Rei-Hwa Lu

Insulin resistance is a major determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon α-2b plus ribavirin

Background  Cross‐sectional studies suggest insulin resistance is strongly associated with hepatic steatosis and fibrosis in patients with chronic hepatitis C (CHC), which might affect the efficacy of antiviral therapy.

Effect of a calcium channel blocker and antispasmodic in diarrhoea-predominant irritable bowel syndrome

Background : Irritable bowel syndrome (IBS) is a colonic function disorder. Both pinaverlum bromide (a selective calcium channel blocker) and mebeverine (an antispasmodic) are reported to be effective in the long‐term (12–16 weeks) treatment of IBS patients. Their efficacy in the short‐term treatment of IBS patients and colonic transit time is unclear. Furthermore, substance P and neuropeptide Y have either excitatory or inhibitory effects on colonic motility. Whether the efficacy of both drugs is mediated through these neuropeptides remains unknown.

Lack of detrimental effects of nitric oxide inhibition in bile duct-ligated rats with hepatic encephalopathy.

Background  The pathogenetic mechanisms of hepatic encephalopathy (HE) are not fully understood. Vasodilatation induced by nitric oxide (NO) may be involved in the development of HE. There is no comprehensive data concerning the effects of NO inhibition on HE in chronic liver disease.

Loss of Sympathetic Coordination Appears to Delay Gastrointestinal Transit in Patients with Spinal Cord Injury

Patients with spinal cord injury (SCI) often suffer from many gastrointestinal (GI) complaints, while delayed GI transit exists in these patients. We are interested in whether the lost sympathetic activity is one of the mechanisms leading to disturbed GI transit in these subjects. Using a noninvasive hydrogen breath test representing orocecal transit time (OCTT) to study GI transit, 36 SCI patients and 12 age- and sex-matched healthy volunteers were enrolled in our study. Meanwhile, electrocardiogram was performed for all subjects. Finally, spectral analysis of heart rate variability (HRV) was then obtained to assess their sympathovagal balance. SCI patients had higher occurrences of GI symptoms, e.g., nausea/vomiting, belching/hiccup, and constipation, compared to controls (P < 0.05). OCTT was delayed in SCI patients compared to controls (180.8 ± 10.7 vs 98.3 ± 14.4 min; P < 0.001). The OCTTs of SCI patients were negatively correlated with their low frequencies of HRV (r = −0.384, P = 0.021). In addition, OCTT was further delayed in quadriplegic patients than paraplegic patients (195.8 ± 14.5 vs 143.6 ± 19.4 min; P = 0.031). However, neither the SCI etiology, the injury duration, nor the high frequency of HRV had any influence on the delayed OCTT in SCI patients. We conclude that the GI transit of SCI patients is delayed. This transit disturbance is probably due to loss of sympathetic activity, which is one of the essential components in the coordination of GI peristalsis.

The potential risk factors leading to peptic ulcer formation in autoimmune disease patients receiving corticosteroid treatment

Aim : To study the potential risk factors leading to peptic ulcer disease among autoimmune disease patients on corticosteroid treatment.

Delayed liquid gastric emptying in patients with hepatocellular carcinoma

OBJECTIVE:Liver cirrhotic patients sometimes have disturbed gastric emptying (GE). Apparently there is no study addressing the issue of whether patients with hepatocellular carcinoma (HCC) have similarly impaired GE. Using impedance tomography to measure liquid GE, we attempted to assess the characteristics of GE in HCC patients.METHODS:We enrolled 34 healthy controls and 45 HCC patients in the current study, and compared their GE according to certain defined criteria. After each subject drank 500 ml of water, 12 electrodes were placed in a circular array around the subjects upper abdomen. One pair of electrodes was applied with electrical current, and the remaining 10 electrodes recorded signals consecutively in a rotating order. Based on tomographic calculation, serial changes in the averaged signals of altered resistivities were constructed to display liquid GE. Meanwhile, the demographic and clinical data, various blood parameters, and gut peptide levels of the patients were recorded.RESULTS:The half-emptying times in controls and HCC patients were 15.14 ± 1.56 and 21.38 ± 1.84 min, respectively (p < 0.05), whereas the areas under the emptying curve were 1732.2 ± 106.4 and 2246.6 ± 109.8 arbitrary units, respectively (p < 0.05). Delayed GE was observed in the HCC patients, as demonstrated by vomiting and anorexia. The cirrhotic component in HCC patients only resulted in a shorter period needed for full distention of the stomach after drinking (4.33 ± 1.02 vs 8.78 ± 2.1 min; p < 0.05). Other characteristics, including demographics, clinical state, tumor size, ascites, blood parameters, and gut peptides, had no influence on GE.CONCLUSIONS:Liquid GE is inhibited in HCC patients, particularly in those mainly showing symptoms of vomiting and anorexia. Other demographic and tumor characteristics are not responsible for delayed liquid GE; however, the cirrhotic component may promote stomach distention.

Role of Hepatic Nitric Oxide Synthases in Rats with Thioacetamide-induced Acute Liver Failure and Encephalopathy

Background: Hepatic encephalopathy is neuropsychiatric derangement secondary to hepatic decompensation or portal‐systemic shunting. Nitric oxide (NO) synthase inhibition aggravates encephalopathy and increases mortality in rats with thioacetamide (TAA)‐induced acute liver failure, suggesting a protective role of NO. This study investigated the roles of endothelium‐derived constitutive NO synthase (eNOS) and inducible NOS (iNOS) in the liver of rats with fulminant hepatic failure and encephalopathy. Methods: Male Sprague‐Dawley rats (300‐350 g) were randomized to receive TAA 350 mg/kg/day, by intraperitoneal injection or normal saline for 3 days. Severity of encephalopathy was assessed with the Opto‐Varimex animal activity meter. Plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin were measured. Hepatic iNOS and eNOS RNA and protein expressions were assessed by reverse transcription‐polymerase chain reaction and Western blot analyses, respectively. Results: The TAA group showed lower motor activity counts than the normal saline group. Hepatic eNOS, but not iNOS, mRNA and protein expressions were enhanced in the TAA group. In addition, hepatic eNOS mRNA expression was negatively correlated with total movement but positively correlated with ALT and AST. Protein expression of hepatic eNOS was positively correlated with ALT, AST and bilirubin. Conclusion: Upregulation of hepatic eNOS was observed in rats with TAA‐induced fulminant hepatic failure and encephalopa‐thy, which might play a regulatory role.

Delayed gastrointestinal transit in patients with hepatocellular carcinoma

Background and Aim: Disturbed gastrointestinal (GI) motility exists in cirrhotic patients; however, less is known about the character of GI transit in hepatocellular carcinoma (HCC) patients. It is interesting to study the GI transit in HCC patients and to explore the patient factors modulating GI transit.

An open-label trial of consensus interferon 15 μg in the treatment of Chinese patients with chronic hepatitis C

Consensus interferon (CIFN), a novel recombinant type 1 interferon (IFN), has been used recently to treat patients with chronic hepatitis C virus (HCV) infection. CIFN 9 µg, given subcutaneously 3 times a week for 24 weeks, offers sustained biochemical and virological responses in 32% of Chinese patients studied in Taiwan. Whether a higher dosage of CIFN will have greater efficacy is of clinical interest. This open-label trial was conducted to determine the efficacy and safety of CIFN 15 µg, given subcutaneously 3 times a week for 24 weeks, in 35 Chinese patients with chronic hepatitis C who in a previous randomized, controlled CIFN trial received placebo (n=16) or showed no sustained response to CIFN 3 µg (n=14) or 9 µg (n=5), 3 times a week for 24 weeks. Efficacy was assessed by normalization of serum alanine transaminase (ALT) levels and clearance of serum HCV RNA to undetectable levels as measured by reverse-transcription polymerase chain reaction (RT-PCR). Results showed 14 of 35 patients (40%) achieved normalized serum ALT and cleared serum HCV RNA at the end of treatment, and 11 patients (31%) maintained a sustained response 24 weeks after treatment was discontinued. The sustained response rate was 31% in patients who had received a placebo injection in the previous trial, 36% in patients who had relapsed or not responded to previous CIFN 3 µg treatment, and 20% in patients who had relapsed or not responded to previous CIFN 9 µg treatment (P>0.05). Upon re-treatment with CIFN 15 µg, sustained response was achieved in two of three patients who had relapsed from previous CIFN 3 µg treatment and in one of three patients who had relapsed from previous CIFN 9 µg treatment. CIFN 15 µg re-treatment achieved a sustained response in three of eleven patients and in none of two patients who were non-responders from previous CIFN 3 µg or CIFN 9 µg treatments respectively. Patients tolerated the treatment well, but two patients withdrew from the study due to intolerable side effects. In conclusion, subcutaneous injection of CIFN 15 µg, 3 times a week for 24 weeks, showed a similar efficacy as CIFN 9 µg 3 times a week treatment in Chinese patients with chronic hepatitis C. The treatment may benefit patients who have relapsed from a previous 3 µg or 9 µg treatment.

Occurrence of peptic ulcer disease in connective tissue disease patients associated with xerostomia

Background : Saliva plays a role in mucosal protection and ulcer healing.