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Background and Aim: Chronic hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma (HCC). Circulating cell-free DNA (cfDNA) methylation of tumor suppressor genes are emerging potential biomarkers in HCC. We aimed to evaluate the cfDNA methylation status of RASSF1 and CDKN2AIP genes in patients with liver cirrhosis (LC) with or without HCC caused by HBV. Materials and Methods: A total of 47 patients with HBV cirrhosis were included in the study. Patients were divided into two groups: HCC and LC (HCC+LC, n=22) and HBV cirrhosis only (LC, n=25). cfDNA was isolated from the plasma samples of the patients. Methylation analysis was performed for RASSF1 and CDKN2AIP genes. Results: Mean methylation percentage of CDKN2AIP gene was 0.001±0.004% in the HCC+LC group and 0.008±0.004 % in the LC only group. The mean methylation percentage of RASSF1 gene was 5.1±16.1% in the HCC+LC group and 9.7±25.9% in the LC only group. The methylation rate of CDKN2AIP was significantly lower in the HCC+LC group (p=0.027). A positive correlation was found with the absence of cfDNA methylation of CDKN2AIP gene in the presence of HCC (R=0.667, p=0.018). Conclusion: cfDNA methylation of CDKN2AIP and RASSF1 genes may provide important diagnostic information regarding the development of HCC in the setting of HBV cirrhosis.
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BACKGROUND/AIMS: Sedation is important for the success and quality of endoscopy. We aimed to evaluate the safety of propofol during the endoscopy under supervision of a gastroenterologist without an anesthesiologist. METHODOLOGY: All propofol using endoscopic procedures between January 2004 and December 2008 were evaluated retrospectively. All patients received i.v. propofol plus midazolam during the procedures. Blood pressure, heart rate and pO2 saturation were all recorded before and during the procedures. RESULTS: Mean age of patients was 39.13 +/- 12.9 years (45% male). 50 endoscopic retrograde colangiography, 1430 colonoscopy, 2478 gastroscopy and 210 double balloon enteroscopy procedures were evaluated. First i.v. midazolam (mean 3 +/- 1.1 mg) was used for sedation, then i.v. propofol (mean dose 50 +/- 10 mg) was titrated to achieve deep sedation. Before the procedures, mean pO2, systolic blood pressure, and heart rate were 95 +/- 3%, 120 +/- 25 mmHg, 87 +/- 20, respectively. Mean pO2 decreased significantly during the procedures (from 95 +/- 3% to 83 +/- 5%) (p < 0.005). Only one patient needed tracheal intubation. Arterial hypotension (< 90 mmHg systolic pressure) was observed in 10% of patients (p > 0.05). Two percent of patients had bradycardia (Heart rate < 50 min). CONCLUSION: Using propofol after midazolam induction seems to be feasible only if the patients are carefully observed and their vital functions monitored during the procedures.