In the univariate analysis, fulminant hepatic failure (odds ratio [OR] 5.714, 95% confidence interval [CI] 1.045–31.245, p = 0.027), life expectancy less than 7 days according to UNOS liver status EPZ015666 chemical structure classification (status 1 and 2a) (OR 2.97, 95% CI 0.883–8.242, p = 0.074), history of recent hemodialysis (OR 3.129, 95% CI 2.340–4.183, p = 0.043), recipient

bile duct opening number of more than 2 (OR 5.208, 95% CI 1.721–15.761, p = 0.002) were significant (p < 0.1). In the multivariate analysis, recipient bile duct opening number of more than 2 was statistically significant risk factor (OR 5.208, 95% CI 1.721–15.761, p = 0.003). Conclusion: Recipient bile duct opening number was associated with spontaneous hemobilia after LT. Further studies are required in order to clarify the role of recipient bile duct opening number in spontaneous hemobilia in LT patients. Key Word(s): 1. liver transplantation; 2. biliary complication; 3. spontaneous hemobilia; 4. risk factor Presenting Author: SOO KYUNG PARK Additional Authors: JONG HO MOON, HYUN JONG CHOI, YUN NAH LEE, TAE HOON LEE, SANG WOO CHA, YOUNG DEOK CHO, SANG HEUM PARK, SUN JOO KIM Corresponding Author: SOO-KYUNG PARK

Affiliations: http://www.selleckchem.com/products/bgj398-nvp-bgj398.html Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, SoonChunHyang University School of Medicine, Soonchunhyang University School of Medicine Objective: Covered

self-expandable metallic stent (SEMS) may improve stent patency but have the risk of migration in comparison with uncovered stent in patients with distal malignant biliary obstruction. Intraductal placement above the papillary orifice of SEMS may 上海皓元 prevent duodeno-biliary reflux after stenting. This study was performed to evaluate the efficacy of modified fully covered SEMS in patients with distal malignant biliary obstruction. Methods: Total 55 patients with distal malignant biliary obstruction and obstructive jaundice were enrolled in this study. The modified fully covered SEMS (12 mm in diameter) has center portion of smaller diameter (8 mm) and long lasso without flare in both ends. Results: Causes of biliary obstruction were 27 common bile duct cancers, 21 pancreatic cancers, 5 gallbladder cancers and 2 metastatic cancers. Intraductal stenting above the papillary orifice was performed in 83.6% (46/55). Early complication rate was 5.5% (3/55, 3 mild pancreatitis). Clinical improvement of obstructive jaundice was achieved in all enrolled patients. 11 patients with operability underwent surgical resection after stenting.

“
“Summary.  The pharmacokinetic (PK) response to factor VIII (FVIII) and factor IX varies between Selleck INCB024360 patients and this has important clinical implications for treatment. Although PK is affected by patient characteristics, this relationship is too weak to infer a result for an individual and, if required, PK must be measured. An important determinant of

the efficacy of prophylaxis is the length of time an individual spends with a low level of coagulation factor. This time is more dependent on the patient’s coagulation factor half-life and the frequency of dosing than in vivo recovery and dose infused. Improved understanding of the effect of PK and dose frequency on factor levels in patients on prophylaxis will help tailor regimens to individuals better and allow KU-60019 solubility dmso more cost effective use of coagulation factor concentrates. Calculations suggest that adults need less FVIII

per kg body weight than children. The effect of half-life on trough levels questions the logic of Monday, Wednesday, Friday dosing and suggests a role for innovative regimens including low-dose daily treatment which leads to either higher trough levels or decreased FVIII requirement. This may expand access to prophylaxis in healthcare systems with limited resources and potentially improve patient outcomes. The ideal trough level will vary between individuals and at different times of their lives and may be <1 IU dL−1. If PK is to be used in routine clinical practice, a simplified method for its measurement

is required and this methodology is becoming available. The haemostatic efficacy of coagulation factors is closely related to their concentration in the blood. It is common clinical practice to measure factor levels to evaluate and adjust dosing. The plasma level of a coagulation 上海皓元医药股份有限公司 factor is determined by the dose(s) and time(s) of infusion and the patient’s pharmacokinetic (PK) response to the dosing. As in most fields of medical treatment, variation in response between patients is a crucial issue. For example, the half-life of plasma-derived or full-length recombinant factor VIII ranged between 6 and 25 h in two recent, large studies on paediatric and adult patients [1,2]. Thus, a correspondingly wide difference in the factor level between patients is to be expected even after infusion of equivalent doses kg−1 (Fig. 1). Despite this, factor VIII (FVIII) is usually prescribed based on the assumption of an average in vivo recovery of 2 (IU dL−1) (IU kg−1)−1 and half-life of approximately 12 h. The role of PK for more individualized dosing in clinical practice has been discussed previously [1–13]. This review aims to summarize our understanding of the influence an individual patient’s PK on their response to prophylactic treatment. The insight into the influence of PK on dosing should be of value regardless of whether actual PK measurements can be performed at a treatment centre.

“
“Summary.  The pharmacokinetic (PK) response to factor VIII (FVIII) and factor IX varies between Cobimetinib mouse patients and this has important clinical implications for treatment. Although PK is affected by patient characteristics, this relationship is too weak to infer a result for an individual and, if required, PK must be measured. An important determinant of

the efficacy of prophylaxis is the length of time an individual spends with a low level of coagulation factor. This time is more dependent on the patient’s coagulation factor half-life and the frequency of dosing than in vivo recovery and dose infused. Improved understanding of the effect of PK and dose frequency on factor levels in patients on prophylaxis will help tailor regimens to individuals better and allow selleck chemicals more cost effective use of coagulation factor concentrates. Calculations suggest that adults need less FVIII

per kg body weight than children. The effect of half-life on trough levels questions the logic of Monday, Wednesday, Friday dosing and suggests a role for innovative regimens including low-dose daily treatment which leads to either higher trough levels or decreased FVIII requirement. This may expand access to prophylaxis in healthcare systems with limited resources and potentially improve patient outcomes. The ideal trough level will vary between individuals and at different times of their lives and may be <1 IU dL−1. If PK is to be used in routine clinical practice, a simplified method for its measurement

is required and this methodology is becoming available. The haemostatic efficacy of coagulation factors is closely related to their concentration in the blood. It is common clinical practice to measure factor levels to evaluate and adjust dosing. The plasma level of a coagulation MCE factor is determined by the dose(s) and time(s) of infusion and the patient’s pharmacokinetic (PK) response to the dosing. As in most fields of medical treatment, variation in response between patients is a crucial issue. For example, the half-life of plasma-derived or full-length recombinant factor VIII ranged between 6 and 25 h in two recent, large studies on paediatric and adult patients [1,2]. Thus, a correspondingly wide difference in the factor level between patients is to be expected even after infusion of equivalent doses kg−1 (Fig. 1). Despite this, factor VIII (FVIII) is usually prescribed based on the assumption of an average in vivo recovery of 2 (IU dL−1) (IU kg−1)−1 and half-life of approximately 12 h. The role of PK for more individualized dosing in clinical practice has been discussed previously [1–13]. This review aims to summarize our understanding of the influence an individual patient’s PK on their response to prophylactic treatment. The insight into the influence of PK on dosing should be of value regardless of whether actual PK measurements can be performed at a treatment centre.

Subsequently, for the remaining 6 years of Rodin, there was a specified data collection form so that the trial was clearly prospective and involved both generation rFVIII concentrates. This article appears to have combined the data from both study periods in their biostatistical analysis rather than analysing the results separately as well as combined. It is not clear 3-MA solubility dmso how this approach may have confounded their conclusions; however, there are currently in process several well-designed prospective studies, which may confirm or contradict Rodin’s findings. Two initial aspects of the Rodin trial design

should be examined. First, patients were allocated to the products indicated by their treaters and thus were subject to the potential ‘biases’ of their treaters and/or their Hemophilia Treatment Centers’ own local guidelines, preferences, or attitudes. It is indeed possible that such treatment decisions resulted in ascertainment or selection bias. Second, although the study authors discount the possibility that centre-specific bias could have confounded their conclusions,

given that the variability of prophylaxis Bafilomycin A1 manufacturer regimens and intensity of treatment have already been adjusted for, it would have been more supportive and reassuring if alternative analytical approaches for this study design had been employed to control for the risk of bias. Such statistical techniques could have included propensity score analysis [8] and centre-stratified or adjusted Cox-regression, or an assessment of deviation from the overall mean rate of inhibitor formation in different centres. In the setting of a post hoc analysis, exploring 上海皓元 the potential sources of variability with multiple techniques is generally useful to distinguish robust findings from chance ones. A further methodological concern of the Rodin trial is that it relied on the Bethesda unit inhibitor levels to be measured at each individual HTC rather than performed at a central laboratory. It is not apparent whether all the HTC laboratories were standardized in their assay techniques. At first

reading this might appear irrelevant for the study, which focuses on only clinically relevant inhibitors, but this is not the case, because Rodin employed a highly laboratory-dependent definition of inhibitor clinical relevance. Of most concern in the Rodin study design is the possible deviation from the complete analysis of the entire inception cohort [9]. According to the Methods of the Rodin study, 648 ‘eligible’ patients were recruited to the study, of whom 74 were ultimately excluded from the statistical analysis. Of these, 19 in the initial cut and 30 patients in the subsequent cut were excluded for reasons related to inhibitor development/ascertainment, based on information provided in the patients’ disposition flow chart. In the third cut, two individuals had documented inhibitors, but were not included in the final statistics.

After that patients were screened for depression using the NICE clinical guideline initial depression screening tool. Data was analyzed in SPSS version 17 using descriptive statistics and Univariate analysis. Results: Out of 246 patients 56.9% were male and 43.1% were female. Mean age was 35.84 years while mean duration of disease was 2.33 years. Out of all patients 28.5% of the patients belong to postprandial distress syndrome, 28.9% belong to epigastric pain syndrome while 42.7% belong to both groups.

Frequency of depression was 75.6% among patients screened for depression Navitoclax purchase with 19% of the patients saying that they had thought of death in the last month. Female sex was significantly associated with depression in univariate analysis (OR 2.32, p value 0.01) while dyspepsia group or duration of the disease were not. Conclusion: Keeping in view the high prevalence of depression in functional dyspepsia all patients with functional dyspepsia must be screened for depression. Key Word(s): 1. GI Gastroenterology; 2. Rome III; Presenting Author: Selleckchem RG-7388 MARIE

ANTOINETTEDE CASTRO LONTOK Additional Authors: ROMMELPARULAN ROMANO, JOSEDECENA SOLLANO Corresponding Author: MARIE ANTOINETTEDE CASTRO LONTOK, ROMMELPARULAN ROMANO Affiliations: Asian Hospital and Medical Center; University of Santo Tomas Hospital Objective: The diagnosis of gastroesophageal reflux disease (GERD) in the community is largely based on the clinicians’ assessment of the symptom presentation by patients. The locally-validated

Filipino version of the Frequency Scale of Symptoms of GERD (FSSG) was used to investigate the most common symptoms associated with reflux in the primary care setting in the Philippines, as well as, determine response to PPI treatment. Methods: Patients presenting with MCE reflux symptoms seen by primary care physicians were recruited. The FIlipino version of the FSSG questionnaire were administered before and after completion of PPI treatment. Patients were given 4 weeks of Rabeprazole 20 mg once a day. Pre and post treatment F test scores were computed. Outcome measured was resolution or non-resolution of symptom/s after PPI treatment. Data were collated and statistical analysis done using SPSS v20. Results: A total of 1,578 subjects were enrolled and analyzed in this study. The most common symptom presented was a sensation of heartburn present in 1,359 (86.12%) of the subjects, followed by bloatedness (83.52%). Evaluating response to treatment, there was a statistically significant difference between the pre- and post-treatment F test scores (p < 0.001). The highest positive symptom response was seen pertaining to sour taste in the mouth (90.3%) and the symptom least responsive to PPI therapy is feeling ill after a binge meal (81.9%). Conclusion: Using the locally validated FSSG questionnaire, the most common clinical presentation of GERD patients include heartburn and bloatedness.

Conclusion: Our novel findings document the key immune regulatory function of Gsk3β signaling in the pathophysiology of liver IRI, and provide a rationale to target Gsk3β as a refined therapeutic strategy to ameliorate liver IRI. (HEPATOLOGY 2011;) Ischemia and reperfusion injury (IRI) is a common clinical problem associated with liver transplantation, partial hepatic resection, or trauma. Although IRI significantly impacts both acute liver failure/graft rejection, as well as chronic liver dysfunction,1-4 no effective therapy is available to prevent or treat the clinical syndrome. The pathogenesis

of IRI is a two-stage process consisting of the initial cellular damage due to ischemia, followed by reperfusion-initiated inflammation-induced hepatocellular damage. Recently, host innate Toll-like receptor 4 (TLR4) activation by endogenous ligands has been identified as the key trigger in the liver immune response against IR.5-9 As cell surface TLR4 ligation activates find more Napabucasin in vivo multiple intracellular signaling pathways10, 11 leading to the induction of pro- and anti-inflammatory gene programs, our better appreciation of their regulatory mechanisms should identify novel therapeutic targets to selectively alleviate pro- while sparing or promoting anti-inflammatory immune responses and ultimately ameliorate tissue damage. Recent studies have revealed that glycogen synthase kinase 3β (Gsk3β) may represent such

a target. Indeed, inhibition of Gsk3β in vitro significantly increased interleukin (IL)-10 production while suppressing release of pro-inflammatory cytokines in macrophages stimulated with TLR ligands. TLR activation leads to Gsk3β phosphorylation by the phosphoinositide 3 (PI3) kinase-Akt pathway. The resultant increase of 3′-5′-cyclic adenosine monophosphate

(cAMP) response element-binding (CREB) but decrease of nuclear factor kappa B (NF-κB) activity diminish the expression of pro-inflammatory medchemexpress genes, such as IL-12, tumor necrosis factor alpha (TNF-α), and IL-1β, while augmenting the expression of anti-inflammatory IL-10.12In vivo, Gsk3β inhibitors effectively protected mice from endotoxin shock.12 These data suggest the therapeutic potential of Gsk3β inhibition and warrant further confirmation in clinically relevant animal inflammatory disease models. Gsk3, a ubiquitously expressed serine/threonine kinase, was initially found to regulate glycogen synthesis.13, 14 There are two highly homologous Gsk3α and Gsk3β isoforms. Gsk3β, constitutively active (in dephosphorylated form) in resting cells, has a broad range of substrates regulating cell activation, differentiation, and survival. In heart IRI models, Gsk3β inactivation represents the convergence point for multiple cytoprotective signaling pathways.15 Gsk3β regulates the induction of the mitochondrial permeability transition pore (MPTP), a key step in triggering mitochondria-mediated cell death, which constitutes the critical IRI effector pathway.

Key Word(s): 1. sodium phosphate; 2. bisacodyl; 3. bowel preparation; 4. electrolytes; Presenting Author: AMRENDRAKUMAR MANDAL Corresponding Author: AMRENDRAKUMAR

MANDAL Affiliations: Dhulikhel Hospital, Kathmandu University Hospital Objective: Gastrointestinal endoscopy and more so gastroscopy has become one of the most commonly performed invasive procedures in the clinical practice. Silmitasertib research buy There is increasing evidence that this procedures can be safely and appropriately performed under general anesthesia with IV propofol where appropriate medical staffs are available and without anesthesia specialists in most circumstances. The use of propofol in endoscopy is now widely performed in most of the western countries. However, the data is lacking in the underdeveloped country. For the first time in Nepal, IV propofol is used at Dhulikhel hospital undergoing gastrointestinal procedure for more than a couple of CHIR-99021 years. Methods: Design: Prospective study of 500 consecutive patients who wished to undergo sedation with IV propofol

were studied during gastroscopy Methodology: All patients undergoing gastroscopy from January 2012 to January 2013 at Dhulikhel Hospital (Tertiary Hospital) in Nepal. Sedation with IV propofol was mostly provided by endoscopists and or trained nurses and in few cases by anaesthesia specialists. During the study the patients were observed for incidence of dose requirement, onset of sedation, loading dose requirement, hypotension, hypertension, bradycardia/tachycardia, arrhythmia, hypoxia, apnea, dyspnea, dizziness, headache, injection site pain, allergy, supplemental

oxygen administration, bag mask ventilation, intubation, recovery from sedation, patient satisfaction, hospital 上海皓元 admission after sedation, death were studied for during and after the procedure. Results: 500 procedures were performed during the period of 1 year. Onset of sedation was observed in 40 seconds to 2 minutes, total dose required was 90 mg to 220 mg, and time to full recovery was 12 to 20 minutes. Minor sedation-related adverse events occurred in most cases including 112 (22.4%) for dizziness, 25 (5%) for headache, 150 (30%) for injection site pain. Other major events occurred were 10 (2%) for hypotension, 50 (10%) for bradycardia, 29 (5.8%) for tachycardia, and 10 (2%) for arrhythmia. Respiratory-related adverse events including hypoxia occurred in 90 (18%) patients requiring oxygen supplementation and 3 (0.6%) required bag mask ventilation however no patients required intubation and hospital admission or death. Anesthesisia specialist was consulted in 15 (3%) cases requiring sedation for prolonged duration especially for intervention endoscopy and in patients with multiple co-morbid conditions in anticipation of major adverse events and its effective management. Conclusion: Propofol can be safely and effectively administered by trained endoscopists and nurses.

However, the expression of albumin, see more but not AFP, was found in the latter in 21 days, indicating that the human iPSCs could also differentiate to normal human hepatocyte-like cells through the expression of albumin in 21 days without knockdown of p21 (Fig. 1). Third, although aldo-keto reductase family 1 B10 (AKR1B10) is overexpressed in human hepatocellular carcinoma,4 a review suggests that AKR1B10 inhibits the cellular differentiation produced by retinoic acid.5 Therefore, we hypothesized that an AKR1B10 inhibitor could be used

to enhance the differentiation effects of retinoic acid. Based on our hypothesis, we tried to investigate the efficacies of acyclic retinoid (10 μM) plus tolestat as an AKR1B10 inhibitor (10 μM) therapy for the human hepatoma-like cells. As a result of this combination therapy, the expression of albumin but not AFP was found in 7 days. Furthermore, we tried to investigate the hepatotoxicities for the combination therapy by using the normal human hepatocyte-like cells. As selleck chemicals a result,

we found that the activities of glutamic oxaloacetic transaminase (GOT) and lactate dehydrogenase (LDH) in the culture medium of the normal human hepatocyte-like cells increased markedly in the case of acyclic retinoid (30 μM) plus tolestat (30 μM) compared with the case of acyclic retinoid (10 μM) plus tolestat (10 μM), although the efficacies for the combination therapy was not different. Therefore, acyclic retinoid (10 μM) plus tolestat (10 μM) would be appropriate regimens for human hepatoma-like cells. However, by using the patient-specific hepatocyte-like cells differentiated from human iPSCs of the patients with hepatocellular carcinoma, the efficacies and toxicities of the abovementioned combination therapy for the individual patients with hepatocellular carcinoma will 上海皓元 be evaluated more specifically in the near future. We are grateful to members of our laboratories for technical support. Furthermore, we are also grateful to Ms. Satoko Iioka for helpful discussions. Hisashi Moriguchi* † ‡, Raymond T. Chung†, Chifumi Sato‡, * Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan, † Gastrointestinal

Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, ‡ Department of Analytical Health Science, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan. “
“In clinical trials with telaprevir (TLV) and boceprevir (BOC) renal impairment was not reported as a relevant adverse event. The PAN study is a noninterventional study enrolling patients treated with peginterferon alfa-2a/ribavirin (PEG/RBV) with or without TVL or BOC. Here we restrict the analysis to hepatitis C virus genotype 1 patients having completed 12 (n = 895) or 24 weeks (n = 591) of treatment. For estimation of glomerular filtration rate (eGFR) the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was chosen.

Albumin levels rose from 2.8 g/dL to 3.2 g/dL, total bilirubin fell from 3.0 mg/dL to 1.9 mg/dL,

and the prothrombin time (PT) improved from 16.3 sec to 13.9 s. As a result, after treatment for 1 year in 49% of cases the Child-Turcotte-Pugh score improved by ≥2 points, declining from the pretreatment average 8.1 ± 1.7 to 6.6 ± 2.4, and 66% of cases improved to Child class A. Similarly, the MELD score decreased from 11.1 ± 3.8 to 8.8 ± 2.3.[255] In a trial where 191 cases of decompensated cirrhosis were allocated randomly to entecavir or adefovir for 96 weeks in a comparison of therapeutic efficacy, a higher rate of HBV DNA negative conversion was seen with entecavir (57% vs 20%),

and in both groups the Child-Turcotte-Pugh score improved or was maintained in 2/3 of patients.[256] Although entecavir improves Erlotinib order hepatic function in patients with decompensated cirrhosis in this way, in order to avoid relapse after cessation of treatment, Ceritinib lifelong continuation of treatment is recommended. On the other hand, the 1 year survival rate was 87% in the first study,[255] and the 6 month survival rate in the latter study was 88%,[256] indicating deaths from failure usually occur in the 3–6 months before the onset of therapeutic effect of NAs. We must recognize that a liver transplant is required to save such cases.[252] Also, for decompensated cirrhosis with a MELD score of ≥20, 5 cases were reported of entecavir therapy causing lactic acidosis, of whom one patient died.[257] Accordingly, careful monitoring is required during treatment of decompensated cirrhosis. Recommendations Entecavir is the treatment of first choice for decompensated cirrhosis. Although improvement of hepatic function can be expected, in order to avoid relapse after MCE公司 cessation of treatment, lifelong continuation of treatment is the norm. There is a report of lactic acidosis associated with entecavir therapy for decompensated cirrhosis, necessitating careful

monitoring. IFN is contraindicated for decompensated cirrhosis, because of the risk of liver failure and serious infection. Studies into the effects of IFN on carcinogenesis have all involved conventional IFN, and none Peg-IFN. Randomized controlled clinical trials evaluating the effects of IFN therapy on carcinogenesis comprise one study of 121 patients with HBeAg positive chronic hepatitis (liver cirrhosis; 10.3% of treated cases and 14.7% of controls),[258] and one small study evaluating 64 patients with HBeAg positive chronic hepatitis.[259] The results of the two trials differed; the former found a reduction in carcinogenesis (1.5% vs 11.8%, P = 0.043), whereas the latter trial found no carcinogenesis suppression effect (3.0% vs 6.4%).

Albumin levels rose from 2.8 g/dL to 3.2 g/dL, total bilirubin fell from 3.0 mg/dL to 1.9 mg/dL,

and the prothrombin time (PT) improved from 16.3 sec to 13.9 s. As a result, after treatment for 1 year in 49% of cases the Child-Turcotte-Pugh score improved by ≥2 points, declining from the pretreatment average 8.1 ± 1.7 to 6.6 ± 2.4, and 66% of cases improved to Child class A. Similarly, the MELD score decreased from 11.1 ± 3.8 to 8.8 ± 2.3.[255] In a trial where 191 cases of decompensated cirrhosis were allocated randomly to entecavir or adefovir for 96 weeks in a comparison of therapeutic efficacy, a higher rate of HBV DNA negative conversion was seen with entecavir (57% vs 20%),

and in both groups the Child-Turcotte-Pugh score improved or was maintained in 2/3 of patients.[256] Although entecavir improves BAY 80-6946 purchase hepatic function in patients with decompensated cirrhosis in this way, in order to avoid relapse after cessation of treatment, Protease Inhibitor Library concentration lifelong continuation of treatment is recommended. On the other hand, the 1 year survival rate was 87% in the first study,[255] and the 6 month survival rate in the latter study was 88%,[256] indicating deaths from failure usually occur in the 3–6 months before the onset of therapeutic effect of NAs. We must recognize that a liver transplant is required to save such cases.[252] Also, for decompensated cirrhosis with a MELD score of ≥20, 5 cases were reported of entecavir therapy causing lactic acidosis, of whom one patient died.[257] Accordingly, careful monitoring is required during treatment of decompensated cirrhosis. Recommendations Entecavir is the treatment of first choice for decompensated cirrhosis. Although improvement of hepatic function can be expected, in order to avoid relapse after medchemexpress cessation of treatment, lifelong continuation of treatment is the norm. There is a report of lactic acidosis associated with entecavir therapy for decompensated cirrhosis, necessitating careful

monitoring. IFN is contraindicated for decompensated cirrhosis, because of the risk of liver failure and serious infection. Studies into the effects of IFN on carcinogenesis have all involved conventional IFN, and none Peg-IFN. Randomized controlled clinical trials evaluating the effects of IFN therapy on carcinogenesis comprise one study of 121 patients with HBeAg positive chronic hepatitis (liver cirrhosis; 10.3% of treated cases and 14.7% of controls),[258] and one small study evaluating 64 patients with HBeAg positive chronic hepatitis.[259] The results of the two trials differed; the former found a reduction in carcinogenesis (1.5% vs 11.8%, P = 0.043), whereas the latter trial found no carcinogenesis suppression effect (3.0% vs 6.4%).