Background: Hepatocellular carcinoma (HCC) is one of the most prevalent cancer worldwide. Early detection of HCC is crucial to improve prognosis and survival. Nearly 30 % of HCC patients present with normal serum alpha fetoprotein (AFP), which highlights the need for new biomarkers for HCC. Annexin A4 (ANXA 4) is one of the annexin family with high expressions found in gastric, liver, lung, colorectal and ovarian cancers. Aim : to evaluate the clinical significance of ANXA 4 in the early diagnosis of HCC. Methods: Thirty patients with hepatitis C virus (HCV) related HCC were enrolled in this study. They were stage A according to Barcelona Clinic Liver Cancer (BCLC) staging and they were grade A or B according to Child Pugh Classification. Twenty patients with HCV-related liver cirrhosis and 20 healthy persons seronegative for both HCV and HBV served as control group. ANXA 4 and AFP were measured in serum of all cases. Results: Serum ANXA 4 level was significantly higher in HCC patients compared to patients with liver cirrhosis and healthy controls (188, IQR 42-428 and 23, IQR 24-33 and and 21, IQR 22-24 ng ̷ ml, respectively). By using the ROC curve, the area under the curve of ANXA 4 was 0.972 and the best cutoff value was115 ng/ml, with sensitivity 95% and specificity 80%. Conclusion: The serum level of ANXA 4 might be a good biomarker for the early detection of HCC.

Background Screening of blood donors in many countries is based on the use of serologic assays to detect specific anti-HCV antibodies (HCV Ab), but it lacks detection sensitivity. So, HCV RNA detection using the current gold standard real-time PCR is a must to rule out HCV infection with the main disadvantage being of high cost. HCV core antigen (HCV-c-Ag) immunoassay is proposed as a more cost efficient alternative to HCV RNA detection with PCR. Aim To evaluate the effectiveness of HCV-c-Ag detection as a cheap alternative to HCV RNA (PCR) in diagnosis of HCV infection in blood donors who are HCV Ab negative. Methods and results One hundred eighty-six volunteer blood donors who tested negative for HCV Ab were examined for HCV-c-Ag. Seven cases out of these 186 cases were HCV-c-Ag positive (4%). HCV RNA detection (PCR technique) was done to 30 cases (seven cases who test positive for HCV-c-Ag and 23 cases who test negative). Six out of the seven cases who were HCV-c-Ag positive (86%) were HCV RNA positive. Twenty-two cases out of the 23 cases who were HCV-c-Ag negative (96%) were HCV RNA negative. Conclusion HCV-c-Ag detection is an efficient method for diagnosis of HCV infection during screening of blood donors with high specificity (95.6%) and high negative predictive value (95.6%).

Aim:The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (-12.1%) compared to TACE (-6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.

Background Gastroesophageal reflux disease (GERD) is one of the most common diseases in modern civilization that originates basically from a disturbance in the structure and function of the lower esophageal sphincter (LES). Liver cirrhosis with or without esophageal varices (EV) may predispose to GERD, and GERD may precipitate rupture of esophageal varices. As variceal bleeding is a serious life-threatening complication of liver cirrhosis, GERD prevalence among cirrhotic patients is continuously subjected to research. We aimed to determine the prevalence of endoscopy-confirmed GERD in patients with liver cirrhosis and its possible risk factors. So, one hundred patients with HCV-related liver cirrhosis were consecutively enrolled in this study. They were subjected to history taking {including Reflux Disease Questionnaire}, thorough clinical examination, abdominal ultrasound, and lab investigations and then referred for upper endoscopy to screen for GERD and/or esophageal varices. Results GERD was endoscopically confirmed in 83 patients (83%) and the highest prevalence was in patients with Child B and C. Among 82 patients with esophageal varices, there were 68 patients who had endoscopic GERD (82.9%), and among 62 patients with ascites, there were 56 patients who had endoscopic GERD (90.3%). Conclusion We found a high prevalence of GERD (83%) among patients with liver cirrhosis. The severity of GERD was significantly related to the Child grade, the grade of varices, and the degree of ascites but ascites was the only significant risk factor for GERD development in cirrhotic patients.

Colorectal cancer (CRC) is the third most common cancer worldwide and is associated with a high level of mortality and morbidity. In this study we evaluate expression of p-p38 and p-MSK1 in CRC and determine whether there is an association between expression of these markers and any clinicopathologic parameters that could be of prognostic value. Expression of p-p38, p-MSK1 and ki-67 were examined by immunohistochemistry in 135 archival CRC cases and the findings were correlated with the patient clinicopathological data. P-p38 and p-MSK1 were expressed at high level in 58.5 % and 60.7% of CRC cases respectively. A statistically significant negative correlation was found between expression of p-p38 and Ki-67 (p < 0.001, r = -0.63) and between p-MSK1 and Ki-67 expression (p < 0.001, r = -0.61). The majority of CRC cases expressing high levels of p-p38 also expressed high levels of p-MSK1 and this correlation was highly significant (p < 0.001, r = 0.863). The high expression of p-p38 and p-MSK1 was also significantly associated with low Dukes and TNM stage. The elevated expression of p-38 and p-MSK1 in CRC was associated with a good prognosis and prolonged overall survival (p < 0.001, each). Our finding showed that activation of the p38-MSK1 axis determines a good outcome in CRC.