GPC3 gene expression and allelic discrimination of FZD7 gene in Egyptian patients with hepatocellular carcinoma.

Background: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide, and especially in Egypt. Early diagnosis of HCC greatly improves the survival and prognosis of patients. Low sensitivity and specificity of alpha-fetoprotein (AFP) has led to the demand for novel biomarkers of HCC. The aim of the present study was to evaluate the validity of frizzled-7 (FZD7) and glypican-3 (GPC3) gene expression as potential biomarkers for HCC early diagnosis, and to investigate the association between FZD7 rs2280509 polymorphism and HCC risk. Materials and methods: Quantification of FZD7 and GPC3 gene expression by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay, and genotyping FZD 7 (rs2280509 SNP) gene polymorphism using RT-PCR. Results: The current results revealed that FZD7 gene expression had a greater area under the curve (AUC) for identifying HCC than GPC3 gene expression and AFP levels. The combination of the three markers as a panel showed a better diagnostic performance with a greater AUC than any of the single markers alone (p < 0.05). The FZD7 rs2280509 polymorphism (CT) was found to be significantly associated with an increased risk of HCC. The CT genotype and T allele were significantly more prevalent in the HCC group compared to either the cirrhosis (p = 0.03) or control groups (p = 0.0009 and 0.002; respectively). Conclusion: FZD7 and GPC3 gene expressions have a complementary role in early HCC detection, with a greater diagnostic sensitivity and accuracy than AFP. In addition, FZD7 rs2280509 polymorphism is significantly associated with an increased risk of HCC in the Egyptian population.

Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma.

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed number of donor organs negatively impact access to liver transplantation. The aim of the work was to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo percutaneous microwave ablation (MWA) alone and in combination with TACE. METHODS: This prospective study included 40 patients with medium-sized HCC lesions who were classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with contrast were obtained from the two groups. Laboratory and radiological follow up of the cases were done at 1 and 3 months after the treatment. RESULTS: There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of treatment. The response was slightly better in the combined treatment group, but it did not show a statistically significant difference. The incidence of complications was higher in the MWA group. CONCLUSION: Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.

Serum Vitamin D Levels in Chronic Hepatitis B Patients Before and During Treatment.

BACKGROUND & AIMS: Hepatitis B is a potentially life-threatening liver infection and it is a major global health problem. Over the past decade, numerous studies have reported that patients with CLD, especially HCV-positive and HBV-positive patients, have decreased 25(OH) D levels. The current study was designed to assess the serum levels of vitamin D [25(OH) D3] in chronic hepatitis B patients, before and during treatment with antiviral therapy. METHODS: It was a prospective study in which 80 subjects were enrolled between December 2017 and June 2018. A total of 50 treatment-naïve chronic HBV patients and 30 healthy subjects were recruited. The studied cases received treatment in the form of Lamivudine 100 mg tablet, once daily. Full routine laboratory investigations, HBV DNA measurement by real-time PCR were conducted once before initiation of antiviral treatment and again at least 6 months later. Serum vitamin D level [25(OH)D3 was assessed twice, once before initiation of antiviral treatment and again at least 6 months later. This was done for all the patients enrolled in the study. RESULTS: The studied cases showed a significantly low mean serum Vitamin D level when assessed before treatment (21.6 ± 5.8 ng/ml), compared to the level after 6 ms of treatment (31.1 ± 7.3 ng/ml) which was comparable to that of the control group (33.4 ± 5 ng/ml). CONCLUSION: The present study highlights the impact of antiviral therapy on vitamin D deficiency in CHB patients, where effective therapy improves vitamin D levels. Meanwhile, it is recommended to study the impact of vitamin D replacement and correction on the disease progression or regression.

Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE