Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding

AIM To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.METHODS This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting(IPW) method. The primary outcome was the mortality of patients within 6 wk.RESULTS A total of 173 patients received urgent endoscopy(i.e., ≤ 12 h after admission), and 101 patients received nonurgent endoscopy(> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before(P = 0.266) and after IPW(P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group(P = 0.033); however, there was no significant difference in the inhospital mortality rate between the two groups(8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality(hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).CONCLUSION In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.

Analysis of apigenin in <i>Blumea balsamifera</i>Linn DC. and its inhibitory activity against aldose reductase in rat lens

To investigate the therapeutic potentials of na- tural sources, stepwise polarity fractions of Blumea balsamifera were tested for their ability to inhibit aldose reductase (AR) activity in rat lenses. Of these, the ethyl acetate (EtOAc) fraction exhibited a unique AR inhibitory activity (IC50 value, 0.11 μg/mL). Apigenin was identified from the active EtOAc fraction and exhibited high AR inhibitory activity (IC50 value, 4.03 μM). The content of apigenin was measured in B. balsamifera (0.47 mg/g) by HPLC/UV analysis. Our result suggests that B. balsamifera could be a useful natural source for the development of a novel AR inhibitory agent against diabetic complications.

Differential risk of 23 site-specific incident cancers and cancer-related mortality among patients withmetabolic dysfunction-associated fatty liver disease:a population-based cohort study with 9.7 million Korean subjects

Introduction:Although an association between metabolic dysfunctionassociated fatty liver disease(MAFLD)and cardiovascular disease or overall mortality has been reported,it is unclearwhether there is an association between MAFLD and cancer incidence or mortality.We aimed to investigate the differential risk of all-and site-specific cancer incidence and mortality according to MAFLD subgroups categorized by additional etiologies of liver disease.Methods:Using the Korean National Health Insurance Service database,we stratified the participants into three groups:(1)single-etiology MAFLD(SMAFLD)or MAFLD of pure metabolic origin;(2)mixed-etiology MAFLD(M-MAFLD)or MAFLD with additional etiological factor(s)(i.e.,concomitant liver diseases and/or heavy alcohol consumption);and(3)non-MAFLD.Hepatic steatosis and fibrosiswere defined using the fatty liver index and the BARDscore,respectively.Cox proportional hazards regression was performed to estimate the risk of cancer events.Results:Among the 9,718,182 participants,the prevalence of S-MAFLD and M-MAFLD was 29.2%and 6.7%,respectively.During the median 8.3 years of follow-up,510,330(5.3%)individuals were newly diagnosed with cancer,and 122,774(1.3%)cancer-related deaths occurred among the entire cohort.Compared with the non-MAFLD group,the risk of all-cancer incidence and mortality was slightly higher among patients in the S-MAFLD group(incidence,adjusted hazard ratio[aHR]=1.03;95%confidence interval[CI]:1.02−1.04;mortality,aHR=1.06;95%CI:1.04−1.08)and highest among patients with M-MAFLD group(incidence,aHR=1.31;95%CI:1.29−1.32;mortality,aHR=1.45;95%CI:1.42−1.48,respectively).The M-MAFLD with fibrosis group(BARD score≥2)showed the highest relative risk of all-cancer incidence(aHR=1.38,95%CI=1.36–1.39),followed by the M-MAFLD without fibrosis group(aHR=1.09,95%CI=1.06–1.11).Similar trends were observed for cancer-related mortality.Conclusions:MAFLD classification,by applying additional etiologies other than pure metabolic origin,can be used to identify a subgroup of patients with poor cancer-related outcomes.

Fucoidan protects hepatocytes from apoptosis and inhibits invasion of hepatocellular carcinoma by up-regulating p42/44 MAPK-dependent NDRG-1/CAP43

Fucoidan is a traditional Chinese medicine suggested to possess anti-tumor effects.In this study the anti-metastatic effects of fucoidan were investigated in vitro in human hepatocellular carcinoma(HCC) cells(Huh-7 and SNU-761) under normoxic and hypoxic conditions and in vivo using a distant liver metastasis model involving injection of MH134 cells into spleen via the portal vein.Its ability to protect hepatocytes against bile acid(BA)-induced apoptosis was investigated in primary hepatocytes.Fucoidan was found to suppress the invasion of HCC cells through up-regulation of p42/44 MAPKdependent NDRG-1/CAP43 and partly,under normoxic conditions,through up-regulation of p42/44MAPK-dependent VMP-1 expression.It also significantly decreased liver metastasis in vivo.As regards its hepatoprotective effect,fucoidan decreased BA-induced hepatocyte apoptosis as shown by the attenuation of caspase-8,and-7 cleavages and suppression of the mobilization of caspase-8 and Fas associated death domain(FADD) into the death-inducing signaling complex.In summary,fucoidandisplays inhibitory effects on proliferation of HCC cells and protective effects on hepatocytes.The results suggest fucoidan is a potent suppressor of tumor invasion with hepatoprotective effects.