5%) PCCs and 26 (6.0%) mixed adenocarcinomas according to modified WHO classification. The clinicopathological characteristics among histologial type were shown in Table 1. Although en bloc resection rate was acceptable (92.3%) in mixed adenocarcinoma, complete resection rate was lower (53.8%) than in other types (P < 0.01) from pathological result after ESD. Additional surgery was performed in 4 patients with deep margin positivity or lymphovascular invasion.

www.selleckchem.com/products/chir-99021-ct99021-hcl.html Of 8 patients with lateral margin positivity, two were treated with endoscopic procedures and 6 were followed up with endoscopic surveillance. During follow-up period (mean ± SD, 47.3 ± 27.5 month), local recurrence was occurred in five mixed adenocarcinoma (19.2%) including 3 with and

2 without lateral GW-572016 cost margin positivity in pathological result from ESD. In multivariate analysis, the independent risk factors to predict local recurrence after ESD for EGC were incomplete resection (HR: 5.002, 95% CI 1.546–16.183, P = 0.007) and mixed adenocarcinoma of histological types (HR: 7.039, 95% CI 1.798–27.552, P < 0.01). Conclusion: Mixed adenocarcinoma according to modified WHO classification has higher possibility of incomplete resection and local recurrence after ESD for EGC. Moreover, it has more lateral margin positivity in pathological result than other histological types, suggesting the discrepancy between endoscopic finding and pathological size. Therefore, careful examination before ESD and meticulous and long-term endoscopic surveillance after ESD might be needed in mixed adenocarcinoma. Key Word(s): 1. Mixed adenocarcinoma; 2. Early gastric cancer;

3. WHO classification; 4. Local recurrence; Table 1. Comparison of clinicopathological characteristics among histological types of early gastric cancer   Mixed adenocarcinoma PCC Tubular/papillary adenocarcinoma P value *Significant difference in age, compared with tubular/papillary adenocarcinoma usign ANOVA Presenting Author: NIANDI TAN Additional Authors: JINHUI WANG, YINGLIAN XIAO, MINHU CHEN Corresponding Author: MINHU CHEN Affiliations: find more the first affiliated hospital of SYSU Objective: To evaluate the effect of peroral endoscopic myotomy (POEM) on esophageal morphology and motility in patients with achalasia(ACH). Methods: All consecutive patients with achalasia, who referred to our hospital from Jan. to Aug. 2012 and underwent POEM, were prospectively enrolled. Before and after POEM, all underwent esophageal manometry and some also had esophagography. Results: Fifteen patients (night male, age 38.7 ± 13.2 yr, symptom onset time 6.0 ± 7.2 yr, follow-up time 3.6 ± 2.7 month) successfully had POEM, without major complications. The esophageal diameter decreased significantly from 35.4 ± 9.2 cm to 26.9 ± 6.8 cm (P = 0.008). All had the high resolution manometry testing of Sandhill system, and based on results of ten 5 mL NS swallows in the supine position, 4 patients were classified as type I, 10 as type II and 4 as type III.

Conclusion: Chest CT scan for achalasia patients undergoing a POEM procedure can be used to detect early signs of postoperative bleeding, but routine

application is probably not warranted. The role in guiding the management of post-POEM pneumothorax who need intervention has to be studied further. Key Word(s): 1. POEM; 2. esophageal achalasia; 3. chest CT scan; Presenting Author: AKRAM POURSHAMS Additional Authors: ELHAM JAFARI Corresponding Author: AKRAM POURSHAMS Affiliations: Tehran University of Medical Sciences; Tehran University of Medical Sciences Objective: The incidence of esophageal squamous cell carcinoma (ESCC) shows geographic variation. Northeastern Iran (Golestan province) Sunitinib purchase has one of the highest incidences of ESCC in the world, over 50 per 100,000 person-years. Aim: to identify host and environmental risk factors associated with ESCC in northeastern Iran. Methods: we included published data of all ecologic, case-control studies, and the Golestan Cohort Study, (50,000 members) that conducted by the Digestive Disease Research Center of Tehran University of Medical Sciences (with collaboration of national selleck chemical and international cancer research centers) in the area during the last 13 years. Results: Socio-economic status was inversely

related to ESCC. The strongest inverse association was found with education. Poor oral health was also correlated to ESCC. A total of 16.7%, 13.7% and 0.7% of cohort members were current tobacco, opium and alcohol consumers respectively. Tobacco and opium use was strongly associated with ESCC in the case-control study but alcohol consumption was not. About 98% of the cohort participants drank black tea regularly, (mean volume >1 L/d), 39.0% drank their tea at temperatures less than 60°C, 38.9% at 60–64°C, and 22.0% at 65°C or higher. Drinking very hot tea was associated with increased risk of ESCC (OR: 8.16, 3.93–16.9). Fresh vegetable, fruit and Vitamin A intake were low especially in ESCC cases and rural dwellers.

Two cross sectional studies have confirmed high exposure of the general population to polycyclic aromatic hydrocarbons (PAHs). An ecologic study suggests that certain foods and cooking methods increase exposure to PAHs. In addition, levels selleck compound of PAH DNA adducts was significantly higher in ESCC tissues than in normal tissues of cases and healthy controls. The highest rate of TP53 mutations ever reported in any cancer was observed. Also a high rate of p16 hyper methylation was reported in ESCC tissues. A nonsense variant of BRCA2 was associated with higher ESCC risk with a frequency of 4.6% among cases and 0.8% among controls. No selenium deficiency was observed among cohort members. Contamination with carcinogenic mycotoxins was not found in raw rice, sorghum and wheat samples. The prevalence of the gluten-sensitive enteropathy was about 1%, so this disease is unlikely to be a risk for ESCC in the area.

Conclusion: Chest CT scan for achalasia patients undergoing a POEM procedure can be used to detect early signs of postoperative bleeding, but routine

application is probably not warranted. The role in guiding the management of post-POEM pneumothorax who need intervention has to be studied further. Key Word(s): 1. POEM; 2. esophageal achalasia; 3. chest CT scan; Presenting Author: AKRAM POURSHAMS Additional Authors: ELHAM JAFARI Corresponding Author: AKRAM POURSHAMS Affiliations: Tehran University of Medical Sciences; Tehran University of Medical Sciences Objective: The incidence of esophageal squamous cell carcinoma (ESCC) shows geographic variation. Northeastern Iran (Golestan province) ICG-001 price has one of the highest incidences of ESCC in the world, over 50 per 100,000 person-years. Aim: to identify host and environmental risk factors associated with ESCC in northeastern Iran. Methods: we included published data of all ecologic, case-control studies, and the Golestan Cohort Study, (50,000 members) that conducted by the Digestive Disease Research Center of Tehran University of Medical Sciences (with collaboration of national selleckchem and international cancer research centers) in the area during the last 13 years. Results: Socio-economic status was inversely

related to ESCC. The strongest inverse association was found with education. Poor oral health was also correlated to ESCC. A total of 16.7%, 13.7% and 0.7% of cohort members were current tobacco, opium and alcohol consumers respectively. Tobacco and opium use was strongly associated with ESCC in the case-control study but alcohol consumption was not. About 98% of the cohort participants drank black tea regularly, (mean volume >1 L/d), 39.0% drank their tea at temperatures less than 60°C, 38.9% at 60–64°C, and 22.0% at 65°C or higher. Drinking very hot tea was associated with increased risk of ESCC (OR: 8.16, 3.93–16.9). Fresh vegetable, fruit and Vitamin A intake were low especially in ESCC cases and rural dwellers.

Two cross sectional studies have confirmed high exposure of the general population to polycyclic aromatic hydrocarbons (PAHs). An ecologic study suggests that certain foods and cooking methods increase exposure to PAHs. In addition, levels click here of PAH DNA adducts was significantly higher in ESCC tissues than in normal tissues of cases and healthy controls. The highest rate of TP53 mutations ever reported in any cancer was observed. Also a high rate of p16 hyper methylation was reported in ESCC tissues. A nonsense variant of BRCA2 was associated with higher ESCC risk with a frequency of 4.6% among cases and 0.8% among controls. No selenium deficiency was observed among cohort members. Contamination with carcinogenic mycotoxins was not found in raw rice, sorghum and wheat samples. The prevalence of the gluten-sensitive enteropathy was about 1%, so this disease is unlikely to be a risk for ESCC in the area.

14 NFκB activation triggers the production of proinflammatory cytokines, whereas IRF3 phosphorylation leads to production of type I IFNs.14 The cellular source of the type I IFNs and inflammatory cytokines remains to be evaluated. Helicase receptors are expressed in several cell types in the liver, including hepatocytes, conventional dendritic cells, Kupffer cells, and NK cells.27, 28 RIG-I–like receptor expression is enhanced by poly(I:C).28 We found that hepatocytes selleck chemical that represent the majority of cells in the liver produce IFNβ after intracellular poly(I:C) stimulation in vitro (data not shown). The RIG-I/Mda5 pathway is also important in the conventional dendritic cells27 and NK cells,29 but less prominent

in plasmacytoid dendritic cells. Thus, we speculate that hepatocytes and conventional DCs are the likely sources of type I IFN production after dsRNA challenge in the liver. Previous studies demonstrated a role of NK cells in NASH.24 Here we found evidence for increased expression of the NK cell–activating ligands PanRae, Rae1α,

and Mult-1 in livers with steatohepatitis without a further increase after dsRNA stimulation. We also determined that NK cell recruitment was not triggered in livers with NASH, suggesting that the liver damage was unlikely to be NK cell–mediated after poly(I:C) challenge. Here we demonstrated that both type I IFNs and proinflammatory cytokine induction Cabozantinib ic50 were selectively disturbed in response to dsRNA, whereas TLR4- or TLR9-mediated pathways remained intact in steatohepatitis. This suggested that the signaling defects in fatty livers learn more occurred upstream from the branching of the NFκB and IRF3 signaling pathways and involved a protein that is common to both pathways upon

dsRNA stimulation. MAVS mediates the activation of both NFκB and IRF3 in response to viral infection.8 Here we show for the first time that total liver MAVS protein levels are decreased in steatohepatitis. Our data showed increased association of MAVS with the proteasome subunit PSMA7 in MCD-induced steatohepatitis, suggesting that proteosomal degradation could contribute to low MAVS levels. In this context, the apparent discrepancy between our finding of decreased MAVS protein and increased liver MAVS RNA could represent a compensatory feedback loop mechanism. Increased mRNA levels of MAVS and PSMA7 were also present in human livers with NASH. Impaired MAVS function was suggested by three of our novel observations. First, MAVS levels were decreased in the mitochondria with a complementary increase in the cytosol in the mouse model of steatohepatitis compared with control mice. Second, in parallel with the MAVS dissociation from the mitochondria, we found decreased MAVS oligomerization in livers of MCD diet–fed mice compared with control mice. Third, we found impaired induction of IRF3 phosphorylation by poly(I:C) in livers with steatohepatitis.

14 NFκB activation triggers the production of proinflammatory cytokines, whereas IRF3 phosphorylation leads to production of type I IFNs.14 The cellular source of the type I IFNs and inflammatory cytokines remains to be evaluated. Helicase receptors are expressed in several cell types in the liver, including hepatocytes, conventional dendritic cells, Kupffer cells, and NK cells.27, 28 RIG-I–like receptor expression is enhanced by poly(I:C).28 We found that hepatocytes Z-VAD-FMK ic50 that represent the majority of cells in the liver produce IFNβ after intracellular poly(I:C) stimulation in vitro (data not shown). The RIG-I/Mda5 pathway is also important in the conventional dendritic cells27 and NK cells,29 but less prominent

in plasmacytoid dendritic cells. Thus, we speculate that hepatocytes and conventional DCs are the likely sources of type I IFN production after dsRNA challenge in the liver. Previous studies demonstrated a role of NK cells in NASH.24 Here we found evidence for increased expression of the NK cell–activating ligands PanRae, Rae1α,

and Mult-1 in livers with steatohepatitis without a further increase after dsRNA stimulation. We also determined that NK cell recruitment was not triggered in livers with NASH, suggesting that the liver damage was unlikely to be NK cell–mediated after poly(I:C) challenge. Here we demonstrated that both type I IFNs and proinflammatory cytokine induction PD0325901 ic50 were selectively disturbed in response to dsRNA, whereas TLR4- or TLR9-mediated pathways remained intact in steatohepatitis. This suggested that the signaling defects in fatty livers selleck inhibitor occurred upstream from the branching of the NFκB and IRF3 signaling pathways and involved a protein that is common to both pathways upon

dsRNA stimulation. MAVS mediates the activation of both NFκB and IRF3 in response to viral infection.8 Here we show for the first time that total liver MAVS protein levels are decreased in steatohepatitis. Our data showed increased association of MAVS with the proteasome subunit PSMA7 in MCD-induced steatohepatitis, suggesting that proteosomal degradation could contribute to low MAVS levels. In this context, the apparent discrepancy between our finding of decreased MAVS protein and increased liver MAVS RNA could represent a compensatory feedback loop mechanism. Increased mRNA levels of MAVS and PSMA7 were also present in human livers with NASH. Impaired MAVS function was suggested by three of our novel observations. First, MAVS levels were decreased in the mitochondria with a complementary increase in the cytosol in the mouse model of steatohepatitis compared with control mice. Second, in parallel with the MAVS dissociation from the mitochondria, we found decreased MAVS oligomerization in livers of MCD diet–fed mice compared with control mice. Third, we found impaired induction of IRF3 phosphorylation by poly(I:C) in livers with steatohepatitis.

Finally, no recipient with a TG or GG genotype

of rs8099917 achieved SVR after they had been transplanted with liver graft from donors with TG or GG genotype of rs8099917. Achievement of ETR was also significantly associated Selleckchem Staurosporine with SNPs around the IL-28B gene. These findings indicate that IL-28B SNPs of both the recipients and the donors influence the response to PEG-IFN and RBV therapy after OLT. These genetic variations were also significantly associated with IL-28 mRNA expression in both the resected liver derived from the recipients and in the donated liver, as reported previously.17,20 In summary, these studies reveal that IL-28B genetic variation in both recipients and donors is associated with IFN sensitivity of HCV infection after OLT. By using a combination of genetic analyses, the efficacy of the post-transplantation PEG-IFN and RBV therapy can now be predicted before OLT. Characterization of IL-28B SNPs in both recipient and donor with HCV-RNA may be a reliable predictor of IFN efficacy in patients with recurrent hepatitis C after OLT. The IL-28B gene has been recently discovered and classified into type III IFN that is a member of the class II cytokine family.26,27IL-28B, referred to as IFN-λ3, belongs to IFN-λ

family, which consists of IL-29/IFN-λ1 and IL-28A/IFN-λ2, and IL-28B. IFN-λs are mainly produced by peripheral blood mononuclear cells (PBMCs) and dendritic cells.26,27 Its expression

is induced by IFN-α, viral infection, and/or stimulation of toll-like receptors (TLRs). Antiviral effects of IFN-λs against HCV were reported before the findings Fluorouracil in vitro by GWAS. In vitro treatment with IFN-α, see more or IFN-λ1 inhibited HCV replication at similar low concentrations.28 Combination treatment with IFN-α and IL-29/28A enhanced the antiviral effect against HCV replicon synergistically.29 As described above, HCV replication is inhibited by the antiviral effects of IFN-λ. A pegylated IFN-λ1 has already been tried against chronic hepatitis C in phase 2 trials.30,31 Interestingly, impressive antiviral effects (at least as good as with PegIFN-α) were observed but with fewer and less severe side effects.31 The expression pattern of IFN-λ receptor is restricted in specific tissues. High expression levels can be observed in the pancreas, liver, prostate, or thyroid, whereas central nervous system and bone marrow show only low level expression.26,27 These results could explain why the use of IFN-lambda seems to cause less severe toxicity than that induced by IFN-α/β. Genome-wide association studies have provided unexpectedly strongly positive results about the genetic factor associated with response to HCV IFN-based antiviral therapy, as well as spontaneous clearance of HCV. These findings imply a previously unsuspected role of IL-28B in the response of humans to HCV infection.

General medical psychology classifies many physical symptoms and phenomena as psychological phenomena, so the so-called anti-anxiety, anti-anti-depression and anti-schizophrenia drugs, which provide good effects in the treatment of physical illnesses, can be considered as

psychology-adjusting drugs or neurotransmitter-modulating drugs. They can treat physical and mental illnesses by modulating neurotransmitters. Romidepsin concentration In this way, the transformation of medical model will be completed automatically. The etiology of psychological factors should be developed. After the establishment of the general medical psychology, psychological factors should become the cause of more than half of non-psychiatric disorders and most mental disorders, and will be precipitating factors for most diseases. Therefore, health care workers must pay attention to whether their every action, every word, and even a noun or a term

throughout their clinical work can have influence on patient’s BMN673 psychological activities. Only in this way, can iatrogenic disease be greatly reduced, and can every doctor be integrated into the bio-psychological model. The disorder caused by psychological factors-related disciplines should be established. For example, the digestive disorder caused by psychological factors is not a disease by itself, but refers to a category of disorders with the same etiology. Most digestive disorders, such as functional dyspepsia (FD) and peptic ulcer disease, are caused by psychological factors. The establishment of this concept can not only eliminate the misunderstanding between “psychological” and “mental”, but also allow the proper application of neurotransmitter-modulating drugs properly in the treatment selleck inhibitor of digestive diseases. In addition, it

is conducive to the study on the pathogenesis and treatment of the digestive disorder caused by psychological factors. Conclusion: The traditional biomedical model is developed from the evidence of biological (such as bacteria) pathogenicity and the effectiveness of its corresponding treatment. For it is intuitive and is based on a long period of treatment practice, it is very important, and must always be followed. On the other hand, because the bio-psychological model is abstract, and “psychological” is confused with “mental”, it is not understood by both doctors and patients. The instruction of psychology-adjusting drugs is limited to psychiatric disorders, resulting in extreme difficulties in the transformation of medical model. As long as the general medical psychology system is established, psychological factors are identified as a major cause of disease, the disorder caused by psychological factors-related disciplines are developed, and the drug instructions are continually modified and improved through clinical practice, the transformation of medical model will be realized inevitably.

1-year cumulative incidence rate of appearance of arterial flow in those nodules, 1-year cumulative incidence rate of diagnosis of HCC in the nodules and in the patients was analyzed. Result: 43 patients with 58 nodules were analyzed.22 male and 21 females were included. Median size

of the nodules was 9mm (range 4-15mm). Median observation period was 522 days (range 126-1580days).1-year cumulative incidence rate of appearance of arterial flow in those nodules was 8.6%.1-year cumulative incidence rate of diagnosis of HCC in the nodules was 17.2%.1-year cumulative incidence rate of diagnosis of HCC in the patients was 18.6%. Conclusion: Sorafenib nmr 1year cumulative incidence rate of diagnosis of HCC in the nodules less than 15mm that show hypovascular in arterial phase and hypointense in hepatobiliary phase was low. The follow-up may be better for those nodules. Disclosures: The following people have nothing to disclose: Yoshihiko Ooka, Fumihiko Kanai, Sadahisa Ogasawara, Tenyu Motoyama, Eiichiro Suzuki, Akinobu Tawada, Tetsuhiro Chiba, Osamu Yokosuka Background and Aim: Accurate tumor staging for see more hepatocellular carcinoma (HCC) has become increasingly important with treatment advances. In extrahepatic metastasis (EHM) cases, radical treatment was not indicated previously,

but sorafenib has been recently recommended. In advanced stages, although 18F-fiudeoxygIucose-positron emission tomography (FDG PET) can detect intra- and extrahepatic lesions with a single noninvasive scan, when this scan should be performed to determine treatment strategies is not clear. To set the indices for PET timing, we analyzed the clinical characteristics of HCC patients with FDG-avid primary lesions (PL) or EHM. Methods: Data from 64

consecutive HCC patients who underwent PET between April 2005 and November 2012 were retrospectively analyzed. The patient cohort selleck chemical had a median age of 74 [49-87] years; 41 men and 23 women; 7 initial occurrences and 57 recurrences; 14 chronic hepatitis and 50 cirrhosis cases; 46 HCV, 4 HBV, 4 alcoholic, 3 NASH, 1 AIH, and 6 unknown cases; and 15 Barcelona Clinic Liver Cancer (BCLC) stage 0, 26 stage A, 10 stage B, 12 stage C, and 1 stage D cases. Patients were not treated for HCC for a month before PET. Univariate and multivariate analyses were used to determine the factors associated with FDG-avid PL or EHM detection. Results: The sensitivity, specificity, and accuracy of PET were 36%, 100%, and 39% for detecting PLs (p = 0.276) and 88%, 75%, and 80% for detecting EHMs (p < 0.0001), respectively. PET detected FDGavid PLs in 34% of cases (22/64: 82% [18/22], hypervascular PLs; 50% [11/22], serum a-fetoprotein levels [AFP] \≤ 200 ng/mL, and 50% [11/22], beyond the Milan criteria).

This was undoubtedly true initially when many laboratories were using the test tube tilt method in the water bath to measure FVIII:C, but now with the advent of full automation Selleckchem Carfilzomib the

same may not apply. Despite these labelling differences, initially this was not a problem because plasma-derived and the first-generation recombinant FVIII concentrates were full length molecules and gave equivalent results. The introduction of the B-domain-deleted product sold as ReFacto AF® in Europe and Xyntha® in the USA caused a problem for both manufacturers and clinical laboratories because the one-stage clotting assay gave results that were 20% lower than the chromogenic. Because of the regulatory preference in the USA the product is labelled with the one-stage clotting assay and in Europe with the chromogenic assay that resulted in the unusual current situation where 1 unit of Xyntha® is equal to 1.38 units of ReFacto AF, even though the two products are the same and come out of the same factory [8]. Measurement by clinical laboratories has continued

using the one-stage assay. Some European laboratories use a product-specific standard provided by the manufacturer that corrects the discrepancy making the one-stage results equivalent to the chromogenic assay. Product-specific standards are, however, not used in the USA possibly because the higher protein content of Xyntha does not result in clinical problems. Recently, a new recombinant CHIR-99021 chemical structure BDD product, NovoEight® (turoctocog alfa) has been licensed check details in the USA and Europe by NovoNordisk. Despite the fact that this is also a BDD product, one chromogenic and a single APTT reagent one-stage clotting assay yielded equivalent results so a product-specific standard may not be required [9]. It is not clear why the two licensed BDD behave differently in the one-stage clotting assay but it is possible that it is due to the different degrees

of B-domain deletion of the two products with Xyntha/Refacto AF having 8 B-domain amino acids whereas NovoEight® has 22 B-domain aminoacids [10]. This is an important issue because most of the new recombinant FVIII concentrates are BDD products with different lengths of residual B-domain segments retained. A major change is about to take place in the field of haemophilia with the introduction of the long-acting concentrates. At least five different products are in development and all but one are BDD products. The concentrates from Bayer, Biogen Idec, CSL Behring and NovoNordisk are BDD while the Baxter product is full-length FVIII. Two important issues are how should these products be potency labelled and how should they be assayed by clinical laboratories. International guidelines on potency labelling of factor VIII and IX concentrates have been published [11]. To understand this issue better, in November 2013. the EMA organized a workshop between manufacturers, clinicians, patient groups and regulators. A full report will be published by the EMA in due course.

This was undoubtedly true initially when many laboratories were using the test tube tilt method in the water bath to measure FVIII:C, but now with the advent of full automation PF-02341066 clinical trial the

same may not apply. Despite these labelling differences, initially this was not a problem because plasma-derived and the first-generation recombinant FVIII concentrates were full length molecules and gave equivalent results. The introduction of the B-domain-deleted product sold as ReFacto AF® in Europe and Xyntha® in the USA caused a problem for both manufacturers and clinical laboratories because the one-stage clotting assay gave results that were 20% lower than the chromogenic. Because of the regulatory preference in the USA the product is labelled with the one-stage clotting assay and in Europe with the chromogenic assay that resulted in the unusual current situation where 1 unit of Xyntha® is equal to 1.38 units of ReFacto AF, even though the two products are the same and come out of the same factory [8]. Measurement by clinical laboratories has continued

using the one-stage assay. Some European laboratories use a product-specific standard provided by the manufacturer that corrects the discrepancy making the one-stage results equivalent to the chromogenic assay. Product-specific standards are, however, not used in the USA possibly because the higher protein content of Xyntha does not result in clinical problems. Recently, a new recombinant ABT-263 mw BDD product, NovoEight® (turoctocog alfa) has been licensed selleck kinase inhibitor in the USA and Europe by NovoNordisk. Despite the fact that this is also a BDD product, one chromogenic and a single APTT reagent one-stage clotting assay yielded equivalent results so a product-specific standard may not be required [9]. It is not clear why the two licensed BDD behave differently in the one-stage clotting assay but it is possible that it is due to the different degrees

of B-domain deletion of the two products with Xyntha/Refacto AF having 8 B-domain amino acids whereas NovoEight® has 22 B-domain aminoacids [10]. This is an important issue because most of the new recombinant FVIII concentrates are BDD products with different lengths of residual B-domain segments retained. A major change is about to take place in the field of haemophilia with the introduction of the long-acting concentrates. At least five different products are in development and all but one are BDD products. The concentrates from Bayer, Biogen Idec, CSL Behring and NovoNordisk are BDD while the Baxter product is full-length FVIII. Two important issues are how should these products be potency labelled and how should they be assayed by clinical laboratories. International guidelines on potency labelling of factor VIII and IX concentrates have been published [11]. To understand this issue better, in November 2013. the EMA organized a workshop between manufacturers, clinicians, patient groups and regulators. A full report will be published by the EMA in due course.