Histologic characteristics of gastric polyps in Korea: Emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen

瞄准：在朝鲜人口调查胃的息肉的组织学的特征。方法：我们与胃的息肉考察了内视镜的相片和病人的医药记录通过 2003 年 2 月从 1996 年 4 月经历了内视镜的粘膜切除术。结果：从 74 个病人的 85 胃的息肉的一个总数被考察。Male-to-female 比率是 1:1.96。吝啬的年龄是 59.9 +/- 10.8 年。多重息肉在 10.8% 被观察。胃的息肉最经常发生在窦(58.8%) 。resected 标本上的病理学的结果如下：管状腺瘤 45.9% ，增生的息肉 31.8% ，煽动性的息肉 9.4% ，错构瘤 3.5% ，底的腺息肉 2.4% ， tubulovillous 腺瘤 2.4% ，腺癌 2.4% ，发育异常 1.1% ，并且粘膜 pseudolipomatosis 1.1% 。在 resected 标本的内视镜的活体检视和病理之间的差异率是 27.1% 。在息肉和词语索引率的尺寸之间没有关系。结论：在在内视镜的钳活体检视和 resected 标本之间的 histologic 调查结果有可观的差异。全部息肉的组织学的评论的途径应该被执行，特别当一个腺瘤被怀疑时。

Management of entecavir-resistant chronic hepatitis B with adefovir-based combination therapies

AIM: To evaluate the long-term efficacy adefovir(ADV)-based combination therapies in entecavir(ETV)-resistant chronic hepatitis B(CHB) patients. METHODS: F i fty CHB pat ient s wi t h genotypic resistance to ETV at 13 medical centers in South Korea were included for the analysis. All the patients received rescue therapy with the combination of ADV plus ETV(ADV/ETV,n = 23) or ADV plus lamivudine(LMV)(ADV/LMV,n = 27) for more than 12 mo. Patients were monitored at least every 3-4 mo during ADV-based combination therapy by clinical examination as well as biochemical and virological assessments. Hepatitis B virus(HBV) DNA levels were measured by realtime PCR and logarithmically transformed for analysis. Cumulative rates of virologic response(VR; HBV DNA < 20 IU/m L) were calculated using the Kaplan-Meier method,and the difference was determined by a logrank test. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors significantly associated with short-term and long-term VR,respectively.RESULTS: Baseline median HBV DNA levels were 5.53(2.81-7.63) log10 IU/m L. The most commonly observed ETV genotypic mutation sites were rt184 and rt202. Patients were treated for a median of 27(12-45) mo. Overall,cumulative VR rates at 6,12,24,and 36 mo were 26%,36%,45%,and 68%,respectively. Patients treated with the ADV/ETV combination showed higher cumulative VR rates(35%,43%,65%,and 76%,respectively) than those with the ADV/LAM combination(18%,30%,30%,and 62%,respectively; P = 0.048). In the multivariate analysis,low baseline HBV DNA levels(< 5.2 log10 IU/m L) and initial virologic response at 3 mo(IVR-3; HBV DNA < 3.3 log10 IU/m L after 3 mo) were independent predictive factors for VR. Patients with favorable predictors achieved cumulative VR rates up to 90% at 36 mo. During the same period,the cumulative incidence of virologic breakthrough was as low as 6% in patients with the both favorable predictors.CONCLUSION: If tenofovir is not available,ADV/ETV combination could be considered in ETV-resistant patients with low HBV DNA titers,and may becontinued if IVR-3 is achieved.

Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding

AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.

Prognostic role of plasma level of angiopoietin-1,angiopoietin-2,and vascular endothelial growth factor in hepatocellular carcinoma

BACKGROUND Most hepatocellular carcinomas(HCCs)are hypervascular,with characteristic features of hepatic arterial supply to the tumor.The factors involved in tumor angiogenesis include angiopoietin-1(Ang-1),angiopoietin-2(Ang-2),and vascular endothelial growth factor(VEGF).AIM To investigate the profiles of plasma levels of angiogenesis markers in patients with HCC and evaluate their roles in predicting overall survival(OS)and progression-free survival(PFS).METHODS Plasma samples from 240 prospectively enrolled HCC patients in the very early to advanced stages were used to measure the levels of Ang-1,Ang-2,and VEGF.Their associations with clinical characteristics,OS,and PFS were analyzed.RESULTS The median plasma levels of Ang-1,Ang-2,and VEGF were 3216 pg/mL,1684 pg/mL,and 26.5 pg/mL,respectively.The plasma level of Ang-2 showed a significant increase from early stage[Barcelona clinic liver cancer(BCLC)A]to intermediate(BCLC B)and advanced stage HCC(BCLC C/D),whereas Ang-1,VEGF,and alpha-fetoprotein(AFP)levels in the plasma did not show any such changes.Multivariable analysis,propensity score-matched analysis,and timedependent receiver operating curve analysis revealed that Ang-2 levels had the highest predictive power for OS and PFS.Neither Ang-1 nor VEGF was significantly associated with OS or PFS.The neutrophil-to-lymphocyte ratio was an independent factor for OS and PFS.CONCLUSION The plasma levels of Ang-2 correlated with liver function,tumor stage,and tumor invasiveness,showing better performance in predicting OS and PFS than AFP,Ang-1,or VEGF.

The effect of diet-induced insulin resistance on DNA methylation of the androgen receptor promoter in the penile cavernosal smooth muscle of mice

Population studies have suggested an association between diabetes and the symptoms of testosterone deficiency. Recently, the expression of the androgen receptor （AR） has been shown to be decreased in diabetic patients. Furthermore, diabetes has been shown to induce global methylation. In this study, we used an animal model to investigate whether diabetes results in increased methylation of the AR promoter and whether these changes are associated with the decreased expression of AR in penile cavernosal smooth muscle tissue. Twenty C57BL/6J mice were divided into two groups, receiving either high- （mature diabetic） or low- （mature control） caloric meals for 14 weeks. Another 10 mice were killed at 1 week （young control）. Animals in the mature diabetic group showed decreased testosterone levels, although this was not statistically significant. In both control groups, no significant methylation was observed in the AR promoter region CpG island （-85 to ＋339）. In the mature diabetic group, significant methylation was observed at ＋ 185 and ＋200 of the AR promoter. These changes were associated with increased homeostatic model assessment for insulin resistance （HOMA-IR） and decreased corpus cavernosal tissue mass and expression of AR mRNA and protein. We conclude that in these animals, insulin resistance increased the methylation of the GC-rich regions of the AR promoter, leading to decreased AR expression.

Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection

AIM To clarify the prevalence of occult hepatitis B virus(HBV) infection(OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma(HCC), worsening of Child-Pugh class, or mortality in cases of chronic hepatitis C virus(HCV) infection. METHODS This prospective cohort study enrolled 174 patients with chronic HCV infection(chronic hepatitis, n = 83; cirrhosis, n = 47; HCC, n = 44), and evaluated disease progression during a mean follow-up of 38.7 mo. OBI was defined as HBV DNA positivity in 2 or moredifferent viral genomic regions by nested polymerase chain reaction using 4 sets of primers in the S, C, P and X open reading frame of the HBV genome. RESULTS The overall OBI prevalence in chronic HCV patients at enrollment was 18.4%, with 16.9%, 25.5% and 13.6% in the chronic hepatitis C, liver cirrhosis and HCC groups, respectively(P = 0.845). During follow-up, 52 patients showed disease progression, which was independently associated with aspartate aminotransferase > 40 IU/L, Child-Pugh score and sustained virologic response(SVR), but not with OBI positivity. In 136 patients who were not in the SVR state during the study period, OBI positivity was associated with neither disease progression, nor HCC development. CONCLUSION The prevalence of OBI in chronic HCV patients was 18.4%, and OBI was not associated with disease progression in South Koreans.