A comparative review of HLA associations with hepatitis Band C viral infections across global populations

Hepatitis B （HBV） and hepatitis C （HCV） viral infection or co-infection leads to risk of development of chronic infection, cirrhosis and hepatocellular carcinoma （HCC）. Immigration and globalization have added to the challenges of public health concerns regarding chronic HBV and HCV infections worldwide. The aim of this study is to review existing global literature across ethnic populations on HBV and HCV related human leukocyte antigen （HLA） associations in relation to susceptibility, viral persistence and treatment. Extensive literature search was conducted to explore the HLA associations in HBV and HCV infections reported across global populations over the past decade to understand the knowledge status, weaknesses and strengths of this information in different ethnic populations. HLA DR13 is consistently associated with HBV clearance globally. HLADRB1＊11/＊12 alleles and DQB1＊0301 are associated with HBV persistence but with HCV clearance worldwide. Consistent association of DRB1＊03 and ＊07 is observed with HCV susceptibility and non-responsiveness to HBV vaccination across the population. HLA DR13 is protective for vertical HBV and HCV transmission in Chinese and Italian neonates, but different alleles are associated with their susceptibility in these populations. HLA class I molecule interactions with Killer cell immunoglobulin like receptors （KIR） of natural killer （NK） cells modulate HCV infection outcome via regulating immune regulatory cells and molecules. HLA associations with HBV vaccination, interferon therapy in HBV and HCV, and with extra hepatic manifestations of viral hepatitis are also discussed. Systematic studies in compliance with global regulatory standards are required to identify the HLA specific viral epitope, stage specific T cell populations interacting with different HLA alleles during disease progression and viral clearance of chronic HBV or HCV infections among different ethnic populations. These studies would facilitate stage specific therapeutic strategies for clearance of HBV and HCV infections or co-infections across global populations and aid in identification of HBV-HCV combined vaccine. HLA associations of chronic HBV or HCV development with confounding host factors including alcohol, drug abuse, insulin resistance, age and gender are lacking and warrant detailed investigation across global populations.

Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

AIM:To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease(PUD)in a general Taiwan Residents population. METHODS:From January to August 2008,consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy.Gastroduodenal mucosal breaks were carefully assessed,and a complete medical history and demographic data were obtained from each patient.Logistic regression analysis was conducted to identify indepen-dent risk factors for asymptomatic PUD. RESULTS:Of the 572 asymptomatic subjects,54(9.4%) were diagnosed as having PUD.The prevalence of gastric ulcer,duodenal ulcer and both gastric and duodenal ulcers were 4.7%,3.9%,and 0.9%,respectively. Multivariate analysis revealed that prior history of PUD [odds ratio(OR),2.0,95%CI:1.3-2.9],high body mass index[body mass index(BMI)25-30:OR,1.5,95%CI: 1.0-2.2;BMI>30 kg/m 2 :OR,3.6,95%CI:1.5-8.7] and current smoker(OR,2.6,95%CI:1.6-4.4)were independent predictors of asymptomatic PUD.In contrast, high education level was a negative predictor of PUD (years of education 10-12:OR,0.5,95%CI:0.3-0.8; years of education>12:OR,0.6,95%CI:0.3-0.9). CONCLUSION:The prevalence of PUD in asymptomatic subjects is 9.4%in Taiwan.Prior history of PUD, low education level,a high BMI and current smoker are independent risk factors for developing asymptomatic PUD.

硒蛋氨酸和塞来考昔预防食管鳞状细胞癌:一项随机、安慰剂、对照试验

Background & Aims: Esophageal squamous cell carcinoma remains a leading cause of cancer death worldwide. Squamous dysplasia, the accepted histological precursor for esophageal squamous cell carcinoma, represents a potentially modifiable intermediate end point for chemoprevention trials in high-risk populations. Methods: We conducted a randomized, controlled trial of selenomethionine 200 μ g daily and/or celecoxib 200 mg twice daily (2 × 2 factorial design) among residents of Linxian, People’s Republic of China. Subjects had histologically confirmed mild or moderate esophageal squamous dysplasia at baseline. Esophagogastroduodenoscopy was performed before and after a 10- month intervention. Per-subject change (regression, stable, or progression) in the worst dysplasia grade was defined as the primary end point. Results were compared by agent group (selenomethionine vs placebo; celecoxib vs placebo). Results: Two hundred sixty-seven subjects fulfilled all eligibility criteria, and 238 (89% ) completed the trial. Overall, selenomethionine resulted in a trend toward increased dysplasia regression (43% vs 32% ) and decreased dysplasia progression (14% vs 19% ) compared with no selenomethionine (P = .08). In unplanned stratified analyses, selenomethionine favorably affected a change in dysplasia grade among 115 subjects with mild esophageal squamous dysplasia at baseline (P = .02), but not among 123 subjects with moderate esophageal squamous dysplasia at baseline (P = 1.00). Celecoxib status did not influence changes in dysplasia grade overall (P = .78) or by baseline histology subgroup. Conclusions: After a 10- month intervention, neither selenomethionine nor celecoxib inhibited esophageal squamous carcinogenesis for all high-risk subjects. However, among subjects with mild esophageal squamous dysplasia at baseline, selenomethionine did have a protective effect. Although it is based on unplanned stratified analyses, this finding is the first report of a possible beneficial effect for any candidate esophageal squamous cell carcinoma chemo-preventive agent in a randomized controlled trial.

内镜与EUS对胃肠上皮下肿瘤的评估比较:一项前瞻性研究

Background: The purpose of this study is to prospectively evaluate the performance characteristics of endoscopy and EUS in the diagnosis of GI subepithelial masses. Methods: A total of 100 consecutive patients referred for the evaluation of a suspected GI subepithelial lesion were prospectively studied with endoscopy followed by EUS. Size, color, mobility, location (intramural or extramural), consistency (solid, cystic, or vascular), and presumptive diagnosis were recorded at the time of endoscopy. EUS then was performed, and size, echogenicity, location, and presumptive diagnosis were determined. Results: A total of 100 subepithelial lesions were evaluated. Endoscopy had 98% sensitivity and 64% specificity in identifying intramural lesions. Size measurement by endoscopy correlated with size measurement by EUS (r = 0.88). Histology was obt-ained in 23 cases, with the presumptive EUS diagnosis correct in only 48% of cases. Most incorrect EUS diagnoses occurred with hypoechoic 3rd and 4th layer masses. Conclusions: Endoscopy has high sensitivity but low specificity in identifying the location (intramural or extramural) of subepithelial lesions. In addition, EUS imaging alone is insufficient to accurately diagnose 3rd and 4th layer hypoechoic masses, and histologic confirmation should be obtained whenever possible.

Barrett食管：诊断和管理

食管鳞状上皮被柱状上皮化生时易发展为食管腺癌，这种癌前状态被称为Barrett食管（编者注：现在中国共识意见中正逐渐采用“巴雷特食管”这一称谓，取代“Barrett食管”。本文为译文，故仍暂用“Barrett食管”）。组织学上必须看到食管下段被覆柱状上皮（图1）才可确诊Barrett食管，其中那些没有肠上皮化生的患者，癌变风险较低。