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Risk Factors for Hepatocellular Carcinoma


Hepatocellular carcinoma (HCC), the third leading cause of cancer deaths worldwide, with incidence rising is expected to increase by another 81% by the year 2020, primarily due to the hepatitis C epidemic. The strongest risk factors for the development of HCC is a hepatitis B (HBV) and hepatitis C (HCV) virus infection, as well as cirrhosis of any cause. Other risk factors that have been reported include exposure to aflatoxin, alcohol, tobacco, obesity and diabetes. To detect potentially curable cases of hepatocellular carcinoma, outpatients with chronic liver disease who have been seen at the Dr. Ion Cantacuzino Hospital, since 10 years and examined periodically with real-time ultrasonography and measurement of serum alpha-fetoprotein.We analyzed the data on these patients for risk factors for hepatocellular carcinoma.

The risk of liver cancer in men was 1.33 times higher than in women; patients in their 60s had significantly higher rate ratios (6.46) than patients in their 40s; patients with liver cirrhosis diagnosed at enrollment had significantly higher rate ratios for liver cancer (1.93) than patients with chronic hepatitis. The high serum alpha-fetoprotein level at enrollment was also confirmed as a significant marker for a high risk, regardless of the stage of disease (chronic hepatitis or liver cirrhosis). The serum markers for hepatitis virus -- HBsAg, and anti-HCV - were significantly associated with the risk of liver cancer: the adjusted rate ratios for HBsAg, anti-HBc, and anti-HCV were estimated to be 6.92, 4.54, and 4.09, respectively. Hepatitis B surface antigen (rate ratio 6,92; 95% CI: 2.92 to 16.39) and hepatitis C antibody (rate ratio 4.09; 95% CI: 1.30 to 12.85) showed the most risk for carcinoma.

Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.

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Confounding in the hyponatremia, bone mineral density and falls relationship

measurements: Estimation of the problem in a tertiary referral hospital . J Crit Care. 2012; 27 : 326.e9-326.e16. 4. AFSHINNIA F., WONG K.K., SUNDARAM B., ACKERMANN R.J., PENNATHUR S. Hypoalbuminemia and osteoporosis: reappraisal of a controversy . J Clin Endocrinol Metab. 2016; 101 (1):167-175. 5. YE Z., LU H., LIU P. Association between essential hypertension and bone mineral density: a systematic review and meta-analysis . Oncotarget. 2017; 8 :68916-68927. 6. PÉREZ-CASTRILLÓN J.L., JUSTO I., SILVA J., SANZ A., IGEA R., ESCUDERO P., et al. Bone mass

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Silent Hypoglycemia in Patients with Diabetes

DM. - The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health 2011; 14: 665-71 20. Feig DS, Asztalos E Corcoy R, De Leiva A et al- CONCEPTT Collaborative Group. CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol. In BMC Pregnancy Childbirth. 2016 Jul 18;16(1):167. doi: 10.1186/s12884-016-0961-5. 21. Rebrin K, Steil GM.-Can interstitial glucose assessment replaces blood glucose measurement

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Non-alcoholic fatty pancreas disease – practices for clinicians

nonalcoholic fatty pancreas disease and its severity in China. Medicine (Baltimore). 2018; 97 (26): e11293. 22. LEE SE, JANG JY, LIM CS, KANG MJ, KIM SH, KIM MA et al. Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann. Surg. 2010; 51 (251): 932-936. 23. NAVINA S, ACHARYA C, DELANY JP, ORLICHENKO LS, BATY CJ, SHIVA SS et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci. Transl. Med 2011; 3 (107): 107ra110

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Circulating anti-phospholipase A2 receptor antibodies as a diagnostic and prognostic marker in Greek patients with idiopathic membranous nephropathy – a retrospective cohort study

receptor antibody titer predicts post-rituximab outcome of membranous nephropathy . J Am Soc Nephrol. 2015; 26 (10):2545-58. 22. TIMMERMANS S.A., ABDUL HAMID M.A., COHEN TERVAERT J.W., DAMOISEAUX J.G., VAN PAASSEN P.; LIMBURG RENAL REGISTRY. Anti-PLA2R antibodies as a prognostic factor in PLA2R-related membranous nephropathy. Am J Nephrol. 2015; 42 (1):70-7. 23. POURCINE F., DAHAN K., MIHOUT F., CACHANADO M., BROCHERIOU I., DEBIEC H., et al . Prognostic value of PLA2R autoimmunity detected by measurement of anti-PLA2R antibodies combined with detection of

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Liver stiffness in chronic hepatitis C virus infection

Impulse Elastography: a retrospective multicentre study . Dig Liver Dis 2013; 45 :762–8. 18. TSUKANO N., MIYASE S., SAEKI T., MIZOBE K., IWASHITA H., ARIMA N., et al. Usefulness of Virtual Touch Quantification for staging liver fibrosis in patients with hepatitis C, and the factors affecting liver stiffness measurement failure compared with liver biopsy . Hepatol Res 2018; 48 :373-82. 19. SUMMERS J.A., RADHAKRISHAN M., MORRIS E., CHALKIDOU A., RUA T., PATEL A., et al. Virtual Touch™ quantification to diagnose and monitor liver fibrosis in hepatitis B and

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The role of spleen stiffness using ARFI in predicting esophageal varices in patients with Hepatitis B and C virus-related cirrhosis

Stiffness Measurement-Based, Noninvasive Prediction Model for High-Risk Esophageal Varices in B-Viral Liver Cirrhosis . Am J Gastroenterol. 2010; 105 (6):1382-90. 8. THABUT D, TRABUT J-B, MASSARD J, RUDLER M, MUNTENAU M, MESSOUS D, et al. Non-invasive diagnosis of large oesophageal varices with FibroTest in patients with cirrhosis: a preliminary retrospective study . Liver International. 2006; 26 (3):271-8. 9. AUGUSTIN S, PONS M, GENESCA J. Validating the Baveno VI recommendations for screening varices . Journal of Hepatology. 66 (2):459-60. 10. CHEN

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Glucose Level Estimation in Diabetes Mellitus By Saliva: A Bloodless Revolution

carriage in the saliva of type 2 diabetics: A case-control study. Contemp Clin Dent 2014; 5 :312-17. 11. SYED S, GIRISH K, SREENIVAS R G, CHANDRIKA K, DARSHAN D D, VIJAY G. Salivary alterations in type 1 diabetes mellitus patients: Salivary glucose could be noninvasive tool for monitoring diabetes mellitus . Indian J Dent Res 2014; 25 :420-24. 12. FABRE B, MACCALLINI G, ONETO A, GONZALEZ D, HIRSCHLER V, ARANDA C, et al. Measurement of fasting salivary insulin and its relationship with serum insulin in children. Endocr Connect. 2012; 1 :58

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In-hospital screening for diabetes mellitus with HbA1c in an internal medicine department was not useful; a prospective pilot study.

.L., SUMITHRAN P., et al. Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes . PLoS One. 2017; 12 (1):e0168471. 18. KUFELDT J., KOVAROVA M., ADOLPH M., STAIGER H., BAMBERG M., HARING H.U., et al. Prevalence and Distribution of Diabetes Mellitus in a Maximum Care Hospital: Urgent Need for HbA1c-Screening . Exp Clin Endocrinol Diabetes. 2018; 126 (2):123-29. 19. RADIN M.S. Pitfalls in hemoglobin A1c measurement: when results may be misleading . Journal of general internal medicine. 2014; 29 (2

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The change in NT-pro-BNP and post-PTMC echocardiography parameters in patients with mitral stenosis. A pilot study

vector imaging. Res Cardiovasc Med. 2013; 2 (3):114-20. 16. BUOB A., JUNG J., SIAPLAOURAS S., NEUBERGER HR., MEWIS C. Discordant regulation of CRP and NT-probnp plasma levels after electrical cardioversion of persistent atrial fibrillation. Pacing Clin Electrophysiol. 2006; 29 (6):559-63. 17. DANICEK V., THEODOROVICH N., BAR-CHAIM S., MILLER A., VERED Z., KOREN-MORAG N., et al . Sinus rhythm restoration after atrial fibrillation: the clinical value of N-terminal pro-BNP measurements. Pacing Clin Electrophysiol. 2008; 31 (8):955-60. 18

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