Hsuan-Hwai Lin

Spontaneous intracranial hemorrhage in cirrhotic patients.

OBJECTIVE The major characteristics of spontaneous intracranial hemorrhage (SICH) in cirrhotic patients have not been completely defined. Cirrhotic patients with SICH were thus analyzed in an effort to better understand the risk factors for SICH and predict patient outcomes. PATIENTS AND METHODS From 1997 to 2006, 4515 hospitalized cirrhotic patients were recruited, with a focus on 36 cirrhotic patients with SICH who had no history of cerebral vascular accidents, head injuries, or cerebral arteriovenous malformations. The patient characteristics, severity of cirrhosis, location of the hematoma, and prognosis were analyzed. RESULTS Of the patients, 78% were males, 72% consumed alcohol, and 81% had a mild-to-moderate degree of cirrhosis. The overall incidence of SICH was related to the etiology of cirrhosis as follows: virus-related cirrhosis (0.3%), alcohol-related cirrhosis (1.9%), and combined virus- and alcohol-related cirrhosis (3%). The outcome of patients with SICH was associated with the size of the hematoma (P<0.005), the initial Glasgow Coma Scale score (P<0.05), the Child-Pugh classification (P=0.05), and the serum total bilirubin level (P<0.05). CONCLUSION SICH occurs primarily in young males with mild-to-moderate alcoholic cirrhosis of the liver. The etiology of cirrhosis is related to the incidence of SICH, but not to the patient outcome. The severity of liver cirrhosis is associated with patient outcome, but not the incidence of SICH.

Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma complicated with tumor thrombi in the inferior vena cava: Surgery or not?

Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma (HCC) complicated with tumor thrombi in the inferior vena cava (IVC) and right atrium is rare [1]. These patients usually die within a short period because of pulmonary embolism, heart failure, or cancer progression [2]. Here, we describe a 57-year-old man who had HCC complicated with tumor thrombi and pulmonary embolism. He was initially unwilling to undergo surgery but agreed to the surgery after developing a tumor thrombus of the right atrium followed within 24 hr by acute respiratory failure. He died from complications arising from surgery. We reviewed published reports of 14 patients who had HCC and pulmonary embolism. The 1-year survival rate was higher for patients who underwent surgery (40%) than for patients who did not undergo surgery (0%). Therefore, hepatic resection and removal of tumor thrombi should be considered to prolong the patient’s life span.

Effects of music on gastric myoelectrical activity in healthy humans

The aim was to study the effects of listening to music on gastric myoelectrical activity in healthy humans. Gastric myoelectrical activity was recorded using surface electrogastrography from 17 healthy volunteers before and for 30 min after they listened to music. All subjects listened to the same music. Ten perceived the music as enjoyable and seven did not. The percentages of normal slow wave, dominant frequency and dominant power did not differ significantly between baseline and during music intervention. An analysis of covariance model that included the subjects’ feelings about the music and dominant power showed significantly higher dominant power during music intervention in subjects who enjoyed the music (p < 0.01). In the individuals who enjoyed the music, dominant power (55.0 ± 9.2 dB) was significantly higher during music intervention than at baseline (49.5 ± 6.8 dB, p = 0.03). In the subjects who did not enjoy the music, dominant power was significantly lower during music intervention than at baseline (48.8 ± 6.8 and 55.7 ± 6.2 dB, respectively; p < 0.01). Listening to enjoyable music increases the amplitude of gastric myoelectrical activity in healthy humans. Music therapy may improve gastric motility and may be used to stimulate gastric emptying.

HCV core inhibits hepatocellular carcinoma cell replicative senescence through downregulating microRNA-138 expression

Hepatitis C virus (HCV) infection is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). HCV core protein is considered as a positive regulator of telomerase activity. In this study, we focused on the deregulated microRNA-138 (miR-138) in HCV-associated HCC. Differential expression of miR-138 was determined by TaqMan quantitative real-time PCR. The target gene of miR-138 was verified by luciferase reporter assay, quantitative real-time PCR, and Western blotting. Moreover, three assays based on telomerase activity, cell proliferation, and senescence-associated β-galactosidase activity were performed. The correlation analysis revealed a significantly negative correlation between miR-138 and telomerase reverse transcriptase (TERT) mRNA expression in HCC. Further, we showed that mature HCV core protein of 173 amino acids, but not full-length form of 191 amino acids, suppressed miR-138 expression. TERT was verified as a direct target of miR-138 in HCC cells. Furthermore, TERT-targeting miR-138 supplementation can prevent HCV core protein from repressing HCC cell replicative senescence. Collectively, HCV core protein can enhance TERT protein expression through downregulating TERT-targeting miR-138 expression, which in turn inhibits HCC cell replicative senescence. This study may further help our understanding on the pathogenic mechanisms of HCV core protein in HCV-associated HCC development.Key messagemiR-138 is downregulated in HCV-associated HCC.Mature HCV core protein plays a pathogenic role in suppressing miR-138 expression.Telomerase reverse transcriptase represents a direct target of miR-138 in HCC cells.miR-138 promotes HCC cell senescence, suggesting potential for HCC treatment.

Increased risks of spontaneous bacterial peritonitis and interstitial lung disease in primary biliary cirrhosis patients with concomitant Sjögren syndrome

AbstractThe incidence of Sjögren syndrome (SS) in primary biliary cirrhosis (PBC) patients is high. The influence of SS on the clinical outcomes of PBC patients, however, remains unclear. Our study retrospectively collected data on PBC-only patients and PBC patients with concomitant SS (PBC-SS) to compare the clinical differences of long-term outcomes between them.A total of 183 patients were diagnosed with PBC from January 1999 to December 2014 at our hospital. Of these, the authors excluded patients with diabetes, hypertension, advanced liver cirrhosis at initial diagnosis of PBC (Child–Turcotte–Pugh classification score of ≥7) and other liver diseases (ie, alcoholic liver disease, alpha-antitrypsin deficiency, viral hepatitis, and primary sclerosing cholangitis), and autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Of the remaining 125 patients, 77 (61.6%) were PBC-only and 48 (38.4%) were PBC-SS patients.The mean follow-up duration was 8.76 years. During the observation period, the incidence of interstitial lung disease was higher in the PBC-SS group than in the PBC-only group (P = 0.005). The occurrence of spontaneous bacterial peritonitis was significantly different in PBC-SS patients than in PBC-only patients (P = 0.002). The overall survival was lower in PBC-SS patients than in PBC-only patients (P = 0.033). Although the incidence of hepatocellular carcinoma, end-stage renal disease, variceal bleeding, and hypothyroidism were all higher in the PBC-SS group than in the PBC-only group, the differences were not significant.Our study suggests that PBC-SS patients have a higher risk of developing interstitial lung disease and spontaneous bacterial peritonitis and have a poor prognosis. Aggressive surveillance of thyroid and pulmonary functions should therefore be performed in these patients.

Outcome of nonsurgical intervention in patients with perforated peptic ulcers

BACKGROUND Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. METHODS Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. RESULTS The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (<IV) American Society of Anesthesiologists class (83.3% vs 0%, P=.015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class (P=.018). CONCLUSIONS A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.

Restriction fragment length polymorphism effectively identifies exon 1 mutation of UGT1A1 gene in patients with Gilbert's Syndrome

Gilberts syndrome causes pharmacological variation in drug glucuronidation and unexpected toxicity from therapeutic agents. The two common genotypes of Gilberts syndrome are a dinucleotide polymorphism (TA)7 in TATA‐Box as well as the 211G>A mutation in the coding exon 1, particularly in Asians, of human UGT1A1 gene. In this study, we aimed to establish an effective method to detect the 211G>A mutation.

Benefits of the povidone–iodine: Simultaneously decrease risk of infection and tumor seeding after percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is a well-established enteral feeding modality in patients with oropharyngeal/esophageal cancer; however, these patients are at risk for two possible PEG-related complications. First, oropharyngeal organisms may be transported to the PEG stoma and thus increase the risk of peristomal infection. Second, oropharyngeal/esophageal cancer cells may adhere to the PEG tube and thus increase the risk of tumor seeding along the PEG tract. Because of its microbicidal and tumoricidal effects, povidone-iodine pretreatment of the PEG tube may decrease the risk of peristomal infection and tumor seeding associated with PEG insertion in patients with oropharyngeal/esophageal cancer. To test this hypothesis, we brushed povidone-iodine onto the outer surface of PEG tubes prior to insertion.

Liver cirrhosis as a predisposing factor for esophageal candidiasis

Esophageal candidiasis (EC) often occurs in human immunodeficiency virus (HIV)‐infected patients, but is uncommon in non‐HIV‐infected patients. It is known that malignancy, diabetes mellitus, previous gastric surgery, and medications (antibiotics, proton pump inhibitors, and steroids) are risk factors for esophageal candidiasis in non‐HIV‐infected patients. However, the relationship between liver cirrhosis and esophageal candidiasis was unclear. This study aimed to elucidate the role of liver cirrhosis in esophageal candidiasis.

Hemorrhagic Shock Secondary to Multiple Duodenojejunal Diverticular Bleeding: A Case Report

Background: Hemorrhagic shock from multiple duodenojejunal diverticular bleeding has rarely been reported in the literature. Case Report: A 75-year-old male was admitted with symptoms of syncope and melena persisting for 1 day. During hospitalization, massive melena and hematochezia were noted with episodes of shock. Upper gastrointestinal pan-endoscopy, colonoscopy and angiography failed to identify the source of bleeding. A technetium-labeled erythrocyte scintigraphy suggested proximal intestinal hemorrhage. Additionally, barium examination of the small intestine revealed diverticulosis over the 4th portion of the duodenum and the proximal jejunum. Surgical intervention with resection of the diverticula cured the patient. Conclusion: Although shock from multiple duodenojejunal diverticular bleeding is rare, this possibility should be considered in patients with gastrointestinal bleeding.