Ender Gunes Yegin

Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment

BACKGROUND Hepatocellular carcinoma (HCC) is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple confounding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortality globally with a rising trend of incidence in some of the developed countries, which indicates the need for better surgical and nonsurgical management strategies. DATA SOURCES PubMed database was searched for relevant articles in English on the issue of HCC management. RESULTS Surgical resection represents a potentially curative option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and microwave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The significant survival benefit with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treatment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential benefit is suggested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immunotherapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications of these innovative approaches. CONCLUSION Treatment decisions have become increasingly complex for HCC with the availability of multiple surgical and nonsurgical therapeutic options and require a comprehensive, multidisciplinary approach.

Quantitative assessment of liver fibrosis by digital image analysis: Relationship to Ishak staging and elasticity by shear-wave elastography.

To analyze the relationship between fibrosis staged by Ishak stage and quantified by digital image analysis (DIA), and to reveal the optimum performance of shear‐wave elastography (SWE) using quantitative DIA measurements as a comparative histological standard.

Activity and damage in granulomatosis with polyangiitis

To retrospectively analyze disease activity and damage‐associated factors in granulomatosis with polyangiitis (GPA) in Turkey.

Digital image analysis in liver fibrosis: basic requirements and clinical implementation

ABSTRACT Accurate assessment of liver fibrosis is a critical aspect of diagnosis, prognosis prediction, surveillance strategies, therapeutic planning and monitoring, and also for validation of non-invasive surrogates of fibrosis. Traditional histopathological stagings depend on subjective visual interpretation process of architectural changes of fibrosis without providing quantification as continuous numerical data, but rather in the form of discrete staging. This makes high level reproducibility practically impossible in its application, which should be minimized in scientific research. In the light of increasing demand for an objective method, digital image analysis (DIA) technology has been increasingly implemented for liver fibrosis assessment. Potential advantages and applications of reproducible quantitative fibrosis ratio measurements with DIA include performing broader scale of statistical analysis and comparison between studies, monitoring minor but potentially important quantity changes during fibrosis regression or progression (especially in the context of therapeutic trials), and to be a better histological reference standard for validity and accuracy of surrogates of fibrosis. DIA may also have a potential role within the new perspective of redefining and sub-classifying cirrhosis. Since DIA algorithm covers multiple domains of hepatopathology and engineering, it may seem to be complicated to a researcher. This review provides an understanding of all basic steps, techniques, clinical applications of computerized image analysis for the particular purpose of liver fibrosis aiming its better implementation in hepatology research. Further work is required for standardization of all stages of pre-imaging, digital image acquisition and digital image processing steps for generation of reproducible outputs.

High treatment modification rates with lamivudine therapy in HBV‐infected patients with low baseline viremia and early virological response: A multicenter study

Low baseline viremia and an early treatment response predict the best outcomes in hepatitis B virus (HBV)‐infected patients treated with nucleoside analogues with low barriers to resistance. The aim of this study was to assess the long‐term results and effectiveness of lamivudine in patients with low baseline viremia and early virological treatment response.

Decision-making dilemma in drug-induced acute pancreatitis

Acute pancreatitis (AP) is a potentially serious medical condition that needs to be managed urgently, and severe cases with AP usually result in prolonged hospitalization and a high mortality. The most common causes of AP are cholelithiasis and alcohol consumption, accounting for 35–40% and 30–35% of cases, respectively; other etiologies include anatomic abnormalities such as pancreas divisum, procedures such as endoscopic retrograde cholangiopancreatogram (ERCP), hypertriglyceridemia, hypercalcemia, medications, toxins, trauma, ischemia, infections and autoimmune diseases. AP due to medications is rare (0.3% to 1.4%), although 525 different drugs have been reported by the World Health Organization (WHO) as producing unwanted side effects linked to this condition.

Partial virological response to three different nucleotide analogues in naive patients with chronic hepatitis B

BACKGROUND The definition of partial virological response (PVR) was proposed because of its clinical relevance. PVR relates to subsequent therapeutic failure which results in the modification of the regimen. Whether this rationale can be applied to all nucleotide analogues (NA) is not clear. This study was undertaken to analyze PVR influence on therapeutic outcomes during lamivudine, entecavir or tenofovir monotherapy in NA-naive patients with chronic hepatitis B in routine clinical practice. METHODS We retrospectively analyzed 150 NA-naive patients with chronic hepatitis B. These subjects received lamivudine, entecavir or tenofovir monotherapy between February 2001 and July 2013. RESULTS Sixty-nine patients were treated with lamivudine, 35 with entecavir, and 46 with tenofovir. The median therapeutic duration was 19.5 (6-147) months. PVR rates at 24 weeks were similar among three NAs (lamivudine 33.3%, entecavir 35.0%, tenofovir 32.4%, P=0.981). For all three NAs, patients with a higher baseline viral load or HBeAg-positive status had a higher serum viral positive rate tested by polymerase chain reaction at week 24 and 48. Cumulative probability of virological breakthrough (VBR) for patients treated with lamivudine was 67% at 5 years, and PVR at 24 weeks was the independent risk factor for VBR (HR: 3.09; 95% CI: 1.09-8.74; P=0.034); also lamivudine treated patients older than 50 years seemed to have a tendency for VBR (HR: 2.80; 95% CI: 0.99-8.18; P=0.052). A majority of entecavir and tenofovir partial responders achieved and maintained virological response with prolonged monotherapy, except one entecavir treated patient who experienced VBR due to resistance mutations. CONCLUSIONS Management strategy for lamivudine treatment should include adaptation of regimen according to PVR as an on-treatment response parameter due to its relation with unacceptably high VBR probability. Similar conclusion should not be directly related to entecavir or tenofovir treatment.