Contrast-enhanced ultrasonography for the evaluation of liver fibrosis after biliary obstruction

AIM:To investigate perfusion change in contrastenhanced ultrasonography(CEUS) to evaluate liver fibrosis based on biliary obstruction using an animal model.METHODS:New Zealand white rabbits(3-4 kg) underwent bile duct ligation to form a biliary obstruction model.We performed liver CEUS and laboratory tests on the day before the operation(day 0) and every 7 postoperative days until the rabbits were sacrificed.After CEUS,signal intensity of liver parenchyma with a time-intensity curve was analyzed.Perfusion parameters were automatically calculated from regionof-interests,including peak signal intensity,mean transit time,area under the curve and time to peak.Histological grades of liver fibrosis were assessed according to the Metavir score system immediately after sacrifice.Generalized estimating equations were used to analyze the association between liver fibrosis grades and perfusion parameters for statistical analysis.The perfusion parameters were measured on the last day and the difference between day 0 and the last day were evaluated.RESULTS:From the nine rabbits,histological grades of liver fibrosis were grade 1 in one rabbit,grade 2 and 3 in three rabbits each,and grade 4 in two rabbits.Among the four CEUS parameters,only the peak signal intensity measured on the last day demonstrated a significant association with liver fibrosis grades(OR =1.392,95%CI:1.114-1.741,P =0.004).The difference in peak signal intensity between day 0 and the last dayalso demonstrated an association with liver fibrosis(OR =1.191,95%CI:0.999-1.419,P =0.051).The other parameters tested,including mean transit time,area under the curve,and time to peak,showed no significant correlation with liver fibrosis grades.CONCLUSION:This animal study demonstrates that CEUS can be used to evaluate liver fibrosis from biliary obstruction using peak signal intensity as a parameter.

Similar clinical characteristics of familial and sporadic inflammatory bowel disease in South Korea

AIM:To investigate differences of clinical characteristics and disease courses between familial and sporadic inflammatory bowel disease(IBD)patients.METHODS:We obtained clinical data on Crohn’s disease(CD)(n=691)and ulcerative colitis(n=1113)from a tertiary referral medical center between 2005and 2012.Seventeen patients(2.5%)with CD and27 patients(2.4%)with ulcerative colitis(UC)were identified as having a familial history of IBD,including the first and second degree relatives.For each control case,three times the number of age-,sex-,and diagnosis year-matched CD and UC patients,without a family history of IBD,were randomly selected in this case control study.RESULTS:There were no significant differences in age or main symptom at diagnosis,extraintestinal manifestation,location/extent,behavior of disease activity,number of hospitalizations,number of operations,operation type,number of relapses,or oral medical treatment between familial and sporadic CD and UC patients.Median(min-max)follow-up periods after diagnosis of familial CD and sporadic CD patients were 84(24-312)and 36(8-240)mo,respectively(P=0.008).Familial CD patients more frequently used anti-tumor necrosis factor(TNF)antibodies compared to sporadic CD patients(17.6%vs 0%,P=0.014).CONCLUSION:In conclusion,a family history of IBD does not seem to be an important predictive factor affecting clinical characteristics or disease course even if there is a more frequent use of anti-TNF antibodies in familial CD patients compared to sporadic CD patients.

Comparison of double pants with single pants on satisfaction with colonoscopy

AIM: To increase satisfaction and diminish anxiety and shame during colonoscopy, we developed novel double pants (NDP) which consist of doubled fabrics with an inner hole. The aim of study was to compare satisfaction, anxiety and shame between NDP and conventional single pants (CSP). METHODS: Total 160 consecutive examinees were randomly divided into NDP and CSP group. Before colonoscopy, questionnaires identifying state and trait anxiety were completed. After colonoscopy, questionnaires for overall satisfaction (Group Health Association of America 9) and pants-specific satisfaction (5-20), state anxiety (20-80), and shame (6-24) were interviewed. RESULTS: Pants-specific satisfaction scores regarding willingness to repeat colonoscopy using same pants (3.3 ± 0.8 vs 2.1 ± 0.9, P < 0.001) and recommendation of same pants to other people (3.3 ± 0.7 vs 2.0 ± 1.0, P < 0.001) were significantly higher in NDP than CSP groups. State anxiety (33.0 ± 7.0 vs 35.4 ± 6.9, P = 0.028) and shame (6.6 ± 1.5 vs 8.1 ± 3.2, P = 0.001) after colonoscopy was lower in NDP group compared with CSP group. CONCLUSION: The NDP contribute to increase satisfaction and decrease anxiety and shame after colonoscopy.