bluuebunny/crossref_metadata_2025_split huggingface dataset:
972 Predicting Transplant Free Survival in Patients With Hepatocellular Carcinoma Undergoing Locoregional Therapy
Authors: Thandassery Ragesh , Lavender Charles A. , Rude Katie , Burdine Lyle , Beheshti Michael 
Published: October 2019

INTRODUCTION:
Recently a few scoring systems have been proposed to predict survival in patients with hepatocellular carcinoma (HCC) undergoing locoregional therapy (LRT). We aimed to compare the NIACE score (tumor Nodularity, Infiltrative tumor, serum Alpha-fetoprotein level, Child-Pugh stage, ECOG performance status), hepatoma arterial embolization prognostic score (HAP), and ABCR score (alpha-fetoprotein, BCLC, change in Child-Pugh stage and radiological response after LRT) with Barcelona Clinic Liver Cancer (BCLC) staging in predicting transplant free survival (TFS) in patients with HCC undergoing LRT.

METHODS:
In a multi-centric United States veteran cohort, we retrospectively analyzed 207 patients who had undergone LRT between January 2012 and March 2019. Pre LRT NIACE and HAP scores and post LRT ABCR scores were calculated for all subjects. Kaplan Meier plots were created to identify sub groups with different TFS within individual BCLC stages.

RESULTS:
The mean age was 65.6 ± 6.3 years (73.4% Caucasians and 26.6% African Americans). Mean MELD-Na score at the time of first LRT was 14.3 ± 7.2. Predominant etiology of liver disease was nonalcoholic fatty liver disease (52.6%) followed by combination of alcohol and hepatitis C virus (18.4%). 65 (31.4%), 42 (20.3%), 84 (40.6%) subjects had BCLC A, B and C disease stages respectively. 146 (70.5%) underwent transarterial chemoembolization (TACE), 12 (5.8%) underwent ablation, and 42 (20.3%) underwent trans arterial radioembolization as first LRT. After a median follow-up of 15.2 months, the overall TFS was 34.6%. BCLC stages A, B and C had 47.5%, 26.3% and 26.2% TFS respectively. In the BCLC B cohort (Figure 1) only NIACE score (at cut off > 1) identified subgroups with significant difference in TFS (52.9% vs. 5.3%, P < 0.001). In BCLC C cohort, HAP score (at cut off > 2; 37.2% vs. 13.9%, P = 0.002) and ABCR score (at cut off > 2, 83.3% vs. 40.5%, P = 0.03) identified subgroups with different TFS. In BCLC A cohort none of these scores identified sub groups with differential TFS. On separate analysis of subjects undergoing TACE, all three scores identified subgroups with differential TFS (Table 2).

CONCLUSION:
In patients with HCC undergoing LRT, the BCLC B and C stages encompass patients with variable TFS. NIACE score for BCLC B, and HAP and ABCR scores for BCLC C refine differential prognosis and identify subgroups with different TFS. These scores should possibly be incorporated into treatment allocation.
978 Prolonged Survival With Radioembolization Using Theraspheres in Unresectable HCC
Authors: Mantry Parvez , Thompson Mallory , Khanna Prachi , Acharya Priyanka , Shahin Islam 
Published: October 2019

INTRODUCTION:
Selective Internal Radiation Therapy (SIRT) with Yttrium 90 using glass beads (Theraspheres) is increasingly being used for the treatment of unresectable Hepatocellular carcinoma approved by the FDA as a Humanitarian Device (HUD exemption). We are presenting data on 70 patients at our center (out of 130) that have undergone this procedure successfully and reporting their outcomes/survival/tolerability and factors impacting survival.

METHODS:
We retrospectively analyzed the charts of 70 patients that underwent SIRT with Theraspheres at our institution from jan 1, 2014 to jan 1, 2019.We performed descriptive statistics on these patients using SAS.

RESULTS:
Demographically 46/70 patients were male. 50% were caucasian, 20% African american and 16% Hispanic. The median age was 64.5 years. In our cohort, Alcohol and HCV infection were responsible etiologies in 77% of all the cancers. 17% patients had NASH as the etiology. 43% of patients had a solitary tumor while 30% had 2 tumors and the remaining 3 or more treatable lesions. The median total tumor diameter was 5.2 cm. 37% of the tumors were bilobar. 39% patients had main or branched portal vein thrombosis (PVT). 65% of the patients had Child's Pugh A cirrhosis while 31% were CPB. Median MELD score was 8. BCLC subdivision was as follows - A (31%), B (41%), C 24%) and D(4%). 67% patients underwent single treatment while 28% patients had 2 treatments done.The dose ranged from 10–110 mci with 50 mci being the median dose. In terms of tumor response, 54% patients had complete response (CR) while 20% had partial response (PR) and 16% had progressive disease (PD) per modified RECIST criteria. Adverse events requiring an intervention were seen in 10% patients.Overall survival is shown in graph below. Mean survival was 14.6 months

CONCLUSION:
In our analysis, SIRT with theraspheres is a safe effective modality of treating patients with advanced HCC even in the setting of multifocal disease with 40% patients having portal vein thrombosis. The median survival was over 12 months with CR seen in 57% patients. Further analysis of our complete data will shed more light on these calculations.
979 MicroRNAs and Biomarkers Clinic as Survival Predictor in Hepatocellular Carcinoma
Authors: Ratnasari Neneng , Renovaldi Dede , Ningsih Juwita Raditya , Lestari Puji , Qoriansas Nanda , Heriyanto Didik Setyo , Indrarti Fahmi , Triwikatmani Chatarina , Bayupurnama Putut , Haryana Sofia Mubarika 
Published: October 2019

INTRODUCTION:
Clinical biomarkers can predict disease progression and clinical outcomes due to inflammation process. Circulating miRs can predict disease progression, therapeutic response and patient survival. Aims of study: to evaluate 1 year survival rate based on regulation miRs (miR29c, miR21, and miR155) plasma and clinical biomarkers [neutrophil to lymphocyte ratio/NLR, platelet to lymphocyte ratio/PLR, α-fetoprotein/AFP] in Hepatocellular Carcinoma (HCC) patients.

METHODS:
The longitudinal cohort design was conducted in 29 HCC patients. Subjects were recruited from Dr.Sardjito General Hospital, Yogyakarta, Indonesia during the year of 2012 until 2018. Outcome of the study was survival rate after enrolled the study until 12 months observation. All subjects were enrolled using criteria: MSCT 4 phases and histology examination. Exclusion criteria: co-morbidity with other malignancy. Blood sample collection was treated as follows: (1)plasma isolation, RNA isolation, cDNA synthesis, and quantification by qRT-PCR; (2)blood examination to determine NLR, PLR, and AFP. The miR's plasma level was analyzed by BioradCFX Manager96 software to determine Cq, the calculation of expression levels using Livak's methods. Hazard Ratio and Kaplan Meyer curve were analyzed using STATA 11.0.

RESULTS:
Baseline data: median of age 53 year old (min29; max74), 62.07% male, etiology [58.62% HBV, 6.90% HCV] and BCLC criteria [31% B, 59% C, 10% D], and 48% treated by TACE/TAE respectively. miR29c might be act as tumor suppressor, and the opposite, miR21 and miR155 as oncogene. The HRs were calculated using cutoff for each variable (miR regulations, NLR ≥ 4, PLR ≥ 165.83, PLR-tertile ≥ 292.40, and AFP ≥ 200). Down-regulation miR29c was the most dominant predictor for survival rate (HR = 4.88), while up-regulation miR155 was the second predictor (HR = 1.31). Most of clinical biomarkers showed HR < 1. The Kaplan Meier curve can be seen at Figures 1 and 2

CONCLUSION:
Plasma miR was detected easily and stable. miRs regulation were played a role in tumor tissues dysregulation, tumor suppressors, or oncogenes. Thus, miRs can be used as diagnostic, targeting therapy and prognostic markers in HCC patients. Down-regulation miR29c as a tumor suppressor and up-regulation miR155 as an oncogene might be potential variable predictor for survival rate in HCC patient compared with miR21 and clinical biomarkers.
980 Renal Resistive Index at the Level of Renal Arcuate Artery as a Predictor of Natriuresis in Cirrhotic Patients
Authors: Ul Haque Muhammad Manzoor , Mehmood Nasir , Ahsam Salman , Farid Muhammad , Yaseen Raja Taha , Luck Nasir Hassan , Tulsi Rani , Khan Shoaib Ahmed , Majid Zain 
Published: October 2019

INTRODUCTION:
It has been postulated that the vasoconstriction at the level of renal arcuate artery plays a key role in the development of Hepatorenal syndrome(HRS). However, the measure of renal resistive index at the level of renal arcuate artery can provide a direct measure of renal hemodynamics among cirrhotics. The aim of this study is to determine the difference in the renal resistive index amongst both compensated as well as decompensated cirrhotics and to evaluate its association with natriuresis.

METHODS:
This prospective study included all consecutive cirrhotic patients visited gastroenterology clinic of our hospital from May 2018 to May 2019. After obtaining informed consent, the demographic parameters were noted along with a detailed drug history (Dose and duration of diuretics and beta blocker). Later on an ultrasound abdomen was also performed for documenting the features of chronic liver disease and the renal resistive index was noted. These patients were then stratified into two groups i.e. compensated cirrhosis and decompensated cirrhosis. Chi square test was applied and P value was calculated.

RESULTS:
A total of 60 patients were included in the study. The mean age of the patients was 40.3 ± 18.1, and were predominantly males 31(51.7%). Hepatitis C was the most common etiology for liver disease seen in 22 patients (36.7%).The mean CTP score, MELD and MELD sodium score were as follows: 7.9 ± 1.93, 15.2 ± 6.6 and 13.3 ± 4.2 respectively. Compensated liver disease was present in 16(26.7%) patients, while decompensated liver disease was present in 44(73.3%) patients. Mean renal resistive index of patient with compensated cirrhosis was 0.59 ± 0.04, while with decompensated cirrhosis was 0.62 ± 0.04. Patients with a higher RI had poor natriuresis as manifested by low urinary sodium potassium ratio < 1.0 and AROC is 0.775. At the cut off value of RI = 0.615 sensitivity, specificity, positive predictive value and negative predictive value for nartriuresis was 65.0%, 70.0%, 73.3% and 60.1% respectively. Patient with higher RI value were having decompensated cirrhosis (P = 0.06, 0.62 vs 0.59)

CONCLUSION:
The renal resistive index at the level of arcuate artery were found to be higher among patients with decompensated cirrhosis. At a higher RI value ( >0.615) patients had poor natriuresis. Therefore, RI can be used to predictor of natriuresis among cirrhotic patients. Key words:
983 A Three-Decade Analysis of Oral and Oropharyngeal Malignancy Following Liver Transplantation
Authors: Al Nimri Sarah M. , Corral Juan E. , Al Nimri Lana , Wijarnpreecha Karn , Patel Arpan , Mousa Omar Y. 
Published: October 2019

INTRODUCTION:
Immunocompromised liver transplant (LT) recipients are at increased risk of de novo malignancy. Data regarding oral and oropharyngeal malignancy following liver transplantation is limited, and recommendations for oral cancer screening are lacking. The impact of these malignancies on patient survival in the United Network for Organ Sharing (UNOS) database has not been assessed. We aim to evaluate the rates of oral and oropharyngeal malignancy among LT recipients in the US and estimate patient survival.

METHODS:
We examined the UNOS database and identified patients with oral and oropharyngeal malignancy who underwent LT between 1988 and 2016. Patients greater than 18 years of age were included. Kaplan-Meier survival analysis and log-rank tests were performed.

RESULTS:
In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 LT recipients.83 patients had oral and oropharyngeal malignancy. 23 patients had cancer of the tongue and floor of the mouth. Mean age 55 years (SD ± 8), mean BMI 26 (SD ± 4), males were 74%, white 83%. 49 patients had tonsillar and oropharyngeal cancer. Mean age 54 years (SD ± 7), mean BMI 25 (SD ± 4), males were 86%, white 80%. 11 patients had oral and palate cancer. Mean age 56 years (SD ± 6), mean BMI 26 (SD ± 5), males were 55%, white 100%. Compared to all LT indications, those who developed oral and oropharyngeal malignancy were more likely to have alcoholic liver disease (P < 0.001). The mean patient survival time in the study population ranged between 5 and 7.5 years. However, patient survival was significantly lower among patients who developed oral and oropharyngeal malignancy compared to other LT recipients (Log-rank test, P < 0.001) (Figure 1).

CONCLUSION:
Analysis of the UNOS database showed that oral and oropharyngeal malignancy is more common among male recipients with a history of alcoholic liver disease. Better outcomes should be expected if such patients were diagnosed earlier, prolonging their life expectancy. Having a history of heavy alcohol use should raise awareness among dentists, gastroenterologists and transplant physicians regarding the increased risk of oral cancers after LT.
985 Racial Difference in the Clinical Features of Non-Alcoholic Fatty Liver Disease
Authors: Qiu He , Shi Michelle , Kyaw May , Sultan Gwyneth , Lee Tai-Ping 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis in the absence of significant alcohol consumption. It is the most common liver disease in Western industrialized countries, characterized by excessive accumulation of triglycerides in hepatocytes. The spectrum of conditions ranges from benign hepatic steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and increased risk of hepatocellular carcinoma (HCC). There has been limited study of Asian Americans with NAFLD comparing to the other races. Our study aims to assess the racial difference in clinical features of NAFLD patients.

METHODS:
We conducted a retrospective chart review of patients age ≥ 18 years and < 90 years with NAFLD followed at Sandra Atlas Bass Center for Liver Disease from 2013 to 2018. Patients with co-existing chronic liver disease or significant alcohol consumption (men > 21 drinks/week, women > 14 drinks/week) were excluded. Clinical data including demographics, anthropometrics, comorbidities, laboratory results, Fibrosis-4 (FIB-4) index, and FibroScan were collected and analyzed. Analysis of variance and Pearson’s chi-squared test were used to analyze continuous variables and categorical variables, respectively.

RESULTS:
We identified 342 patients with NAFLD. We analyzed 289 patients including 209 Caucasians (72.3%), followed by 38 Hispanics (13.2%), 26 Asian Americans (9%), and 16 African Americans (5.5%). There is no difference in age, gender, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, blood pressure, steatosis score, FIB-4 index, and fibrosis stage among these four groups. However, Asians are less likely to be obese (26% BMI ≥ 30, vs. 66.5%, 62.5% and 60.5% for Caucasians, Africans, and Hispanics, respectively; P = 0.001); yet, they are more likely to have elevated hemoglobin A1c (HA1c) (100% with HA1c >5.6% vs. 63.3%, 62.5% and 84% for Caucasians, Africans, and Hispanics, respectively; P = 0.0002).

CONCLUSION:
Our study suggests that Asian Americans with the diagnosis of NAFLD are less likely to be obese but are more likely to have elevated hemoglobin A1c compared to the other racial groups. The difference observed in this study raises the possibility that the Asian Americans may be different from that among the other racial/ethnic groups in the pathogenesis of NAFLD. Further research is warranted to assess the detailed relationship and possible mechanisms between HA1c and NAFLD.
988 Severe Thrombocytopenia Predicts Lower Survival Rate and Higher Transplant Rate in Patients With Liver Cirrhosis
Authors: Moore Andrew , Jensen Donald , Reau Nancy , Wu Andy 
Published: October 2019

INTRODUCTION:
Thrombocytopenia (TMP) is one of the most common hematologic abnormalities seen in patients with chronic liver disease and cirrhosis. TMP is largely due to two factors: decreased thrombopoietin production and splenic sequestration due to portal hypertension. We hypothesized that the most severe TMP would have a significant impact upon survival. Since the current MELD-Na score does not factor these components, we sought to compare ‘marked’ (25K-50K) and ‘severe’ (<25 K) TMP with MELD-Na score and 90 day survival.

METHODS:
A retrospective study was conducted and identified 131 patients at a tertiary academic institution between 7/12016 and 7/1/2018 who had a diagnosis of cirrhosis (any-cause) and a platelet count < 50 K. Patients were then divided as ‘marked’ TMP or ‘severe’ TMP based on the lowest platelet count. Age, BMI, sodium, creatinine, total bilirubin, INR, hemoglobin, and white blood cell count at the time of the lowest platelet value were also recorded and compared. Mortality between the two groups was compared using Kaplan-Meier curves, and survival models were created using multivariate proportional hazard models with an endpoint of death/transplant at 90 days.

RESULTS:
Of the 131 patients identified with a platelet count of <50 K, 107 were included in the study (24 were excluded; 6 received transplant prior to lowest platelet count and 18 were lost to follow-up at 90 days). 74 were identified as ‘marked’ TMP and 33 were identified as ‘severe’ TMP. In the ‘marked’ TMP group, there were 22 deaths (29.7%) at 90 days, while in the ‘severe’ group there were 23 deaths (69.7%) at 90 days (HR 2.56, 95% CI 1.87-3.24, P = 0.0078). In the <25 K group, 3 patients (9.1%) had a transplant prior to 90 days. In the 25–50 K group, one patient (1.4%) underwent transplant prior to 90 days. The survival rate between the two groups at 90 days was statistically significant (P < 0.0001). MELD-Na score was not significantly different between the two groups (21.84 vs 23.61, P = 0.12).

CONCLUSION:
Despite similar MELD scores, patients with severe TMP had a significantly decreased survival probability and higher rate of transplant at 90 days. Platelet count was a better predictor of mortality than MELD score among this subgroup of patients. Patients with severe thrombocytopenia had a mortality rate more than triple that predicted by MELD-Na score. Confirmation of this important finding in a larger patient population and delineation of the role of TMP in outcomes require additional investigation.
990 The Association of Obstructive Sleep Apnea and Nonalcoholic Steatohepatitis: A Nationwide Inpatient Sample Analysis
Authors: Renno Anas , Abdel-Aziz Yousef , Alastal Yaseen , Khuder Sadik , Hasan Syed , Assaly Ragheb , Nawras Ali 
Published: October 2019

INTRODUCTION:
Obstructive sleep apnea (OSA) has been suggested to be a potential contributing factor for nonalcoholic steatohepatitis (NASH). The oxidative stress caused by chronic intermittent hypoxia is known to play a vital role in the pathogenesis of NASH. There is conflicting data in the literature regarding the association of OSA and NASH. The primary purpose of this study was to determine the association of OSA and NASH from a large national inpatient sample database.

METHODS:
We conducted a retrospective analysis using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). NASH patients were identified by ICD-10-CM code K75.81. Non-NASH patients (control) were randomly selected and matched to each NASH patient 4:1 by age and gender. Weighted logistic regression models were used to calculate the association between OSA and NASH for different comorbidities.

RESULTS:
A total of 54,169 patients were included in our analysis, 10,740 cases of NASH were matched to 43,429 controls (non-NASH). NASH was significantly higher in the white population (82.12% vs. 76.64%, P < 0.001). The prevalence of NASH among OSA patients was significantly higher compared to the non-OSA group (15.8% vs. 8.9%; adjusted OR: 1.34, 95% CI: 1.14–1.56, P = 0.0003). Celiac disease and Crohn’s disease were significantly higher in patients with NASH (0.7% vs. 0.2%, P < 0.0002 and 1.28% vs. 0.76%, P < 0.0001). Multiple comorbidities were significantly elevated in the NASH group compared to the non-NASH group including diabetes mellitus (36.0% vs. 17.6%, P < 0.0001), obesity (36.4% vs. 18.2%, P < 0.0001) and metabolic syndrome (0.86% vs. 0.06%, P < 0.0001). Mortality rate was significantly higher in the NASH group (3.8% vs. 2.0%, P < 0.0001).

CONCLUSION:
This is the first study using ICD-10-CM code with a specific search code for NASH. Our large population database results emphasize that there is a significant association between OSA and NASH. This important association should prompt physicians to evaluate for the presence of NASH in OSA patients. Additional studies are needed to evaluate this association and the effect of OSA treatment on NASH.
998 Can You Treat Me Now? An Evaluation of Patient-Centered Resources Discussing Fatty Liver Treatment Options
Authors: Dawit Lillian , Tabbara Nadeem , Clarke Lindsay , Szvarca Daniel , Baumgartner Scott , Basso Jessica , Dave Jenny , Borum Marie 
Published: October 2019

INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent liver disorder estimated to occur in up to 46 percent of the U.S. adult population. Management includes optimization of weight, diabetes, dyslipidemia, and vitamin E in selected patients. However, patients may opt to self-treat NAFLD based on internet available information, including therapies such as vitamin E which may be potentially harmful if taken in excess. This study evaluated internet accessible information addressing the treatment choices and management of NAFLD.

METHODS:
The search terms “fatty liver” identified the first 100 websites in the Google search engine. Exclusion criteria for this study included non-accessible websites, video postings without transcripts, or articles discussing veterinary topics. The remaining websites were classified by target audience: patient or professional. Statistical analysis using a two-tailed Fisher’s Exact Test was performed with a P-value set at <0.05.

RESULTS:
88 websites met inclusion criteria with 52 (59.1%) targeting patients and 36 (40.9%) for medical professionals. 71 (80.7%) provided management recommendations, with significantly more patient websites discussing treatment (P = 0.02) compared to professional sites. Patient sites more often discussed lifestyle modifications (P = 0.02) as therapy. There was no significant difference in the discussion of diabetic agents, vitamin E, statins, or bariatric surgery between patient and professional websites. Patient websites preferentially discussed treatment benefits compared to possible side effects (P < 0.0001). Patient-clinician shared decision-making was emphasized on patient websites (57.7%; P < 0.01) and websites focused on management strategies (50.7%; P = 0.01).

CONCLUSION:
Individuals are increasingly using online resources to obtain information about NAFLD management. While patient websites were more likely to discuss lifestyle modification, patient and professional websites did not specifically focus on other potential intervention. Only half the websites recommended shared decision-making, more often occurring in patient websites and in sites addressing management. Across all sites, the benefits rather than potential risks of NAFLD treatment were more frequently discussed. It is important that online websites addressing NAFLD offer treatment options that are evidence-based, promote safe interventions, and encourage discussion with a provider.