, 19 patients). All parameters were collected after cessation of NAs treatment. The relapse was defined as HBV DNA > 1.0*103copies/ml. Results: The cumulative relapse rates of group A and group B after withdrawal of NAs treatment in 6, 12, 18, 24, 36 Epigenetics inhibitor and 48 months were 52.5%vs29.2%, 72.5%vs35.4%, 75.0%vs37.5%, 77.5%vs39.6%,

80.0%vs41.7% and 82.5%vs41.7%. The cumulative relapse rates of three subgroups were 38.8%, 50.0%, 51.9%, 53.7%, 53.7% and 53.7% in Group 1; 17.4%, 17.4%, 21.7%, 26.1%, 30.4% and 30.4% in Group 2; 15.8%, 15.8%, 15.8%, 15.8% and 21.1% in group. The relapse rate of Group 1 was the highest, the following was of Group 2, and of Group 3 was the lowest one. Conclusion: CHB patients treatmented

with longer duration of extended consolidation therapy after meeting NAs cessation criteria may have the lower relapse rates GSK2118436 mouse after withdrawal of NAs. Key Word(s): 1. Chronic Hepatitis B; 2. Consolidation; 3. Withdrawal; 4. Relapse; Presenting Author: ZHANG QIAN Additional Authors: WENQIAN QI, SHAOYOU QIN, YAN XU, YONGGUI ZHANG, XU WANG, YAN LI, PING ZHAO, HONGHUA GUO, JIAN JIAO, CHANGYU ZHOU, JIANGBIN WANG Corresponding Author: ZHANG QIAN, JIANGBIN WANG Affiliations: China-Japan Union hospital of JiLin University Objective: To estimate the prevalence hepatic Steatosis in HBV infection in northern china and to determine risk factors. Methods: Datas were collected from medical groups of 3rd hospital of jilin university in Jilin Province, China. Questionnaires were used to obtain socio-demographic data. HBsAg, HBsAb, HBeAb, HBeAb, HBcAb and anti-HCV were detected by enzyme immunoassays. Patients with HBsAg/anti-HCV Edoxaban positive were tested by Color Doppler, liver enzymes

and HBV DNA/ HCV RNA, HBV DNA /RNA genotype, IL 28B. To identify risk factors. Results: The prevalence of Steatosis in HCV was 27.33%, which was significant higher than the one in HBV (14.98%), and the steatosis in none HBV or HCV infection was 9.76%. And it was highest in HCV among 45–65 years old patients, however it was highest in HBV among 35–55 years old patients. HCV RNA level and positive rate was significant higher in steatosis co HCV than HCV infection, however this was no significant in steatosis co HBV and HBV infection. Steatosis in HBV or HCV was significantly associated with BMI > 25, Diabetes, hypertriglyceridemia and hypercholesterolemia. Conclusion: The prevalence of steatosis in HCV was signicicant higher than HBV, and higher than no HBV or HCV infection in the northern of China. Risk factors of steatosis in HBV or HCV infection were BMI > 25, Diabetes, hypertriglyceridemia and hypercholesterolemia. Key Word(s): 1. hepatic Steatosis; 2. Epidemiology; 3. HBV; 4.

With the precious new concentrate, however, our patient’s hemostasis during dental extractions was perfectly normal. Cutter could not produce much of this marvellous material because the yield of concentrated FVIII from plasma was low. Enter Dr. Judith Graham Pool. She had earned her Ph.D. in physiology from the University of Chicago in 1946 and had joined the faculty of Stanford SCH772984 University in 1953, investigating coagulation with particular attention to FVIII. With Jean Robinson, she had developed the ‘two-stage’ assay for FVIII in 1959.

In the early 1960s she used that method to assay FVIII in plasma fractions prepared by Cutter’s Drs. Albert Pappenhagen and Edward Hershgold. Their starting material

was pooled plasma, frozen in large containers, which they thawed cautiously. They knew that the potency of FVIII in plasma dwindled at room temperature, so they were careful not to thaw the plasma completely. buy Alvelestat But Dr. Pool found very little FVIII in their thawed supernatant. She then tested the small amount of unthawed, fibrous-looking paste at the bottom of the containers, and, in 1964, found the FVIII [5]. The genius of Dr. Pool was her leap from that laboratory observation to the practical idea of using the last-to-thaw property of FVIII to separate ‘cryoprecipitate’ from whole plasma in an ordinary blood bank, re-freezing the small volume in its own sterile plastic bag and storing bags in a freezer so that eventually several could be given to a patient at one time [4]. Meanwhile, the thawed plasma could be used for extraction of other plasma proteins. The method was so simple, and

cost so little for the additional materials, that it was rapidly copied by blood banks around the world. Cryoprecipitate became widely available not only for patients with haemophilia A or von Willebrand disease but also for patients deficient in fibrinogen or factor XIII. It was a great, miraculous gift to the world. Many tens of thousands of patients have benefitted. Meanwhile, more highly concentrated commercial, lyophilized FVIII preparations were developed, using various technologies (often including Bcl-w cryoprecipitation). The first was licensed in the USA at the end of the 1960s and then cost ten cents (U.S.$0.10) per FVIII unit in Los Angeles. We quickly adopted its use and, by 1970, started to introduce our haemophilia patients to self-infusion at home. Our local blood bank had switched from the use of glass bottles for blood collection to plastic bags only in the late 1960s, delaying the development of cryoprecipitate. Furthermore, instead of charging only the incremental costs of the additional processing required to extract cryoprecipitate from plasma, they divided the total cost of blood processing among all components.

Results: There was a statistically significant inverse correlation between TIGAR expression and endogenous AKT phosphorylation in the various HCC cell lines. At the two ends of the spectrum, HepG2 exhibited high TIGAR

levels with low AKT phosphorylation, while FOCUS cells had low TIGAR levels coupled with high AKT phosphorylation. Importantly, TIGAR levels correlated with sorafenib sensitivity: HepG2 cells with high TIGAR levels were found to be highly sensitive, while FOCUS cells with low TIGAR levels were shown to be resistant to the effects of sorafenib. Overexpression of TIGAR in cells with low endogenous TIGAR levels was shown to increase cellular X5P abundance and suppressed AKT phosphorylation. The phosphorylation of AKT was significantly improved when a PP2A-inhibitor okadaic PF-562271 datasheet acid was employed, confirming that TIGAR suppresses AKT phosphory-lation via PP2A activation. Most importantly, overexpression of TIGAR significantly improved sorafenib-sensitivity in the originally resistant FOCUS cells. Conclusions: TIGAR activation in HCC may be a feasible strategy in the treatment of HCC. This approach may represent a dual-hit to suppress cancer growth by inhibiting aerobic glycolysis, which is selleck chemicals the main source of energy in aggressively growing cancer cells, as well as by suppressing AKT phosphorylation to augment the growth-suppressing

effects of tyrosine-kinase inhibitors. Disclosures: The following people have nothing to disclose: Zoltan Derdak, Ragheb Harb, Jack R. Wands Mitochondrial chelatable iron contributes to ischemia/reperfusion injury and Etoposide order the hepatotoxicity of acetaminophen. To measure mitochondrial chelatable iron in living cells and tissues, we synthesized a new fluorescent indicator, mitoferrofluor (MFF). MFF is a cationic fluorophore

designed to accumulate electro-phoretically into the matrix space of polarized mitochondria. MFF was further designed to have a reactive group that forms covalent adducts with mitochondrial proteins to allow retention of MFF after subsequent mitochondrial depolarization. MFF fluorescence showed excitation and emission peaks at 554 and 598 nm, respectively. In cell free medium, MFF fluorescence was strongly and stoichiometrically quenched by Fe2+ but not by Fe3+. In cultured rat hepatocytes, MFF selectively accumulated into mitochondria. Unlike the membrane potential (ΔΨ) indicator rhodamine 123, MFF was retained by mitochondria after collapsing ΔΨ by uncoupler (10 CCCP) in the presence of inhibitors of the mitochondrial ATP synthase (10 ng/ml oligomycin) and respiratory Complex III (10 myxothiazol). In MFF-loaded hepatocytes, intramitochondrial MFF fluorescence decreased by ∼80% when excess extracellular Fe2+ was added. In conclusion, MFF retention by mitochondria is independent of mitochondrial ΔΨ unlike earlier mitochondrial iron indicators, such as rhodamine B-[(1,10-phenanthrolin-5-yl) aminocarbonyl]benzyl ester (RPA).

In support of LGK974 this hypothesis, we demonstrate that STA-21 treatment induces

significant disorganization of the MT network in Huh-7.5 cells (Fig. 6A). α-Tubulin displayed a dispersed punctate pattern in STA-21 treated cells, which was not observed in control treated cells, that displayed an organized MT network with long intact MTs radiating from the MT-organizing center (MTOC). If the STAT3/STMN1 interaction plays a role in HCV replication then the siRNA mediated knockdown of STMN1 should restore HCV replication in the presence of STA-21. To establish if this observation was dependent on STMN1, investigation of α-tubulin cellular distribution was performed in the presence of an siRNA knockdown of STMN1 (Fig. 6C) and STA-21 treatment (Fig. 6B). As predicted, siRNA knockdown of STMN1

rescued the effect of MT disorganization induced by STA-21. We therefore monitored JFH-1 RNA in the presence of STMN1 knockdown and STA-21 treatment and showed that under these conditions a significant but partial rebound selleck products in HCV RNA levels occurred (Fig. 6D). This partial rescue was most likely attributed to some residual STMN1 expression and the likelihood that STAT3 impacts HCV replication through multiple mechanisms. These results indicate that STAT3 may play an important role in mediating MT dynamics to create a cellular environment favorable for HCV replication. The number of host factors that impact the HCV life cycle continues to grow. These factors have been shown to play roles in multiple facets of the HCV life

cycle, including entry, RNA replication, and egress.[24] Early work using the HCV replicon model and more recently using a genome-wide siRNA screen have implicated STAT3 as a candidate host factor playing a role in HCV replication.[1, 2] However, to date the role of STAT3 in the HCV life cycle has been observational and this raises the Methane monooxygenase question of how STAT3 exerts its effect on HCV replication, whether it is in an indirect or a direct manner. The highly pleiotropic nature of STAT3 due in part to its ability to be activated by such a large variety of growth factors and cytokines suggests that STAT3′s impact on HCV replication will be multifactorial. It is likely that in the liver, during an active HCV infection, STAT3 activation may occur by way of multiple pathways including virally induced oxidative stress, IL-6, LIF, and EGF. To this end we have shown in vitro that LIF treatment of Huh-7.5 cells markedly increases HCV RNA replication. Oxidative stress is a known activator of STAT3 and as such it is not surprising that HCV replication is capable of activating STAT3.[2] Our study extends the work of Waris et al.

[12] TGF-β1 derived from cancer cells has been shown to promote MF activation

and secretion of growth factors (i.e., hepatocyte growth factor, heregulin) in colon[44] and squamous carcinoma.[45] Here, we showed that in HLMF, TGF-β1 stimulates HB-EGF synthesis. Thus, CCA cell-derived TGF-β1 may sustain MF in an activated state to produce HB-EGF and thereby maintain the HB-EGF/EGFR pathway active in the tumor cells. In conclusion, the present study provides evidence of the existence of a cross-communication between cancer cells and MF in CCA tumor based on the HB-EGF/EGFR axis. These data reinforce the notion that the EGFR system plays a crucial role in CCA progression. Therapies targeting EGFR (erlotinib and/or cetuximab) in combination with GEMOX have been tested in clinical trials for CCA treatment.[46-48] Despite encouraging results, EGFR therapies have shown restricted efficiency in patients with CCA. http://www.selleckchem.com/products/ink128.html Our study suggests that EGFR-targeted therapies could be more effective in CCA in subgroups of patients showing marked EGFR expression and prominent stroma. The authors thank the Tumeur-Est tissue bank for cholangiocarcinoma human samples. The authors also thank Colette Rey (INSERM, UMRS 938, learn more Centre de Recherche Saint-Antoine) for assistance in animal experiments, Dr. Françoise Praz (INSERM, UMRS 938,

Centre de Recherche Saint-Antoine) for technical assistance for Alu sequence detection, and Dr. Bruno Saubaméa (Cellular and Molecular Imaging facility

of the IFR71-IMTCE, Paris Descartes University) for confocal imaging. Additional Supporting Information may be found in the online version of this article. “
“Division of Gastroenterology/Hepatology, Hepatitis Phosphoprotein phosphatase C Center, University of Colorado Health Sciences Center and National Jewish Hospital, Denver, CO Department of Biochemistry and Immunology, Trinity College Dublin, Ireland T cell activation and the resultant production of interleukin (IL-2) is a central response of the adaptive immune system to pathogens, such as hepatitis C virus (HCV). HCV uses several mechanisms to evade both the innate and adaptive arms of the immune response. Here we demonstrate that liver biopsy specimens from individuals infected with HCV had significantly lower levels of IL-2 compared with those with other inflammatory liver diseases. Cell culture–grown HCV particles inhibited the production of IL-2 by normal peripheral blood mononuclear cells, as did serum from HCV-infected patients. This process was mediated by the interaction of HCV envelope protein E2 with tetraspanin CD81 coreceptor. HCV E2 attenuated IL-2 production at the level of secretion and not transcription by targeting the translocation of protein kinase C beta (PKCβ), which is essential for IL-2 secretion, to lipid raft microdomains. The lipid raft disruptor methyl-β-cyclodextrin reversed HCV E2-mediated inhibition of IL-2 secretion, but not in the presence of a PKCβ-selective inhibitor.

[12] TGF-β1 derived from cancer cells has been shown to promote MF activation

and secretion of growth factors (i.e., hepatocyte growth factor, heregulin) in colon[44] and squamous carcinoma.[45] Here, we showed that in HLMF, TGF-β1 stimulates HB-EGF synthesis. Thus, CCA cell-derived TGF-β1 may sustain MF in an activated state to produce HB-EGF and thereby maintain the HB-EGF/EGFR pathway active in the tumor cells. In conclusion, the present study provides evidence of the existence of a cross-communication between cancer cells and MF in CCA tumor based on the HB-EGF/EGFR axis. These data reinforce the notion that the EGFR system plays a crucial role in CCA progression. Therapies targeting EGFR (erlotinib and/or cetuximab) in combination with GEMOX have been tested in clinical trials for CCA treatment.[46-48] Despite encouraging results, EGFR therapies have shown restricted efficiency in patients with CCA. Pexidartinib price Our study suggests that EGFR-targeted therapies could be more effective in CCA in subgroups of patients showing marked EGFR expression and prominent stroma. The authors thank the Tumeur-Est tissue bank for cholangiocarcinoma human samples. The authors also thank Colette Rey (INSERM, UMRS 938, CB-839 in vitro Centre de Recherche Saint-Antoine) for assistance in animal experiments, Dr. Françoise Praz (INSERM, UMRS 938,

Centre de Recherche Saint-Antoine) for technical assistance for Alu sequence detection, and Dr. Bruno Saubaméa (Cellular and Molecular Imaging facility

of the IFR71-IMTCE, Paris Descartes University) for confocal imaging. Additional Supporting Information may be found in the online version of this article. “
“Division of Gastroenterology/Hepatology, Hepatitis ADAMTS5 C Center, University of Colorado Health Sciences Center and National Jewish Hospital, Denver, CO Department of Biochemistry and Immunology, Trinity College Dublin, Ireland T cell activation and the resultant production of interleukin (IL-2) is a central response of the adaptive immune system to pathogens, such as hepatitis C virus (HCV). HCV uses several mechanisms to evade both the innate and adaptive arms of the immune response. Here we demonstrate that liver biopsy specimens from individuals infected with HCV had significantly lower levels of IL-2 compared with those with other inflammatory liver diseases. Cell culture–grown HCV particles inhibited the production of IL-2 by normal peripheral blood mononuclear cells, as did serum from HCV-infected patients. This process was mediated by the interaction of HCV envelope protein E2 with tetraspanin CD81 coreceptor. HCV E2 attenuated IL-2 production at the level of secretion and not transcription by targeting the translocation of protein kinase C beta (PKCβ), which is essential for IL-2 secretion, to lipid raft microdomains. The lipid raft disruptor methyl-β-cyclodextrin reversed HCV E2-mediated inhibition of IL-2 secretion, but not in the presence of a PKCβ-selective inhibitor.

Moreover, inhibition of BRAF signaling with a selective BRAF inhibitor (PLX4720) induced ERK activation without any cyto-toxicity in HCC cells. Co-immunoprecipitation MG-132 revealed that sorafenib-induced ERK activation was a result of BRAF heterod imerization with CRAF. The activation of ERK

after sorafenib was confirmed in vivo in spontaneous models of HCC. Moreover, combination treatment with sorafenib and selumetinib delayed primary tumor growth, while monotherapy of selume-tinib did not inhibit tumor growth. Gene silencing with siRNA of CRAF or ERK in combination with sorafenib also delayed primary tumor growth, but RNA interference of either CRAF or ERK did not affect the tumor growth. We found that cell apop-tosis (evaluated by TUNEL staining) was increased when siRNA for CRAF was combined with sorafenib in tumors, while siRNA for CRAF alone did not increase

apoptosis in vivo. Conclusion: We demonstrate that HCC cell viability is independent Lumacaftor chemical structure of RAF/ ERK activity. Sorafenib treatment leads to RAF dimerization, ERK activation and converts HCC cell survival dependence on the RAF/MEK/ERK pathway. Thus, reversing the drug-induced mechanism of resistance using MEK inhibitors such as selume-tinib may increase the efficacy of sorafenib in HCC. Disclosures: Thomas Reiberger – Grant/Research Support: Roche, Gilead, MSD, Phenex; Speaking and Teaching: Roche, Gilead, MSD Rakesh K. Jain – Board Membership: XTuit, H&Q Healthcare Investors, H&Q Life Sciences Investors; Consulting: Enlight Biosciences,

Noxxon, Zyngenia; Grant/ Research Support: Dyax, MedImmune, Roche; Stock Shareholder: Enlight Biosci-ences, SynDevRx, XTuit Dan G. Duda – Advisory Committees or Review Panels: Hexal The following people have nothing to Cyclooxygenase (COX) disclose: Rakesh R. Ramjiawan, Yunching Chen, Annique M. Duyverman, Peigen Huang, Keith Flaherty, Andrew X. Zhu Background. Cholangiocarcinoma (CCA) is an aggressive liver malignancy characterized by early and strong invasiveness. We have recently showed that S100A4 protein is a major determinant of CCA invasiveness when expressed in the nucleus of CCA cells. We aimed at studying whether manipulation of S100A4 nuclear expression by Paclitaxel (PTX), a microtubule stabilizing agent, hampers CCA cell invasiveness both in vitro and in vivo. Methods. Human CCA cells expressing nuclear S100A4 were treated with PTX at increasing doses. We studied nuclear and cytosolic expression of S100A4, cyto-skeletal integrity, cell proliferation, apoptosis, motility and inva-siveness. Functional effects of PTX were tested on the activity of Rho GTPases. CCA cells were xenotrasplantated in SCID mice by spleen injection. Once tumor engraftment was confirmed by bioluminescence imaging, mice were treated with PTX at 2 different low-dose metronomic regimens (1,3 and 2,6mg/kg/ die) for 14 days and compared with non-treated mice (n=5 for each group).

Most patients with fXI deficiency

are mild bleeders, but it has been recognized that patients with similar fXI activity may exhibit different bleeding phenotypes. Routine laboratory assays such as measurement of fXI clotting activity is crucial for establishing the diagnosis, but does not correlate with the individual bleeding risk of patients. A recent study assessing thrombin generation capacity of patients with fXI deficiency reported a dramatic impairment of thrombin generation in patients exhibiting severe bleeding tendency and patients having unusually good JNK inhibitor libraries thrombin generation profiles were associated with a less severe bleeding phenotype, independently of their fXI level [16]. Over the last decade, a large number of pilot studies assessing thrombin generation tests have reported promising data in the field of bleeding disorders. There is now sufficient translational research data demonstrating the potential interest of the assay in clinical

settings, as well as in clinical trials to test its correlation with the clinical this website outcome of patients. A working party of the ISTH fVIII/fIX SSC is currently expending tremendous efforts to standardize the assay [17,18] and will be making recommendations for the use of thrombin generation assays in bleeding disorders, which is a crucial step before bringing the test into clinical haematology laboratories. As of today, the traditional thromboelastographic principle introduced by Hartert [19] has been adopted in computerized version of the TEG® apparatus manufactured by Haemoscope® and a modified version was introduced in 1996 by Calatzis today named thromboelastometry (ROTEM®) [20] in which the pin oscillates instead of the cup. A ball bearing focusing the pin apparently makes the ROTEM® less sensible for movements. Both the TEG® and the ROTEM® provide a digital signal allowing for additional computation of the continuous coagulation signal leading to the derivation of several quantifiable

parameters (Figs 1A and B). TEG or ROTEM allows a continuous assessment of the viscoelastic properties of a forming clot. Both devices consist of a cup into which the sample (whole blood, platelet-rich or –poor plasma) and reagents are placed, and a pin which sits OSBPL9 in the center of the cup when the device is running. In the ROTEM® device the pin is oscillating, whereas the cup is the moving part in the TEG®. Clot formation reduces movement of the pin and this is electronically registered and visualized on a computer providing a coagulation signal similar to that of the traditional thromboelastography (Fig. 1A). Table 1 lists currently recommended pre-analytical and analytical procedures for performing thromboelastometry measurements. Each of the currently available assays reflects a part of the haemostatic process. Thrombin generation measurements are excellent in providing detailed information on the kinetic pattern of thrombin generation.

4 6.0 (ALT-N)   10.8 9.0 (ALT-N)       7.5 (ALT 1-5x)     12.0 (ALT 1-5x)   Metformin cost Sensitivity (%) 95 90 90 26 51 66 Specificity (%) 5 63 66 92 96 92   PPV(%) 40 62 64 69 91 85 NPV(%) 58 90 90 65 74 80   LR+ 1.0 2.45 2.65 3.36 14.0

8.47 LR- 1.06 0.16 0.16 0.40 0.51 0.37   No. of biopsy correctly avoided 7/142(5%) 90/142(63%) 94/142(66%) 25/96(26%) 49/96(51%) 63/96(66%)   No. of incorrect diagnosis 5/142(4%) 10/142(7%) 10/142(7%) 11/96(11%) 5/96(5%) 11/96(11%) Validation Sensitivity (%) 97 79 79 32 41 65 Specificity (%) 14 51 61 86 94 86 PPV(%) 43 52 57 61 82 76 NPV(%) 88 79 82 66 71 79 LR+ 1.12 1.62 2.02 2.36 7.0 4.71 LR- 0.21 0.40 0.34 0.78 0.62 0.41 No. of biopsy correctly avoided 7/51(14%) 26/51(51%) 31/51(61%)

11/34(32%) 14/34(41%) 22/34(65%) No. of incorrect diagnosis 1/51(2%) 7/51(14%) 7/51(14%) 7/34(21%) 3/34(9%) 7/34(21%) Disclosures: Grace LH Wong – Advisory Committees or Review Panels: Otsuka, Gilead; Speaking and Teaching: Echosens, Furui Vincent W. Wong – Advisory Committees or Review Panels: Otsuka, Roche Pharmaceuticals, Selleck ITF2357 Gilead, Abbott; Speaking and Teaching: Bristol-Myers Squibb, Novartis Pharmaceuticals, Echosens Henry Lik-Yuen Chan – Advisory Committees or Review Panels: Gilead, Vertex, Bristol-Myers Squibb, Abbott, Novartis Pharmaceutical, Roche, MSD Background / Aims: The common causes of portal hypertension in India are cirrhosis, non cirrhotic portal hypertension (NCPF) and extra hepatic portal hypertension (EHPVO). The present gold standard to differentiate NCPF from cirrhosis is liver biopsy; there is paucity of data to differentiate these by non invasive means. We therefore assessed the reliability of LS to differentiate cirrhosis from NCPF. Methods: LS was measured, using 5-MHz US transducer probe mounted on the axis of a vibrator (Fibro Scan; Echosens), Ergoloid in 34 consecutive biopsy-proven NCPF, 44 EHPVO and 41 Child A cirrhosis patients. 43 healthy subjects were evaluated as controls. EHPVO was diagnosed if there was portal cavernoma with or without splenic vein cavernoma, and no evidence of liver disease. Patients with NCPH were

excluded if they had hepatitis B or C, alcohol consumption, recent variceal bleed, portal biliopathy or previous shunt surgery. Institutional ethics committee approval and informed consent were obtained. ROC curves were plotted to assess the sensitivity and specificity of LS in differentiating NCPF from Child A cirrhosis. Results LS was higher in patients with EHPVO and NCPF than in healthy controls (p = 0.008). LS was similar in EHPVO patients who presented with bleed as compared to those who did not (6.23 [1.4] kPa vs.6.32 [1.2] kPa, p=0.50). LS was similar in NCPF patients who had variceal bleed at presentation as compared to those who had not (7.6 [2.7] vs 7.1 [3.3], p=0.41). NCPF patients who presented with bleed were older (37 [23-70] y vs.