Anders, MD, PhD Hepatology Associates Course Hepatology Associates Course Sunday, November 3 8:00 AM -1:30 PM Room 147 COURSE DIRECTORS: Linda M. Stadheim, RN Mary Panther, RN 5.5 CME Credits / 5 Contact Hours This one day course aims to provide basic and advanced up-to-date knowledge

for the management of patients with liver disease. Learning Objectives: Explain the current nonalcoholic steatohepatitis (NASH) practice guidelines and appropriate, patient specific strategies to treat NASH & nonalcoholic fatty liver disease (NAFLD) www.selleckchem.com/B-Raf.html Identify patient selection indication for liver biopsy or a non-invasive alternative to stage fibrosis Describe controversial decisions with transplant patient selections and orgean allocations including split vs full liver transplant Discuss benefits and risks of Coffee, CAM and Cannabis in the liver patient Examine complex Hepatitis C (HCV) treatment populations and identify appropriate strategies to Depsipeptide mw manage difficult HCV treatment side effects 8:00 – 8:05 AM Opening Remarks

Session I MODERATORS: Donald Gardenier, DNP Linda M. Stadheim, RN 8:05 – 8:45 AM NASH & NAFLD: Cutting Through the Fat Andrea A. Gossard, NP 8:45 – 8:55 AM Awarded Poster Presentation Geri Hirsch, MSN, RN-NP and Gail Butt, MD 8:55 – 9:30 AM Biopsy versus Non-invasive Approaches to Assessing Fibrosis R. Todd Stravitz, MD 9:30 – 9:40 AM Awarded Poster Presentation Amy Nelson, BSN, RN, ACRN 9:40 – 10:20 medchemexpress AM Liver Transplantation Controversies Jacqueline Laurin, MD 10:20 – 10:30 AM Discussion 10:30 – 11:00 AM Break and Brunch Session II MODERATORS: Mary Panther, RN Dustin C. Latimer, PA-C 11:00 – 11:45 AM HCV Triple Therapy Lessons Learned Antonio J. Sanchez, MD 11:45 AM – 12:30 PM Point-Counterpoint: Hepatitis C Treatment Douglas R. LaBrecque, MD and Paul Y. Kwo, MD 12:30 – 1:00 PM Coffee, CAM and Cannabis: Stirring the Pot Kiran Bambha, MD 1:00 – 1:30 PM Discussion and Closing Thomas E. Starzl Transplant Surgery State-of-the-Art Lecture Sunday, November 3 9:30 – 10:00 AM Hall

E/General Session Regenerative Medicine: New Approaches to Healthcare SPEAKER: Anthony Atala, MD MODERATOR: Kenneth D. Chavin, MD, PhD Patients with diseased or injured organs may be treated with transplanted organs. There is a severe shortage of donor organs which is worsening yearly due to the aging population. Regenerative medicine and tissue engineering apply the principles of cell transplantation, material sciences, and bioengineering to construct biological substitutes that may restore and maintain normal function in diseased and injured tissues. Stem cells may offer a potentially limitless source of cells for tissue engineering applications and are opening new options for therapy. Recent advances that have occurred in regenerative medicine will be reviewed and applications of these new technologies that may offer novel therapies for patients with end-stage tissue and organ failure will be described.

The duration of each step was determined experimentally using specific controls (Supporting Fig. 2). The results clearly show that a decrease in HCVcc infection was only observed when EGCG was present during virus infection (Fig. 3A, second, third, fourth, and sixth bars in the bar-graph), and that there was no effect of EGCG if added as a pretreatment of the cells (Fig. 3A, first bar) or postinfection (Fig. 3A, fifth bar). These results suggest that EGCG inhibits an early step of the HCV life cycle, most likely the entry step. To confirm the effect of EGCG on HCV entry, HCVpp harboring E1 and E2 of different genotypes were produced. HCVpp

infectivity was reduced by approximately 10-fold with a concentration of 50 μM, confirming the effect of EGCG on HCV entry, whatever the genotype used (Fig. selleckchem 3B). However, MG-132 clinical trial some differences between genotypes could be observed at a lower EGCG concentration (5 μM). In contrast, vesicular stomatitis virus (VSV)pp entry was much less inhibited. These results suggest that the antiviral activity of EGCG is directed against HCV envelope glycoproteins and is genotype independent. Together, these data indicate that

EGCG inhibits HCV entry in a genotype-independent manner. Although the above data indicate that EGCG has a strong effect on HCV entry, we cannot exclude additional effects on other steps of the HCV life cycle. To analyze the effect of EGCG on HCV genome replication, Huh-7 cells were electroporated with in vitro transcribed assembly-defective JFH1-ΔE1/E2-Luc RNA, to bypass the entry step, and avoid any interference with late steps of the HCV life cycle. EGCG had no major effect on HCV replication, even after a longer period of treatment (96 hours postelectroporation) (Fig. 4A). In contrast, IFN-α, at 2 IU/mL, approximately twice the IC50 calculated for HCVcc in Huh-7 cells (1.15 IU/ml), 28 induced 1 log10 decrease of luciferase activity. To determine whether EGCG could have any effect on HCV assembly or secretion, intra- and extracellular core protein was quantified in infected

cells treated postinfection with 50 μM of EGCG for 70 hours. The amount medchemexpress of core in the culture supernatant reflects the quantity of secreted viral particles. A slight, but not significant (P = 0.10), decrease in intracellular core was observed in the presence of EGCG (Fig. 4B). This cannot be explained by a decrease in RNA replication, because it has been shown above that EGCG has no effect on HCV replication (Fig. 4A). However, the quantification of extracellular core showed a small, but not significant (P = 0.10), increase of secreted core in the presence of EGCG, as compared to the nontreated control (Fig. 4B), showing that EGCG does not impair viral secretion. Similar experiments were performed with JFH1-ΔE1/E2 to avoid reinfection of the cells and to quantify the levels of extracellular core resulting from cell lysis.

Use of these agents has been studied across a variety of indications and populations, and at different stages in the disease course. Failure to respond or loss of response can result from different causes, and can be medically managed in many cases. More research on the pleiotropic

Fer-1 research buy effects, safety of biological agents and biomarkers in the prediction of response will provide a sounder basis for individually directing therapy. Adverse events such as opportunistic infection and malignancy can occur, and screening prior to therapy and discussion on risk-benefit of the various management options are important. Cost of these medications especially with maintenance therapy remains an important issue in many Asia-Pacific countries. New and more specific agents will better target therapy and minimize adverse events. Biological agents” describe a class of substances manufactured from a living organism

or by recombinant technology that includes peptides, monoclonal antibodies, fusion proteins and antisense oligonucleotides that bind to nucleic acids.1 In inflammatory bowel diseases (IBD), this group of drugs manipulates key molecules that are involved in the induction and maintenance of intestinal inflammation. They are expensive and risk adverse effects, but this is counterpoised by their superiority to conventional immunosuppressive agents in their efficacy to decrease refractory inflammation, induce mucosal healing, and reduce rates of surgical intervention and long-term complications. Romidepsin concentration Molecules MCE and targets.  An evolving understanding of the pathogenesis of IBD has identified several immunomodulatory therapeutic targets. In Crohn’s disease (CD), T helper 1 (Th1) and the distinctively different T helper 17 (Th17) cells mediate proinflammatory cytokines.2 Both Th1 and Th17 pathways lead to increases in circulatory and tissue

tumor necrosis factor (TNF)-α, the target of anti-TNF-α therapy in both CD and ulcerative colitis (UC).1 Three anti-TNF agents are used in the treatment of IBD. Infliximab is a murine-human chimeric monoclonal antibody, adalimumab is a humanized monoclonal antibody, and certolizumab pegol is a pegylated monoclonal antigen binding fragment (Fab’) to TNF-α. Other anti-TNF-α biological agents currently in clinical trial include golimumab, and this may offer an additional therapeutic option. The alternative Th17 pathway involves interleukin (IL)-23, liberating IL-17A, IL-17F, IL-22 and TNF-α. IL-23 receptor polymorphism is known to protect against the development of CD, and other polymorphisms of the pathway are linked to the development of inflammatory diseases such as ankylosing spondylitis and Grave’s ophthalmopathy.3 Therapeutic neutralization of human IL-12/23 using ustekinumab and briakinumab, approved or are under trial for psoriasis, are currently under evaluation for IBD.

[109] They are also low in abundance and difficult to detect.[109] The pure arithmetic and subtlety of protein transformations and interactions has led to many semiofficial subcategories of proteomics that constrict their profiling domains to specific molecule classes, cellular functions, or PTMs, etc.[110-112] Simply put, the scale of the proteome is staggering. The constitution SCH727965 mw of the metabolome meanwhile continues to be deliberated. From an original study of glucose processing in

E. coli under specific growth rates, the “metabolome” could be defined as “total complement of metabolites in a cell,” with an emphasis on representing the global metabolic processes of a cell by low-molecular weight compounds.[113] This definition was further expounded by successive metabolome studies, perpetuating a correlation between small molecule size (a metabolite weighs less than 15 kilodaltons[114]), with biochemical finality (“metabolites serve as direct signatures of biochemical activity”[21])

because a small molecule must be the result of many enzymatic processes from a gene-transcribed protein origin. While this may be true, it is inadequate in describing the important functional roles of metabolites in biology. The specific physiological functions of metabolites are appreciated and scrutinized in detail in metabolomic studies,[21, 115] but the widely accepted GPCR Compound Library definition of the metabolome, “the comprehensive study of naturally occurring small molecules,”[116] or some variation thereof,[21] does not generally take this into account. Metabolites may be end points of metabolism but they are not end points of physiological process, acting as catalysts, signaling molecules, and nutrients, among other

roles.[115, 117] The metabolome can perhaps be more comprehensively described as the study of the complete expression and biological function of molecules less than 25 kilodaltons within a given cell. This higher molecular mass inclusion takes MCE into account the capability of NMR spectroscopy and MS in reliably resolving higher mass molecules in metabolomic studies than what some would consider a metabolite.[118] Molecule size runs along a continuum, and those not chemically or proportionally considered a metabolite or a protein may be important. This aspect is further discussed in this review. Fundamentally, reevaluations of what constitutes the proteome and metabolome illustrate the immense complexity of human biology and how “omics” have allowed us to understand this in a more complete way. The next challenge is in maneuvering this new expanse of information to unravel the mechanisms behind complex diseases such as the IBDs and build functional tools for their treatment and management. Some of the principles behind the novel ways in which the proteomic and metabolomic toolboxes are being used to these effects are discussed.

ostenfeldii and A. peruvianum. Phylogenetic analysis of rDNA sequences from the A. ostenfeldii XL184 cell line or A. peruvianum cultures examined in this study revealed a complex genetic structure, consisting of six distinct, but closely related groups. A detailed qualitative and quantitative analyses of isolates belonging to four of these groups showed that the diagnostic morphological characters (shape differences in the 1′,

s.a. and 6″ plates) used to define the original species were more variable than previously assumed, exhibiting extensive intra- and inter-strain variability. Instead of the morphological features being consistently associated with a given group, as would be expected if A. ostenfeldii and A. peruvianum were distinct species, each group examined contained strains morphologically click here identified as either A. ostenfeldii or

A. peruvianum. In group 1, for instance, Baltic A. ostenfeldii and North American A. peruvianum strains (as identified by Kremp et al. 2009, Borkman et al. 2012, Tomas et al. 2012) form a monophyletic subgroup in the phylogenetic tree (Fig. 1). Two nearly identical sequences were obtained from A. ostenfeldii (AOKAL0909) and A. peruvianum (e.g., AP0905). Also, strains from the type localities of A. ostenfeldii and A. peruvianum were closely nested in the same phylogenetic group, group 6. Strain IMPLBA033, which represents the type location of the species in Callao, Peru (Balech and de Mendiola 1977) and which is morphologically in accordance with the A. peruvianum description, appears as the immediate neighbor of AONOR4, an A. ostenfeldii strain isolated from the location of the A. ostenfeldii redescription in Norway (Balech and Tangen 1985). The strain AOIS4 from the Iceland where Paulsen first found the species, was nested in group 5. AONOR4 in contrast, more closely resembles the description of A. peruvianum than the type described from the same location. Thus, though MCE the A. ostenfeldii and A. peruvianum

morphotypes as originally described appear distinct, their often nearly identical rDNA sequences indicate they represent the extreme ends in a continuum of A. ostenfeldii morphotypes. Consistent with this conclusion, the isolates examined in this study often showed a combination of the type A. ostenfeldii and A. peruvianum morphologies. Morphological characters were generally not consistently distributed. AONOR4 has some features that are typical for A. peruvianum such as small cell size and a predominantly A-shaped s.a. plate, which is not in accordance with what Balech and Tangen (1985) observed in field samples, collected from the same location. Cells of the Peruvian strain, on the other hand, were not particularly small as originally reported in the species description. The most inconsistent character, considered diagnostic in the original description, is the curved right anterior margin of the 1′ plate of A. peruvianum.

ostenfeldii and A. peruvianum. Phylogenetic analysis of rDNA sequences from the A. ostenfeldii selleck kinase inhibitor or A. peruvianum cultures examined in this study revealed a complex genetic structure, consisting of six distinct, but closely related groups. A detailed qualitative and quantitative analyses of isolates belonging to four of these groups showed that the diagnostic morphological characters (shape differences in the 1′,

s.a. and 6″ plates) used to define the original species were more variable than previously assumed, exhibiting extensive intra- and inter-strain variability. Instead of the morphological features being consistently associated with a given group, as would be expected if A. ostenfeldii and A. peruvianum were distinct species, each group examined contained strains morphologically MI-503 identified as either A. ostenfeldii or

A. peruvianum. In group 1, for instance, Baltic A. ostenfeldii and North American A. peruvianum strains (as identified by Kremp et al. 2009, Borkman et al. 2012, Tomas et al. 2012) form a monophyletic subgroup in the phylogenetic tree (Fig. 1). Two nearly identical sequences were obtained from A. ostenfeldii (AOKAL0909) and A. peruvianum (e.g., AP0905). Also, strains from the type localities of A. ostenfeldii and A. peruvianum were closely nested in the same phylogenetic group, group 6. Strain IMPLBA033, which represents the type location of the species in Callao, Peru (Balech and de Mendiola 1977) and which is morphologically in accordance with the A. peruvianum description, appears as the immediate neighbor of AONOR4, an A. ostenfeldii strain isolated from the location of the A. ostenfeldii redescription in Norway (Balech and Tangen 1985). The strain AOIS4 from the Iceland where Paulsen first found the species, was nested in group 5. AONOR4 in contrast, more closely resembles the description of A. peruvianum than the type described from the same location. Thus, though 上海皓元 the A. ostenfeldii and A. peruvianum

morphotypes as originally described appear distinct, their often nearly identical rDNA sequences indicate they represent the extreme ends in a continuum of A. ostenfeldii morphotypes. Consistent with this conclusion, the isolates examined in this study often showed a combination of the type A. ostenfeldii and A. peruvianum morphologies. Morphological characters were generally not consistently distributed. AONOR4 has some features that are typical for A. peruvianum such as small cell size and a predominantly A-shaped s.a. plate, which is not in accordance with what Balech and Tangen (1985) observed in field samples, collected from the same location. Cells of the Peruvian strain, on the other hand, were not particularly small as originally reported in the species description. The most inconsistent character, considered diagnostic in the original description, is the curved right anterior margin of the 1′ plate of A. peruvianum.

001. In subjects with Occult Hep B infection and chronic Hepatitis C there was more severe necro inflamation and fibrosis as compared to without occult Hep B

infection (p = 0005). Efficacy of antivral treatment 70% in occult Hep B positive Hep C patients Vs 85% in Occult B negativeHep C patients (p = 0.001). Conclusion: Conclusions: Occult Hep B infection is more common in Chronic Hep C patients than healthy subjects. Occult Hep B in chronic Hep C patients is assoiated with more advaced disease and less efficacy of antiviral treatment. It is a single center study, more studies are needed to confirm/refute our observation. Key Word(s): 1. occult hepatitis B; 2. chronic hepatitis C; Presenting Author: JING LAI Additional Authors: HAI-XIA SUN, KA ZHANG, WEI-QIANG Selleckchem MAPK inhibitor GAN, YU-SHENG JIE Corresponding Author: JING LAI Objective: HBV related acute-on-chronic liver failure (ACLF)

is a clinical syndrome where acute hepatic insult manifesting as jaundice (serum total bilirubin (TBil) ≥ 5 mg/dL and coagulopathy (international normalized ratio (INR) ≥1.5), complicated within 4 weeks by ascites and/or encephalopathy in a patient with chronic HBV infection. But the correlation of hepatitis B surface antigen (HBsAg) level with INR in hepatitis B e antigen (HBeAg) negative ACLF has been scarcely investigated. The aim of this study was to retrospectively investigate the correlation MCE of HBsAg levels with INR in patients receiving lamivudine. Methods: Fifty-seven HBeAg-negative ACLF patients were enrolled and treated with 100 mg of lamivudine Galunisertib supplier daily. Serum levels of HBsAg and INR were detected at baseline,

before death (patients died within 12 weeks), week 12 (patients survived over 12 weeks). Dynamic of HBsAg and INR were analyzed. Results: Thirty-two patients were pretreatment HBsAg levels above 4000 COI, whose HBsAg and INR were 8096 ± 2535 COI, 2.39 ± 0.77 respectively at baseline but were 7509 ± 378 COI, 2.13 ± 0.77 in sequence after treatment. The other 25 patients were pretreatment HBsAg levels below to 4000 COI, whose HBsAg and INR were 3173 ± 2026 COI, 2.55 ± 0.73 respectively at baseline but were 2015 ± 1069 COI, 2.84 ± 0.78 in sequence after treatment. Significant differences were found in pre- and post-treatment HBsAg levels between two groups (all P > 0.05). No significant difference was found in pretreatment INR (t = 0.252, P = 0.802). However, post-treatment INR of patients with pretreatment HBsAg levels above 4000 COI was significantly lower than that of below to 4000 COI (t = −2.493, P = 0.019). Conclusion: In HBeAg-negative ACLF, the patients with higher HBsAg level may have better improvement of INR during lamivudine treatment. Key Word(s): 1. HBsAg level; 2. ACLF; 3. lamivudine; 4.

preoperative ultrasound examination provide strong technical support for clinicians to select the incision, to quick find appendix in surgery, to reduce the negative appendectomy rate. Key Word(s): 1. ultrasonography; Small molecule library 2. appendectomy; 3. appendicitis; Presenting Author: JIANHONG WANG Additional Authors: TAO LI, HAIRU LV, XIAN WANG, MIN ZHOU, YIMIN LEI, KAICHUN WU Corresponding Author: JIANHONG WANG, KAICHUN WU Affiliations: Xijing Hospital of Digestive Diseases, Fourth Military Medical University; Xijing Hospital of Digestive Diseases, Fourth Military Medical University Objective: We aimed

to evaluate the short-term efficacy, feasibility, and safety of ultrasonography-guided percutaneous injection of pingyangmycin for the treatment of hepatic hemangiomas. Methods: From Feb 2009 to Mar

2012, 138 patients (59 male and 76 female, with mean age of 46.5 ± 10.2) with 151 liver hemangiomas over 4 cm underwent ultrasound-guided percutaneous injection of pingyangmycin in 21G PTC needle. For tumors with a diameter < 5 cm, 5–8 cm and >8 cm, the dose of pingyangmycin was 8 mg, 16 mg and 24–32 mg, respectively. For tumors with a diameter >5 cm, the injection was undertaken in selleck compound multiple area in tumor. All the cases were followed up over 6 months in serial CT scans or ultrasonography. Results: All cases were cured by one times except three cases, others with giant liver hemangioma were cured by two times. The mean diameter of hemangioma was 6.9 ± 0.9 cm (4.0–14.3 cm). All tumors (100%) were successfully treated by this method. The mean diameter of hemangiomas was decreased to 4.5 ± 2.1 cm (p < 0.001) in follow-up 6 months. The overall effective rate of this approach was 100%. There were 18 adverse events in 15 patients including fever (lower 38.5 C), abdominal pain, slight dyspnea, sick medchemexpress and vomited. The complications rate was 11.0% (15/138). After treatment, all the symptoms disappeared. Conclusion: Ultrasound-guided percutaneous injection of pingyangmycin is a good short-term effective, almost no invasive, economic, simple and safe procedure for therapy of liver hemangioma. Key Word(s): 1.

liver hemangioma; 2. ultrasonography; 3. sclerotherapy; 4. pingyangymycin; Presenting Author: FANGLING DU Corresponding Author: FANGLING DU Affiliations: army Objective: Research the nursing intervention to reduce the effectiveness of liver biopsy postoperative adverse reactions Methods: I division in 148 cases of patients with liver, according to the statistical research random allocation table gives grouping: intervention group 80 cases, control group 68 cases, the intervention group according to the design of the nursing intervention measures to intervene, control group according to traditional nursing mode. Compare two groups of postoperative adverse reactions. Results: The incidence of adverse reactions after intervention group and control group were 48.

preoperative ultrasound examination provide strong technical support for clinicians to select the incision, to quick find appendix in surgery, to reduce the negative appendectomy rate. Key Word(s): 1. ultrasonography; Crenolanib purchase 2. appendectomy; 3. appendicitis; Presenting Author: JIANHONG WANG Additional Authors: TAO LI, HAIRU LV, XIAN WANG, MIN ZHOU, YIMIN LEI, KAICHUN WU Corresponding Author: JIANHONG WANG, KAICHUN WU Affiliations: Xijing Hospital of Digestive Diseases, Fourth Military Medical University; Xijing Hospital of Digestive Diseases, Fourth Military Medical University Objective: We aimed

to evaluate the short-term efficacy, feasibility, and safety of ultrasonography-guided percutaneous injection of pingyangmycin for the treatment of hepatic hemangiomas. Methods: From Feb 2009 to Mar

2012, 138 patients (59 male and 76 female, with mean age of 46.5 ± 10.2) with 151 liver hemangiomas over 4 cm underwent ultrasound-guided percutaneous injection of pingyangmycin in 21G PTC needle. For tumors with a diameter < 5 cm, 5–8 cm and >8 cm, the dose of pingyangmycin was 8 mg, 16 mg and 24–32 mg, respectively. For tumors with a diameter >5 cm, the injection was undertaken in Napabucasin supplier multiple area in tumor. All the cases were followed up over 6 months in serial CT scans or ultrasonography. Results: All cases were cured by one times except three cases, others with giant liver hemangioma were cured by two times. The mean diameter of hemangioma was 6.9 ± 0.9 cm (4.0–14.3 cm). All tumors (100%) were successfully treated by this method. The mean diameter of hemangiomas was decreased to 4.5 ± 2.1 cm (p < 0.001) in follow-up 6 months. The overall effective rate of this approach was 100%. There were 18 adverse events in 15 patients including fever (lower 38.5 C), abdominal pain, slight dyspnea, sick MCE公司 and vomited. The complications rate was 11.0% (15/138). After treatment, all the symptoms disappeared. Conclusion: Ultrasound-guided percutaneous injection of pingyangmycin is a good short-term effective, almost no invasive, economic, simple and safe procedure for therapy of liver hemangioma. Key Word(s): 1.

liver hemangioma; 2. ultrasonography; 3. sclerotherapy; 4. pingyangymycin; Presenting Author: FANGLING DU Corresponding Author: FANGLING DU Affiliations: army Objective: Research the nursing intervention to reduce the effectiveness of liver biopsy postoperative adverse reactions Methods: I division in 148 cases of patients with liver, according to the statistical research random allocation table gives grouping: intervention group 80 cases, control group 68 cases, the intervention group according to the design of the nursing intervention measures to intervene, control group according to traditional nursing mode. Compare two groups of postoperative adverse reactions. Results: The incidence of adverse reactions after intervention group and control group were 48.

20 The results showed a significant inverse correlation between Doppler measurements and HVPG values. However, a correlation between the portal vein velocity and the HVPG was not confirmed in a recent study.21 Surprisingly, in these studies, neither hepatic artery resistance nor mesenteric artery resistance was correlated with the severity of portal hypertension. It should be noted that this method may not accurately characterize the portal blood flow because it measures only the peak velocity, whereas the flow is known

to be parabolic. Furthermore, selleck kinase inhibitor this method is operator-dependent and has poor reproducibility in obese patients. Thus, further studies are needed to confirm these results, and studies should be performed in patients with asymptomatic cirrhosis to determine the portal vein velocity or flow values that correspond to the presence Selleckchem Ruxolitinib of severe portal hypertension. Different factors contribute to the increased vascular resistance of the liver in patients with cirrhosis.22 One component is the hyperproduction of endogenous vasoconstrictors. For example, serum endothelin levels have

been shown to be significantly correlated with HVPG values in patients with cirrhosis.23 Thus, serum endothelin levels could be used to evaluate the degree of portal hypertension; however, further studies are needed to determine whether this dosage can be used in clinical practice. Recently, peripheral circulating cells associated with vascular injury were evaluated in patients with cirrhosis.24 The results showed

that the circulating endothelial cell count or the ratio of circulating endothelial cells to the platelet count is potentially a new biomarker of portal hypertension, but further clinical investigations are needed to confirm these results. Increased hepatic vascular resistance in patients with cirrhosis is also influenced by the presence and extent of fibrosis.4, 5 In one recent study, the area of liver collagen, which is MCE the major component of fibrous tissue, was measured by computer-assisted image analysis and was found to be significantly correlated with the HVPG in patients with cirrhosis.5 Accordingly, an evaluation of the extent of hepatic fibrosis may provide information about the presence and severity of portal hypertension. The noninvasive estimation of hepatic fibrosis has been a subject of extensive research in the last 10 years. However, only a few of these procedures have been evaluated for the noninvasive diagnosis of portal hypertension (Table 2). Only the methods that have evaluated the relationship between hepatic fibrosis and portal hypertension are reported in this review. Different markers of hepatic fibrosis have been studied to assess portal hypertension.