Risk factors for hepatocellular carcinoma in patients with drug-resistant chronic hepatitis B

AIM:To investigate the risk factors and characteristics of hepatocellular carcinoma(HCC) in the patients with drug-resistant chronic hepatitis B(CHB).METHODS:A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004to December 2012. The patients were divided into two groups:the HCC group(n = 57) and the non-HCC group(n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC.Secondarily,patient and tumor characteristics of HCC patients with na ve CHB(N group,n = 117) were compared to the HCC group(R group,n = 57) to identify any difference in HCC characteristics between them.RESULTS:A significant difference was found for age,platelet count,alpha-fetoprotein(AFP),positivity of HBeAg,seroconversion rate of HBeAg,virologic response,the Child-Pugh score,presence of rtM204I,and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis,age(> 50 years),HBeAg(+),virologic non-responder status,and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein(CRP) and AFP levels,earlier stage tumors,and a shorter mean tumor surveillance period than the N group. However,the total follow-up duration was not significantly different between the two groups.CONCLUSION:13.2% of patients with drug-resistant CHB developed HCC. Age,cirrhosis,YIDD status,HBeAg status,and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.

Clinical significance and risk factors of postembolization fever in patients with hepatocellular carcinoma

AIM:To investigate tumor response and survival in patients with postembolization fever(PEF) and to determine the risk factors for PEF.METHODS:Four hundred forty-three hepatocellular carcinoma(HCC) patients who underwent the first session of transcatheter arterial chemoembolization(TACE) between January 2005 and December 2009 were analyzed retrospectively.PEF was defined as a body temperature greater than 38.0 ℃ that developed within 3 d of TACE without evidence of infection.The tumor progression-free interval was defined as the interval from the first TACE to the second TACE based on mRECIST criteria.Clinical staging was based on the American Joint Committee on Cancer tumor,node,metastases(TNM) classification of malignant tumors.All patients were admitted before their 1 st TACE treatment,and blood samples were obtained from all patients before and after treatment.Clinicoradiological variables and host-related variables were compared between two groups:patients with PEF vs patients without PEF.Additionally,variables related to 20-mo mortality and tumor progression-free survival were analyzed.RESULTS:The study population comprised 370(85.4%) men and 73(14.6%) women with a mean age of 62.29 ± 10.35 years.A total of 1836 TACE sessions were conducted in 443 patients,and each patient received between 1 and 27(mean:4.14 ± 3.57) TACE sessions.The mean follow-up duration was 22.23 ± 19.6 mo(range:0-81 mo).PEF developed in 117 patients(26.41%) at the time of the first TACE session.PEF was not associated with 20-mo survival(P = 0.524) or computed tomography(CT) response(P = 0.413) in a univariate analysis.A univariate analysis further indicated that diffuse-type HCC(P = 0.021),large tumor size(≥ 5 cm)(P = 0.046),lipiodol dose(≥ 7 mL,P = 0.001),poor blood glucose control(P = 0.034),alanine aminotransferase(ALT) value after TACE(P = 0.004) and C-reactive protein(CRP) value after TACE(P = 0.036) served as possible risk factors correlated with PEF.The ALT value after TACE(P = 0.021) and lipiodol dose over 7 mL(P = 0.011) were independent risk factors for PEF in the multivariate analysis.For the 20-mo survival,poor blood sugar control(P < 0.001),portal vein thrombosis(P = 0.001),favorable CT response after TACE(P < 0.001),initial aspartate aminotransferase(P = 0.02),initial CRP(P = 0.042),tumor size(P < 0.001),TNM stage(P < 0.001) and lipiodol dose(P < 0.001) were possible risk factors in the univariate analysis.Tumor size(P = 0.03),poor blood sugar control(P = 0.043),and portal vein thrombosis(P = 0.031) were significant predictors of survival in the multivariate analysis.Furthermore,the tumor progression-free interval was closely associated with CRP > 1 mg/dL(P = 0.003),tumor size > 5 cm(P < 0.001),tumor type(poorly defined)(P < 0.001),and lipiodol dose(> 7 mL,P < 0.001).CONCLUSION:PEF has no impact on survival at 20 mo or radiologic response.However,the ALT level after TACE and the lipiodol dose represent significant risk factors for PEF.

Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease

AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.

Metastasis of hepatocellular carcinoma to the small bowel manifested by intussusception

Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.

Randomized controlled trial to evaluate the efficacy and safety of fexuprazan compared with esomeprazole in erosive esophagitis

BACKGROUND Fexuprazan,a novel potassium-competitive acid blocker,reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells.Fexuprazan’s suppression of gastric acid was maintained in healthy individuals for 24 h in a dose-dependent manner.AIM To compare fexuprazan to esomeprazole and establish its efficacy and safety in patients with erosive esophagitis(EE).METHODS Korean adult patients with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg or esomeprazole 40 mg once daily for eight weeks.The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy at week 8.The secondary endpoints included the healing rate of EE at week 4,symptom response,and quality of life assessment.Safety profiles and serum gastrin levels were compared between the groups.RESULTS Of the 263 randomized,218 completed the study per protocol(fexuprazan 40 mg,n=107;esomeprazole 40 mg,n=111).Fexuprazan was non-inferior to esomeprazole regarding the healing rate at week 8[99.1%(106/107)vs 99.1%(110/111)].There were no between-group differences in the EE healing rate at week 4[90.3%(93/103)vs 88.5%(92/104)],symptom responses,and quality of life assessments.Additionally,serum gastrin levels at weeks 4 and 8 and drug-related side effects did not significantly differ between the groups.CONCLUSION Fexuprazan 40 mg is non-inferior to esomeprazole 40 mg in EE healing at week 8.We suggest that fexuprazan is an alternative promising treatment option to PPIs for patients with EE.

Underwater endoscopic mucosal resection for neoplasms in the pyloric ring of the stomach: Four case reports

BACKGROUND Tumors located in the pylorus are technically more complex to resect by endoscopic resection,as the anatomical characteristics of this region can affect the adequate assessment of margins and performance of the procedure.We reported the results of underwater endoscopic mucosal resection(UEMR)of benign mucosal neoplasms located in the pyloric ring.CASE SUMMARY This case series describes 4 patients with 4 mucosal neoplasms located in the pyloric ring.The diameter of each neoplasm was less than 15 mm.We performed UEMR for the lesions.Water immersion enabled slight floating of the lesions,resulting in easy identification.We achieved en bloc resection with a snare and electrosurgical unit.All procedure were performed within 3 min without adverse events.Pathologic examination showed low-grade dysplasia with clear resection margins in one case and hyperplastic polyps in three cases.CONCLUSION UEMR can be an effective and safe treatment method for neoplasms in the gastric pyloric ring.

Effect of Dioscorea batatas on longitudinal bone growth rate in adolescent female rats

OBJECTIVE The root of Dioscorea batatas,rich in steroidal saponins,alkaloids,tannins,phytosterols,and starch,is an herbal medicine of tonifying qi and nourishing stomach after invigorating spleen with a long history of safe use for treatment of chronic dysentery and weakness of the spleen and stomach in Korea.This study was aimed to investigate the effect of D.batatas on longitudinal bone growth rate in adolescent female rats.METHODS D.batatas was extracted with 30% EtOH for 3h at 90℃in a reflux apparatus.In two groups,we administered a twice daily dosage of D.batatas extract(at 30 and 300mg·kg-1,respectively)per os for 4d,and in a control group,we administered vehicle only under the same conditions.Recombinant human growth hormone(rhGH)was subcutaneously injected once daily.All rats were born at same day(33d-old).On day 3,tetracycline was injected intraperitoneally to form a fluorescent band on the growth plates.RESULTS The bone growth rate in groups administered D.batatas 300mg·kg-1 and rhGH was significantly increased to 343.8±20.7,and 359.6±30.2μm·d-1 respectively from control group,320.7±23.2μm·d-1.No difference was observed in the amount of food intake or mean body weight among all groups during the acclimation or administration period.CONCLUSION These results suggest that D.batatas extracts have the potential to induce height increase;however,further research,including clinical trials,is necessary.

Effects of Angelica sinensis on longitudinal bone growth rate in adolescent female rats

OBJECTIVE To investigate the effect of A.sinensis on longitudinal bone growth rate in adolescent female rats.METHODS A.sinensis was extracted with 30% EtOH for 3h at 90℃in a reflux apparatus.Female Sprague-Dawley rats(33d-old)were randomly divided into three groups:control(vehicle),recombinant human growth hormone(rhGH;20μg·kg-1·d-1),and A.sinensis(300mg·kg-1·d-1).A.sinensis extracts or vehicle was administered orally twice daily for 4d.Longitudinal bone growth rate in newly synthesized bone was observed using tetracycline labeling(20mg·kg-1,intraperitoneally).RESULTS A.sinensis significantly increased longitudinal bone growth rate in adolescent female rats at 300mg·kg-1(6.1%,357.34±32.67μm·d-1)compared to control group(336.80±14.47μm·d-1).CONCLUSION A.sinensis extract significantly increased longitudinal bone growth rate and growth plate height in adolescent female rats.These results suggest that A.sinensis could be helpful for increasing bone growth rate in children who have growth retardation.

Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.

Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report

BACKGROUND Cytomegalovirus(CMV)colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection,solid organ transplant,inflammatory bowel disease,or malignancy.Therefore,many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients.We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient.CASE SUMMARY A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation.Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon.Initial sigmoidoscopic findings and result of polymerase chain reaction(PCR)for CMV revealed the compatible findings of CMV colitis,the patient was treated with intravenous ganciclovir.After treatment,sigmoidoscopic findings and CMV PCR results improved.However the patient continued to suffered from constipation.Eight months after the initial admission,patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation.We performed subtotal colectomy to control patient’s symptom.Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon.CONCLUSION Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease,and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.

Pancreatic pseudocystocolonic fistula treated without surgical or endoscopic intervention

We report here a case of pancreatic pseudocystocolic fistula that was treated without surgical or endoscopic intervention.A 76-year-old woman,presenting with a fever and epigastric pain,was referred to our institution.Three months prior to this admission,the patient had been admitted to the hospital for acute pancreatitis.Abdominal computerized tomography(CT)revealed a 9 cm pseudocyst containing air,and a fistular opening was observed via colonoscopy.After colonoscopy,the abdominal pain was slightly improved,the fever subsided and laboratory results showed decreased C-reactive protein levels.The observed improvement was likely due to the cleansing of the bowel,which induced spontaneous drainage from the pseudocyst into the colon.Antibiotic therapy was administered and daily bowel cleansing was performed using a polyethylene glycol solution.After three weeks,a follow-up CT revealed that the size of the pseudocyst had decreased significantly from 9 to 5.3 cm.In addition,laboratory tests were improved.The patient was able to resume a normal diet and was discharged in good overall health from the hospital,without aggravation of the symptoms.A colonoscopy performed 3 mo later and a follow-up CT performed 6 mo later confirmed that both the fistula and pseudocyst had completely disappeared.

Protective effect of sulfated polysaccharides from a Celluclast-assisted extract of Hizikia fusiforme against ultraviolet B-induced photoaging in vitro in human keratinocytes and in vivo in zebrafish

Our previous study evaluated the in vitro and in vivo antioxidant activities of sulfated polysaccharides from a Celluclastassistedextract of Hizikia fusiforme (HFPS). The results indicate that HFPS possesses potent antioxidant activity and suggestthe potential use of HFPS to combat photoaging. In this study, we investigated the ultraviolet (UV) protective effect of HFPSin vitro in keratinocytes (HaCaT cells) and in vivo in zebrafish. The results indicate that HFPS significantly reduced thelevel of intracellular reactive oxygen species (ROS) and improved the viability of UVB-irradiated HaCaT cells. In addition,HFPS remarkably decreased apoptosis formation in UVB-irradiated HaCaT cells in a dose-dependent manner. The in vivotest results also demonstrate that HFPS significantly reduced intracellular ROS levels, cell death, NO production, and lipidperoxidation levels in UVB-irradiated zebrafish in a dose-dependent manner. These results suggest that HFPS possessesstrong in vitro and in vivo UV-protective effects, making it a potential ingredient in the cosmeceutical industry.

Detection and pathogenesis of a novel swine H3N2 influenza virus containing three genes from the 2009 pandemic H1N1 influenza viruses in Korea in 2015

Dear Editor,Influenza A viruses cause pandemics at an interval of approximately 10-40 years,and pigs are regarded as a＂mixing vessel＂because they are easily infected with avian and human influenza viruses（Ito et al.,1998）.According to previous studies,H3N2,H1N2,and H1N1 subtypes o（swine influenza viruses have been detected in Korean pigs （Pascua et al., 2013; Kim et al., 2014; Song et al., 2007）. Moreover, a novel H3N2 influenza virus containing the matrix （34） gene from a 2009 pandemic influenza virus was detected in Korean pigs in 2013 （Pascua et al., 2013）, an H1N2 influenza virus con- taining the internal genes from a 2009 pandemic influ- enza virus was found in Korean pigs in 2014 （Kim et al., 2014）, and an H1N1 influenza virus containing all genes from the classical swine influenza viruses was isolated from Korean pigs in 2007 （Song et al., 2007）.