We assessed functional status of PZ system

in 158 patients with liver cirrhosis and 59 healthy controls. Plasma PZ and ZPI levels were measured by enzyme immunoassay. Thrombin generation assays (TGA) were performed with and without thrombomodulin (TM) or PZ, and the ratios were calculated by dividing TGA values with TM or PZ by Romidepsin chemical structure values without TM or PZ. PZ and ZPI levels were reduced and elevated in advanced cirrhosis, respectively. The lag time ratio–PZ was significantly higher in cirrhosis patients than controls and correlated with the model for end-stage liver disease (MELD) score. The peak thrombin ratio–PZ and endogenous thrombin potential (ETP) ratio–PZ were significantly lower in cirrhosis patients than controls and correlated with the severity of liver cirrhosis. The peak thrombin ratio–PZ was dramatically reduced in advanced cirrhosis. Cirrhosis patients had a significantly higher ETP ratio–TM than the controls, although the ratio was not correlated

with cirrhosis severity. The lag time ratio–PZ and peak time ratio–PZ were significantly correlated with the levels of all coagulation and anticoagulation factors. Interestingly, the lag time ratio–PZ and peak thrombin ratio–PZ were significantly associated with thrombotic events. The anticoagulant role of PZ is insufficient in advanced stages of cirrhosis. Our newly developed functional assay for measuring the PZ system is expected to reflect the ongoing hypercoagulability of cirrhosis. “
“Background and Aim:  The development of endoscopic treatment, such as endoscopic click here submucosal dissection, extends the indications for endoscopic resection in patients with early gastric cancer (EGC). Endoscopic ultrasonography (EUS) is the first-choice imaging modality for determining the depth of invasion of gastric cancer. The aim of the present study was to prospectively assess the accuracy of EUS for determining the depth of EGC, according to the accepted/extended indications. Methods:  We prospectively included

a total of 181 lesions in 178 MCE patients, with an endoscopic diagnosis of EGC, who underwent EUS for staging the depth of tumor invasion using a 20-MHz catheter probe. We investigated the accuracy of EUS for determining the depth of endoscopically-suspected EGC and then analyzed the difference in the accuracy of EUS according to the accepted/extended indications. Results:  Of the 178 patients, five patients were dropped because of the absence of final histological results. For the 176 lesions in 173 patients, the accuracy of EUS assessment for the depth of tumor invasion was 80.7% (142 of 176 lesions). The accuracy of EUS for the lesions with accepted indications and with extended indications was 97.6% (40 of 41 lesions) and 83.6% (46 of 57 lesions), respectively (P = 0.040). Of the lesions with extended indications, the accuracy of EUS decreased especially for the lesions with ulceration and those with minute submucosal invasion (79.