Riaz et al. showed that combining measurements of the entire tumor and of its enhancing portion (especially WHO and EASL) could increase complete pathological response detection.[4] Considering imaging as a potential surrogate mTOR inhibitor marker of pathological response to liver-directed therapies, we advocate that combining anatomical and functional criteria are currently to be considered the next steps of research. Among these, DWI could play an important role as a potential adjunct tool in response assessment after Y90. However, when used as unique response criteria, ADC calculation was disappointing for detection of pathological response. However, our results necessitate some comments.

ADC calculation methodology was heterogeneous in the literature and highly debated. Also,

DWI sequences parameters are still to be defined (use of b-values, echo-planar versus spin-echo, and single versus multishot sequences). Some researchers propose calculating ADC values in the entire lesion (necrotic or viable), wheras others advocate studying only the borders. Even if automated segmentation software is available, some prefer a manual FK866 drawing of the ROI. Finally, a choice must be made between measurements directly performed on ADC maps or calculated after measurements on both low and high b-value sequences series, that is, bypassing automated postprocessing ADC calculation (we chose this latest methodology to optimize the accuracy of series coregistration). Whatever the chosen methodology, we have to accept advantages and disadvantages. As a potential optional tool in response assessment for borderline cases, we opted 3-mercaptopyruvate sulfurtransferase for a

more restrictive and discriminant technique; when possible, we placed our ROI on the suspected viable portions of the tumors. However, baseline and posttreatment ADC values in our study (baseline: median, 1.5; range, 1.0-2.2; 1 month: median, 1.5; range, 0.7-2.9; 3 months: median, 1.5; range, 1.1-2.7) were consistent with other studies evaluating ADC changes after TACE and sorafenib. Despite equivocal results in our study, we recognize that ADC could constitute a useful optional tool in clinical practice for borderline cases. For instance, one of the investigators (F.M.) showed better results in subjectively estimating CPN, partially because of DWI as ancillary data. Further improvements in ADC methodology and software (i.e., volumetric ADC mapping) would be beneficial. The use of ADC after sorafenib may be problematic because patients may develop hemorrhagic necrosis as a favorable treatment response, which can decrease ADC values and hence mimic residual tumor.[12, 13] There are strengths to this study. This is the first radiological/pathological correlative study generated from a prospective, randomized trial; these are rare. Second, the analysis was comprehensive and investigated relevant parameters, including size (WHO and RECIST), enhancement (EASL and mRECIST), and functional imaging criteria (DWI).

42 Patients with CC were, on average, 8 years older than patients with HCV at the time of development of cirrhosis and about 3 years older at the time when HCC was detected.42 Emerging evidence has established multiple independent risk factors for the development of HCC including obesity, diabetes, and iron deposition (Table 2). These factors also increase the risk for the development of NASH, a probable precursor to CC. It is well established that HCC develops in the presence of chronic liver

disease, typically associated with cirrhosis from HBV, HCV, and/or alcoholic liver disease. Cirrhosis is the most important single risk factor for HCC and is present in about 80% of patients with HCC, regardless of underlying liver disease.57 As noted previously, NASH likely HKI-272 mouse accounts for a large proportion of the idiopathic cirrhosis that makes up 6.9%-50% of underlying liver disease in patients with HCC in developed countries.7 This conclusion is further supported by evidence of linking common risk factors for NASH with risk factors for HCC. Obesity has been established

as a significant risk factor for the development of various malignancies, including liver cancer.49, 58-60 selleck kinase inhibitor A large, prospective mortality study by the American Cancer Society61 demonstrated increased cancer mortality with increased body weight. The death rates from all types of cancers among the heaviest patients in the cohort (patients with a BMI > 40 kg/m2) were 52% higher for men and 62% higher for women compared with patients

of normal weight. These significant mortality rates included death from esophageal, stomach, colorectal, liver, gallbladder, pancreatic, prostate, and kidney cancer as well as leukemia, non-Hodgkin’s lymphoma, and multiple myeloma. Compared to patients with normal BMI, the relative L-NAME HCl risk (RR) of mortality from liver cancer was 1.68 times higher in women and 4.52 times higher in men with BMI > 35 kg/m2. Death from liver cancer among obese males demonstrated the highest RR of all the cancers in the study. This confirmed the results of another population-based study from Denmark of more than 40,000 obese patients, which showed that the RR of liver cancer was increased to 1.9 compared to the general population.62 A study from Korea published in 2005 examined the relationship between BMI and various cancers in 781,283 men without a prior diagnosis of cancer.63 The patients were followed over a 10-year period. Korean men with a BMI > 30 kg/m2 had a 26% increase in risk for all types of cancer compared to men with a normal BMI.63 An RR of 1.53 was demonstrated for HCC in obese males compared to normal controls, even after controlling for HBV infection, which is the most common cause of HCC in Korea.63, 64 A review of data from 19,271 patients who underwent orthotopic liver transplant in the United States between 1991 and 2000 showed the overall incidence of HCC was 3.4% with a slightly higher incidence among obese patients at 4.0%.

Further research

is needed to determine why IFN produces opposite effects in UC. Existing data suggest two possible reasons for these conflicting results: (i) differences in the balance of T helper cell 1 (Th1) and T helper cell 2 (Th2) associated with population differences in bodyweight, body surface area and body mass index (BMI); and (ii) differences in the time of IFN treatment initiation. The cause of UC remains unclear; however, Th1/Th2 imbalance is thought to be involved. The Th1 cells produce interleukin (IL)-2 and IFN-γ, and the Th2 cells produce IL-3, IL-4, IL-5, IL-6, IL-10, and IL-13, promoting cellular immunity versus humoral immunity. Th1/Th2 imbalance is strongly correlated with numerous diseases.34 For example, Crohn’s AUY-922 solubility dmso disease is associated with Th1 cell expression, whereas UC is associated with Th2 cell expression.35 Th2 dominance is associated with chronic hepatitis C34,36 and conventional MS, whereas opticospinal MS is thought to be associated with Th1 dominance.37 In addition to Th1 and Th2, Th17 cells producing tumor necrosis BMS-777607 order factor (TNF)-α, IL-17, IL-21, and IL-22 were recently discovered. This finding may provide additional insight into the causes of autoimmune diseases, rheumatoid arthritis in particular.38 IFN-β–induced remission of UC was reported in a patient with chronic hepatitis

C,39 and the peripheral Th1/Th2 ratio was decreased in a similar case.40 Ning et al. recently reported that IFN-β-1a suppresses inflammation in UC, and this effect is accompanied by the inhibition of IL-13 production.41 Furthermore, pretreating transgenic mice with a Lactobacillus strain that expresses IFN-β upregulated TNF-α, IFN-γ, IL-17A, and IL-13 in intestinal tissues.42 Accordingly, interest in the effects of IL-13 and IL-17 on the development or exacerbation of UC, or recovery or remission from UC, has

increased. Földes et al. reported that RIB alters the Th1/Th2 balance, inducing resistance to the hepatitis C virus by cellular immune processes.43 They previously reported that RIB inhibits viral-induced macrophage production of TNF, IL-1, and the procoagulant fgl2 prothrombinase, preserving Th1 cytokine production but inhibiting the Th2 cytokine response.43 Thus, the imbalance of Th1/Th2 may explain, at least in part, the effect of IFN and/or RIB on UC. However, prospective studies are needed to elucidate the role of Th1/Th2 balance Beta adrenergic receptor kinase in patients with UC caused by IFN therapy. Despite fears that PEG-IFN may exert a stronger effect on the immune system because its use produces higher levels in the blood than standard IFN treatment,10,13 the incidence of thyroid dysfunction is similar between patients treated with each form of IFN.27 Therefore, the risk associated with PEG-IFN does not appear to be higher than that of standard IFN.27 However, combination therapy consisting of PEG-IFN and RIB may have stronger additive or synergistic effects on immunomodulation than RIB combined with standard IFN.10,13 Carella et al.

Our data in surgically resected human HCC and a mouse model of I-BET-762 cell line carcinogen-induced HCC support a potential tumor suppressor function of Col18a1. Further studies are underway to establish what roles Col18a1 may play in controlling the rates of HCC progression. Disclosures: Lewis R. Roberts – Grant/Research Support: Bristol Myers Squibb, ARIAD Pharmaceuticals, BTG, Wako Diagnostics, Inova Diagnostics, Gilead Sciences The following people have nothing to disclose: Michael Duncan, Renumathy Dhanasekaran, Priyanka Thakur Background & Aims: Recent single nucleotide polymorphism (SNP) studies revealed several host genetic risk factors for hepatocellular carcinoma (HCC); however, the majority

of genetic factors remain unclear. MicroRNAs (miRNAs) are small non-coding RNAs that control

gene expression post-transcrip-tionally. As for HCC, two common SNPs in mature miRNAs (rs2910164 in miR-146a and rs11614913 in miR-196a2) have been extensively studied, but published results are inconsistent and inconclusive. Almost all these studies compared hepatitis B virus (HBV)-related HCC patients and healthy controls in China. We aimed to investigate the association between these GSK2118436 mouse SNPs and HBV-related as well as hepatitis C virus (HCV)-related HCC risk in a Japanese population using a large number of patients. Methods: We analyzed the effect of rs2910164 and rs11614913 on HCC development in over 1,500 chronic HBV patients, including 407 with HCC (cases) and 1,141 without HCC (controls), and over 3,300 chronic HCV patients, including 1,026 cases and 2,349 controls, by multiplex-PCR-based Invader assay. Results: According to 1000Genomes database, risk allele frequencies (AFs) of rs2910164 and Edoxaban rs11614913 vary among ethnic groups: 0.22 and 0.41 in Europeans, 0.54 and 0.58 in Han Chinese, and 0.60 and 0.60 in Japanese, respectively. Estimated statistical power is 60% and over 90% for our HBV and HCV studies, respectively. First, we analyzed chronic HBV patients and found that risk AF of rs2910164 was significantly higher in cases than in controls (P = 0.040, odds ratio [OR] = 1.19).

We also found a similar result for rs11614913 (P = 0.017, OR = 1.21). Because both of age and male ratio were significantly higher in cases than controls, we adjusted for age and gender and again found significant associations with HBV-related HCC for both SNPs (P = 0.014 and 0.037, OR = 1.23 and 1.19, respectively). Next, we analyzed chronic HCV patients, but we could not find any significant differences between risk AFs of cases and those of controls for either SNP (P = 0.266 and 0.861, respectively), despite sufficient statistical power. After adjusting for age and gender, we again observed no association. Finally, we investigated the association between these two SNPs and expression of possible target genes using expression quantitative trait loci (eQTL) with public databases, but we failed to find any supporting evidence.

IB1001 was well tolerated and without safety concerns. The non-inferiority of IB1001 to nonacog alfa supports IB1001 becoming a useful alternative recombinant agent for the management of haemophilia B. “
“This chapter contains sections titled: Introduction Health economic methods and the economic perspective Health economic analyses in practice

Health economic evaluation Conclusion References “
“Experienced peer support groups (EPSG) are expected to improve self-care and complement professional health care for haemophilic patients, even those living in inconvenient clinical setting. However, these benefits have not been verified quantitatively. The structural equation modelling (SEM) was used to evaluate the effects of contact LEE011 order with EPSG on self-care for haemophilic patients in the Japanese clinical settings. Factors affecting

self-care were compared between groups with and without EPSG contact. Self-reported questionnaires were mailed to 652 haemophilic patients with HIV in Japan (September 2005–January 2006). SEM demonstrated significant associations Doxorubicin supplier between EPSG contact, self-care scores and other social and individual factors. The total effect of EPSG contact on self-care was calculated. The structural differences between models were analysed in a multi-group analysis. Of the 257 respondents (response rate, 39.4%), 109 reported having contact with an EPSG (EPSG+ group) and 139 reported no contact (EPSG− group). EPSG contact Y-27632 2HCl was significantly associated with better self-care. In the multi-group analysis, the total effect of inconvenient access to medical services on self-care in the EPSG+ group was 10% of that in the EPSG− group and was significantly associated with poor illness-related knowledge and high anxiety level only

in the EPSG− group. In the EPSG+ group, patient age was strongly associated with self-care than in the EPSG− group. These findings suggest that EPSG contact may alleviate inconvenience in medical services. Factors associated with self-care differed between groups. Health care professionals must carefully assess self-care behaviours and service accessibility based on these results. “
“Many adult patients diagnosed with phenotypically moderate and severe haemophilia living in the Auckland region of New Zealand do not report bleeding episodes within a timeframe that allows for optimal assessment and management. This can result in poor clinical outcomes for patients and poor oversight of the use of expensive clotting factor concentrates. Our goal was to improve both the number and speed at which bleeding episodes were reported to our centre, improving access to care and clinical oversight of the use of expensive factor concentrates and aiding the development of a care partnership with patients. We worked with 70 adult PWH living in the Auckland region of New Zealand with moderate and severe haemophilia A and B.

Furthermore, tamoxifen has been used primarily to treat patients with nonbreast cancers, including hepatocellular, pancreatic, renal cell, ovarian, and melanoma carcinomas.3 Above all, we believe that although the use of tamoxifen for the prevention of breast cancer is exceptionally low, the use of tamoxifen for cancer prevention and treatment will become more popular and extensive with Selleck SCH727965 the decision-making process. Zhihua Liu Ph.D.*, Yanlei Ma Ph.D.*, Huanlong Qin M.D.*, * Department of Surgery, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China. “
“A 65-year-old man was admitted to hospital with probable cholangitis.

He described intermittent pain in the upper abdomen over the preceding 2 weeks and subsequently developed nausea, vomiting Selleck ABT 263 and fever. Ten years previously, he had been treated by laparoscopic cholecystectomy for cholelithiasis. On examination, he had mild tenderness on palpation over the upper abdomen. His serum bilirubin and white cell count were normal but there were abnormalities in liver enzymes including gammaglutamyl transpeptidase (478 IU/L), alkaline phosphatase (210 IU/L) and alanine aminotransferase (67 IU/L). A plain radiograph of his

abdomen revealed several clips in the right upper quadrant as well as a clip that had migrated medially and inferiorly. A computed tomography scan of his abdomen revealed metallic radiodense material in the distal bile duct (arrow, Figure 1). At endoscopic retrograde cholangiopancreatography,

there was an elongated filling-defect in the distal bile duct with a narrow lower bile duct. As the clip could not be removed by endoscopic sphincterotomy, laparotomy was performed and a small pigmented stone was removed with a metal clip in the center of the stone (Figure 2). There were no post-operative complications. After cholecystectomy, approximately 5–10% of patients are subsequently diagnosed with bile duct stones. Some of these stones are retained stones but the majority seem likely to reform within the bile duct. Risk factors for recurrent bile duct stones include previous bile duct stones, periampullary diverticula, dilatation of the bile duct and a gallbladder that remains ID-8 in situ. An additional issue is the migration of sutures or clips from the cystic duct stump into the bile duct. Many of these seem likely to pass spontaneously into the duodenum but, if this does not occur, the foreign body can act as a nidus for further stone formation. In a recent compilation of 69 case reports of clip migration (J Gastrointest Surg 2010; 14:688–96), the median time from cholecystectomy to clinical presentation was 26 months. The median number of clips on the cystic duct stump was six but usually only one migrated into the bile duct.

Six- to 8-week-old female C57Bl/6 wild-type mice were fed a diet deficient in methionine and choline for 5 weeks. Control animals received a diet supplemented with methionine (3 g/kg) and choline bitartrate (2 g/kg) (Dyets Inc., Bethlehem, PA). Poly(I:C) (InvivoGen, San Diego, CA), a synthetic dsRNA (5 mg/kg), or cytidine–phosphate–guanosine-rich DNA (CpG)-ODN (InvivoGen, San Diego, CA; 5 mg/kg) or LPS (Sigma-Aldrich Co., St. Louis, MO; 0.5 mg/kg) were injected intraperitoneally for 2 or 6 hours. The

study was approved by the Institutional Animal Use and Care Committee at the University of Massachusetts. Serum alanine aminotransferase (ALT) levels were determined NVP-LDE225 manufacturer using a kinetic method (D-TEK, Bensalem, PA), and liver triglyceride levels were assessed using

an L-Type Triglyceride H kit (Wako Chemicals USA Inc., Richmond, VA). Serum cytokine levels were determined by way of BD Cytometric Bead Array (BD Biosciences, Sparks, MD). Liver thiobarbituric acid reactive substances (TBARS) were assayed using whole liver homogenates and an Oxi-TEK TBARS assay kit (ZeptoMetrix Corp., Buffalo, NY). Serum high-mobility group box protein-1 (HMGB1) protein levels were measured by enzyme-linked immunosorbent assay (IBL Transatlantic, Toronto, Ontario, Canada). Sections of formalin-fixed livers were stained with hematoxylin and eosin. All slides were analyzed by way of microscopy. RNA was purified using an RNeasy kit (Qiagen Sciences, Germantown, MD) and on-column DNA digestion. selleck products Complementary DNA was transcribed with the Reverse Transcription System (Promega Corp., Madison, WI). Real-time quantitative polymerase chain reaction was performed using the iCycler (Bio-Rad Laboratories Inc., Hercules, CA) as described12; primer sequences

are shown in Table 1. Isolation of mitochondrial and cytosolic fraction from fresh liver tissue was based on the principle of differential centrifugation using a Mitochondrial Extraction kit (Imgenex Co., San Diego, CA). Whole liver lysates or mitochondrial oxyclozanide fractions were extracted and Western blotting was performed as described.12 The following antibodies were employed: MAVS (Santa Cruz Biotechnology Inc., sc-6881), cytochrome c (Imgenex, IMG101-A), caspase 1 p10 (Santa Cruz Biotechnology Inc., sc-514), cleaved caspase 8 (Imgenex, IMG5703), RIP3 (Abcam, ab72106), β-actin (Abcam, ab6276), β-tubulin (Abcam, ab6046), and Tim23 (BD Biosciences, 611222). A Native PAGE Novex Bis-Tris Gel System (Invitrogen Life Science, Carlsbad, CA) was used. Liver samples were lysed using 5% Digitonin as a mild detergent and separated on Native PAGE Novex 3-12% Bis-Tris gels. Proteins were transferred to a polyvinylidene difluoride (PVDF) membrane, fixed with 8% acetic acid, diluted in distilled water and identified with specific primary antibodies followed by horseradish peroxidase–labeled secondary antibodies and chemiluminescence assay.

The risk of this second issue is highlighted by the high frequency of bleeding symptoms reported by the general population [2, 3]. In response to these challenges, a number of attempts have been made to standardize bleeding histories. Over the years, multiple investigators have made attempts to standardize bleeding histories by identifying questions that best distinguish between affected and unaffected individuals. In

1990, Higham and colleagues published the Pictorial Bleeding Assessment Chart (PBAC) which allows women with heavy menstrual bleeding BMS-777607 mw to track the number of pads or tampons used for a menstrual period as well as the degree of soiling [4]. Based on that information, a score is generated and PBAC scores ≥100 correlate with menorrhagia, defined as ≥80 mL menstrual blood loss. In 1995, Sramek and colleagues published their experience with a bleeding questionnaire

that was administered to patients known to have a bleeding disorder and to a group of normal controls [5]. The most informative questions, in terms of discrimination, were about bleeding following traumatic events, such as tonsillectomy or dental extraction (but not childbirth), and the presence of a bleeding disorder in a family member. In 2005, the International Society on Thrombosis and Haemostasis (ISTH) Scientific and Standardization Committee (SSC) on von Willebrand factor (VWF) established a set of provisional criteria for the diagnosis of von Willebrand disease (VWD) type 1 including the threshold that must be met for mucocutaneous bleeding symptoms to be considered significant [6]. Over time, the field PD0332991 manufacturer has increasingly focused on quantitative assessments of bleeding, and on the need for standardization. Building on the ISTH provisional Aldol condensation criteria, Rodeghiero et al. developed and validated a bleeding assessment tool (BAT) for the diagnosis of type 1 VWD in a primarily adult population [7]. This bleeding questionnaire subsequently underwent a series of modifications, including one by Bowman et al. specifically

aimed at decreasing administration time [8] and culminating with the publication of the ISTH-BAT in 2010 [9]. Studies focused on evaluating the utility of these and other BATs for use in patients with RBDs have begun. As a first step, a classification system for RBDs based on the association between coagulant factor activity and clinical bleeding severity was published by Peyvandi et al. in 2012 [10]. So far, the largest study to date was published by the European Network of Rare Bleeding Disorders (EN-RBD) Group [11]. The objective of this study was to explore the relationship between coagulation factor levels and bleeding severity in patients with RBDs using data from 489 patients registered with the EN-RBD. Clinical bleeding episodes were classified into four categories of severity following consensus. Strong correlations were identified for deficiencies of fibrinogen, FX, FXIII and FV+FVIII.

Other genetic markers of potential importance for the immune response to the deficient factor include the human leucocyte antigen (HLA) class II (i.e. DRB1*15 and DQB1*0602) and immune regulatory genes [4-7]. A twofold higher incidence of inhibitors in those of African descent compared with Caucasians

further supports the importance of genetic factors [2, 8]. It has been suggested that this discrepancy may be due to the different distribution of F8 haplotypes by race, with a higher risk for inhibitors in the case of a mismatch between the proteins encoded by the endogenous F8 haplotype and those comprising replacement products used for treatment [9, 10]. The haplotypes consist of four non-synonymous single nucleotide polymorphisms (SNPs) located across Cell Cycle inhibitor the gene. Each mutation results in a non-terminating amino acid change in the factor VIII protein construction. The biologic implications of the amino acid changes have not fully been explored, but two of the residues are located in immunodominant epitopes, i.e. R484H and M2238V, whereas R776G and D1241E are located in the B-domain. The haplotypes H3, Cabozantinib order H4 and H5 have only been found among blacks, whereas H1 and H2 are found primarily in whites and are most commonly present in infused recombinant products [10]. The Hemophilia Inhibitor Genetics Astemizole Study (HIGS) Combined

Cohort was used to further explore the suggested relationship between haplotype and inhibitor status

among those of African ancestry, and mismatch of haplotype and product use on inhibitor development by adjustment for the type of F8 mutation and previously described HLA class II risk alleles among the subset of HIGS participants. Our data comprised three multicentre studies: the Hemophilia Inhibitor Genetics Study (HIGS), the Malmö International Brother Study (MIBS) and the Hemophilia Growth and Development Study (HGDS) (N = 833). The HIGS study group included in the current analysis is composed of brother pairs, one or both of whom has a history of an inhibitor, and singletons with a history of inhibitors, enrolled in Europe, North America, Latin America and South Africa. The MIBS is composed, almost exclusively, of siblings pairs enrolled in Europe and North America, and the HGDS is a population-based group enrolled in haemophilia treatment centres in the US. Data collection from all cohorts included demographics, severity of haemophilia, history of and current inhibitor status, maximum lifetime Bethesda titre and type of F8 mutation. Hemophilia Inhibitor Genetics Study data collection also included retrospective identification of the type(s) of replacement products used prior to development of the inhibitor. For those not having an inhibitor, i.e.

HCV infection (HCV+) status was defined as positive for HCV RNA. Non-B, non-C status was defined as negative for HBsAg and not having a high titer of anti-HBc Ab (HBV−) as well as negative for HCV RNA (HCV−). Radiation dose to the liver was estimated for each subject according to Dosimetry System DS02.30 A weighted sum of the gamma dose in gray plus 10 times the neutron dose

in gray was used. Because of the countermatched selection of cases, direct comparison of doses between cases and controls RG-7388 ic50 in the study requires that control doses be weighted by the inverses of their selection probabilities. Information on alcohol consumption was obtained from the 1965 AHS questionnaire when available, with missing data complemented using the 1978 mail survey. Alcohol consumption was quantified as volume of each type of alcoholic beverage; mean ethanol amounts were calculated as grams per day this website as described.31 BMI (kg/m2) was calculated from height and weight measured at the AHS examination. Subjects were classified based on BMI quintiles with cutpoints of 19.5, 21.2, 22.9, and 25.0. Following the recommendations for Asian people by the World Health Organization (WHO), the International Association for the Study of Obesity, and the International obesity Task Force,32 21.3 to 22.9 kg/m2 was considered normal,

23.0 to 25.0 kg/m2 as overweight, and >25.0 kg/m2 as obese. We used information on BMI obtained 10 years before the time of HCC diagnosis or control matching because this condition is subject to change due to disease progression in the later stages before development of HCC. Information Sodium butyrate on smoking habit was obtained from the 1965 questionnaire; subjects were categorized as never, current

(at time of survey), or former smoker. This study (RERF Research Protocol 1-04) was reviewed and approved by the Research Protocol Review Committee and the Human Investigation Committee of RERF. The nested case-control design was analyzed using a partial likelihood method analogous to that used for cohort follow-up studies,33 which is in practice the same as the conditional binary data likelihood for matched case-control studies34 except that the subjects (cases and “controls”) in the study are not completely independent due to repeated selection. Cumulative incidence of HCC by follow-up time (year) and age was derived according to the method of Nelson and Aalen, using Cox regression to adjust for age at start of follow-up. Cumulative incidence by radiation dose groups (0-0.0009, 0.001-0.999, and 1.0+ Gray) was compared using the Gehan/Breslow generalized Wilcoxon test. All factors other than radiation were analyzed using relative risks (RRs) estimated by a log-linear model.