Patients who provided informed consent received LSM and were consecutively Akt inhibitor enrolled in

this prospective study. Using our exclusion criteria (Fig. 1),16-19 we excluded 99 patients; the remaining 1,130 patients were selected for statistical analysis. Twenty-five patients who were excluded due to LSM failure (n = 8) or an invalid LSM (n = 17) had significantly higher body mass index than the other patients (28.5 versus 23.7 kg/m2; P < 0.001), whereas the other variables did not differ significantly (all P > 0.05, data not shown). On the same day as LSM, blood parameters including serum albumin, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time, platelet count, and alpha-fetoprotein (AFP) were recorded. HBsAg and hepatitis B e antigen (HBeAg) were measured using standard enzyme-linked immunosorbent assays (Abbott Diagnostics, Abbott Park, IL). Hepatitis B virus DNA levels were assessed with a hybridization capture assay (Digene Diagnostics, Gaithersburg, MD) having

a detection limit of 141,000 copies/mL. If histologic information was not available, clinically diagnosed liver cirrhosis (cLC) was defined as follows: (1) platelet count <100,000/μL and ultrasonographic findings suggestive of cirrhosis, including a blunted, nodular liver edge find more accompanied by splenomegaly (>12 cm); (2) esophageal or gastric varices; or (3) overt complications of liver cirrhosis, including ascites, variceal bleeding, and hepatic encephalopathy.20, 21 The study protocol conformed to the ethical guidelines

of the 1975 Declaration of Helsinki and was approved by the institutional review board of our institute. Each patient was screened for HCC with ultrasonography at their initial visit. Two patients were excluded due to presence of HCC at the initial visit. If no evidence of HCC was detected, patients were followed up with AFP and ultrasonography every 3 or 6 months. During the surveillance, MCE公司 HCC was diagnosed based on the guideline of American Association for the Study of Liver Diseases.2 Briefly, patients were diagnosed with HCC if they had a tumor with a maximum diameter of >2 cm and the typical features of HCC on dynamic computed tomography (defined as hyperattenuation in the arterial phase and early washout in the portal phase), and AFP >200 ng/mL.2 If the maximum diameter of the tumor was 1 to 2 cm, dynamic computed tomography and magnetic resonance imaging were performed. HCC was diagnosed if coincidental typical features of HCC were noted. If the tumor did not satisfy the above criteria, a biopsy was performed. When the tumor was <1 cm, ultrasonographic examination was repeated after 3 months. The last follow-up date was December 2009. LSM was performed on the right lobe of the liver through the intercostal spaces on patients lying in the dorsal decubitus position with the right arm in maximal abduction.