Yen-Chun Peng

Expression and clinical significance of antinuclear antibody in hepatitis C virus infection.

Background The prevalence of antinuclear antibody (ANA) has been documented in patients with hepatitis C virus (HCV) infection. We attempted to determine the titer and to characterize the patterns and clinical significance of ANA in HCV infection. Study Forty-eight consecutive patients with positive anti-HCV antibody and positive HCV RNA were included in this study. Sera from patients were tested for ANA and anti–smooth muscle antibody by indirect immunofluorescence. Serum aminotransferase, alkaline phophatase, alpha-fetoprotein, and cryoglobulin levels also were determined. Results Eleven (23%) of 48 HCV-infected patients were positive for ANA. Antinuclear antibody revealed speckled pattern in 10 (91%) of the 11 ANA-positive HCV-infected patients. Twenty (54%) of 37 ANA-negative HCV-infected patients had detectable pattern with equivocal titer (titer <1.5). The ANA pattern was speckled in all 20 patients. Hepatitis C virus–infected patients with positive ANA were older than the HCV-infected patients with negative ANA (62.90 ± 11.05 years vs. 56.46 ± 14.94 years, respectively;p < 0.1). Serum levels of aspartate aminotransferase (39.36 ± 14.98 IU/L vs. 30.70 ± 23.15 IU/L, p < 0.05), alkaline phosphatase (189.00 ± 75.63 IU/L vs. 122.41 ± 40.88 IU/L, p < 0.01), and alpha-fetoprotein (47.72 ± 80.47 pg/dL vs. 7.00 ± 8.28 pg/dL, p < 0.01) were higher in ANA-positive HCV-infected patients than in ANA-negative HCV-infected patients, respectively. There were no significant differences in gender, alanine aminotransferase, anti–smooth muscle antibody, or cryoglobulin between the two groups. Conclusions Antinuclear antibody was present in 11 (23%) of 48 patients with HCV infection in our study. Speckled pattern is the major expression pattern of ANA in HCV infection. Antinuclear antibody–positive HCV-infected patients have significantly higher serum aspartate aminotransferase, alkaline phosphatase, and alpha-fetoprotein levels than ANA-negative HCV-infected patients.

Efficacy of endoscopic isotonic saline-epinephrine injection for the management of active Mallory-Weiss tears.

Therapeutic endoscopy with isotonic saline-epinephrine (ISE) injection is a convenient and widely used procedure for hemostasis in upper gastrointestinal bleeding. We retrospectively evaluated 36 patients (from January 1996 to April 1999) who had been diagnosed with recent or active bleeding due to Mallory–Weiss tears in emergency endoscopic examination. The endoscopic hemostatic method with ISE injection was performed in 15 of 36 patients. The other 21 patients received conservative treatment with hemodynamic support. Patients clinical data, laboratory data, transfusion requirements, endoscopic findings, and length of hospital stays were evaluated. Initial hemoglobin was significantly lower in the ISE group than the conservative treatment group (9.74 ± 2.86 g/dL vs. 12.57 ± 2.80 g/dL, respectively;p < 0.01). Mean transfusion requirements were significantly higher in the ISE group than the conservative treatment group (7.26 ± 8.78 units vs. 2.85 ± 6.21 units, respectively;p < 0.1). Patients in the ISE group were supposed to be having a more severe bleeding episode. Most patients achieved initial hemostasis in the ISE group and the conservative treatment group (93% and 95%, respectively). The rebleeding rate was also similar in both groups (1 in 15 in the ISE group and 1 in 21 in the conservative treatment group). There was no significant difference in length of hospital stay and rebleeding between these two groups (3.47 ± 1.92 days vs. 2.47 ± 1.47 days, respectively;p = 0.89). The endoscopic ISE injection is an inexpensive, simple, convenient therapeutic method and it can achieve initial hemostasis for active Mallory–Weiss tears.

Successful Treatment with a Combination of Endoscopic Injection and Irrigation with Coca Cola for Gastric Bezoar-induced Gastric Outlet Obstruction

We report a case of gastric bezoar-induced gastric outlet obstruction that was successfully treated with a combination of endoscopic injection and irrigation with Coca Cola. A 73-year-old diabetic woman had a history of perforated peptic ulcer and had received pyloroplasty more than 20 years previously. She had been ingesting Pho Pu Zi (Cordia dichotoma Forst. f.) as an appetizer for 1 month. She presented with epigastric pain, nausea, and vomiting. Upper gastrointestinal endoscopy, performed at a local hospital, showed 2 gastric bezoars in the stomach, and 1 of them impacted at the pylorus. She was referred to our emergency department for removal of the gastric bezoars that were suspected to be causing gastric outlet obstruction. All attempts at endoscopic removal using a polypectomy snare, biopsy forceps and Dormia basket failed. We then injected Coca Cola directly into the bezoar mass, followed by irrigation with Coca Cola. Follow-up endoscopy was performed the next day, which revealed that the gastric bezoars had dissolved spontaneously.

Factors associated with failure of initial endoscopic hemoclip hemostasis for upper gastrointestinal bleeding.

Background: Endoscopic hemoclip is widely used for the management of bleeding peptic ulcers. The major difficulty in clinical application of the hemoclip is deployment to the lesion during initial hemostasis. The aim of this study was to define factors associated with the failure of endoscopic hemoclip for initial hemostasis of upper GI bleeding. Patients and Methods: From January to December 2003, we prospectively studied 77 randomized patients with clinical evidence of upper GI bleeding due to either active bleeding or a visible vessel identified by upper GI endoscopy in our emergency department. Results: Among the 77 patients, 13 (16.9%) failed treatment (Group 1) and 64 (83.1%) were successfully (Group 2) treated by endoscopic hemoclip for lesions related to upper GI bleeding. There were no differences due to gender, blood pressure, initial heart rate, and hemoglobulin before or after endoscopic treatment, platelet count, serum creatinine, and albumin between groups. The mean age of Group 1 was higher than that of Group 2 (73.31 ± 9.38 years vs. 65.41 ± 16.45 years, respectively; P = 0.083). Most patients who did not achieve initial hemostasis by endoscopic hemoclip had upper GI lesions over the gastric antrum and duodenal bulb. Among the 13 patients who failed to achieve endoscopic hemoclip initial hemostasis, four lesions were located over the posterior wall of the antrum, and four lesions over the lesser curvature side of the duodenal bulb. Conclusion: Endoscopic hemoclip is an effective hemostatic method for upper GI bleeding. Age, gastric antrum, and duodenal bulb lesions may be associated with the failure of initial hemostasis by endoscopic hemoclip.

Statins are associated with a reduced risk of cholangiocarcinoma: a population‐based case–control study

AIMS Cholangiocarcinoma (CCA) is the second most common primary liver cancer in the world. Due to the lack of effective treatments, the survival rate of CCA is low and it is usually considered difficult to diagnose early. To date, no effective strategies for the prevention of CCA have been developed. Statins are cholesterol-lowering agents which possess pleiotropic properties and the use of statins may reduce cancer risk. The aim of the study was to investigate the effect of statin use on the risk of CCA. METHODS We used nationwide insurance data to perform a case-control study including 3174 CCA patients diagnosed in 2002-2011 and 3174 propensity score matched controls. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated to assess the association between CCA risk and statin use by type of statin and dose. RESULTS Patients with CCA were slightly younger than controls with mean ages of 67.4 (SD 12.3) and 68.5 (SD 13.2) years (P = 0.001), respectively, and had less users of statins (22.7 vs. 26.5%, P < 0.001). The overall adjusted OR of statin use associated CCA was 0.80 (95% CI 0.71, 0.90) and lowered for those with longer medications. The OR ranged from 0.65 to 0.77. Stronger dose-response association was seen when using lovastatin. CONCLUSIONS Statin use is associated with reduced risk of CCA and there is a dose-response relationship between the use of statins and risk of CCA.

Effect of a nonthermal-atmospheric pressure plasma jet on wound healing: An animal study.

Background The use of a nonthermal plasma (NTP) jet in the treatment of living tissue has been the subject of considerable interest in the field of medical technology, and has the potential to reduce the recovery time of open wounds. We aimed to investigate the wound‐healing process by clinical observation, blood tests, and expression of cell adhesion markers and reactive oxygen species in NTP jet‐treated rats. Methods This study utilized Sprague‐Dawley (SD) rats as experimental subjects, and wounds measuring 2 cm × 2 cm were produced on the animals’ backs. The experimental group was treated with NTP for 5 min/d for 4 weeks. The NTP was injected in a diffused manner into the cage housing the rats. The SD rats that had not received plasma treatment were designated as the control group. Blood was drawn on Postoperative Day 2, Day 4, and at 3 months. An immunohistochemical stain of E‐cadherin and 4‐hydroxy‐2‐nonenal (4‐HNE), a reactive oxygen species marker, were evaluated and quantified for analysis using a CMYK color model. Results A total of 35 SD rats were included in the study (25 in the NTP group and 10 in the control group). Low dose plasma treatment shortened the wound‐healing time without damaging organs. In the NTP group, the white blood cell counts at Day 2 post‐NTP treatment was not increased significantly more than that in the control group. After quantification of immunohistochemical staining, 4‐HNE was increased at Day 14 compared with Day 7 (16.16 ± 12.81% vs. 55.11 ± 8.11%, p < 0.001), and E‐cadherin was also increased (52.17 ± 14.96% vs. 70.46 ± 12.78%, p = 0.04) in the NTP group. After comparison of NTP and the control, it was observed that 4‐HNE and E‐cadherin were increased in the NTP group on Day 14. Conclusion Short‐term, low‐dose NTP wound treatment was demonstrated to accelerate wound healing in SD rats without vital organ toxicity.

Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

AIM To investigate the symptom presentation and quality of life in obese Chinese patients with gastroesophageal reflux disease (GERD). METHODS Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass index (BMI) < 25 kg/m(2)], overweight (25-30 kg/m(2)), and obese (BMI > 30 kg/m(2)) groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared. RESULTS Among the 173 enrolled patients, 102, 56 and 15 patients were classified in the normal, overweight, and obese, respectively. There was significantly more erosive esophagitis (73.3% vs 64.3% vs 39.2%, P = 0.002), hiatal hernia (60% vs 33.9% vs 16.7%, P = 0.001), and males (73.3% vs 73.2% vs 32.4%, P = 0.001) in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively correlated with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health. CONCLUSION In patients with GERD, obese men had the most severe endoscopic and clinical presentation. Obese women had the poorest mental health.

Association Between the Use of Proton Pump Inhibitors and the Risk of ESRD in Renal Diseases: A Population-Based, Case-Control Study

AbstractProton pump inhibitors (PPIs) use may be associated with nephritis and acute renal injury. The risk of PPIs and deterioration of renal function, in patients with renal diseases, needs to be investigated.A case-control study was conducted in a nation-wide data setting from the Taiwan National Health Insurance Research Database (NHIRD). This case-control study used data extracted from NHIRD between the years 2006 and 2011. We used propensity scores to match 3808 patients suffering from renal diseases (ICD-9-CM codes 580–589), with patients (aged ≥20 years) who had had a recent diagnosis of end-stage renal diseases (ESRDs) and had undertaken renal replacement therapy during the period of 2006 to 2011. The 3808 control subjects were selected from people who had a history of renal diseases, but no ESRD. The risk of ESRD in patients with renal diseases and PPIs use was estimated by using odds ratios (ORs) and 95% confidence intervals (CI).The use of a PPIs was associated with a significantly higher risk of ESRD (adjusted OR = 1.88, 95% CI = 1.71–2.06) in renal disease patients. Of all the types of PPI combined, the adjusted OR was 1.92 (95% CI = 1.74–2.13) for those on <100 cumulative DDD and was 1.74-fold (95% CI = 1.52–2.00) for those on ≥100 cumulative DDD.PPIs use is associated with the risk of ESRD in patients with renal diseases. It is necessary that appropriate prescription of PPIs coordinated with the close monitoring renal function of patients diagnosed with renal disease.

Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study.

The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (13C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.

Clinical Predictors of Large Esophagogastric Varices in Patients with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, especially in Asia. Gastrointestinal bleeding due to esophagogastric variceal hemorrhage is one of the leading causes of death in HCC patients. The aim of study was to determine whether clinical variables were predictive of the presence of large esophagogastric varices (EGV) before performing endoscopy. Three hundred and four HCC patients who received endoscopy were enrolled and studied retrospectively. Univariate and stepwise logistic regression analysis were used to evaluate associations between the presence of large EGV and patient characteristics. There were 248 patients with small or no EGV and 56 patients with large EGV. The optimal critical values determined by a receiver operating characteristic curve for platelet count and albumin level were 135,000/mm3 and 3.5 g/dl, respectively. Stepwise logistic regression analysis demonstrated that splenomegaly [odds ratio (OR): 9.72; confidence interval (CI): 3.75–25.17], portal vein thrombosis (OR: 2.73; CI: 1.50–4.97), low platelet count (<135,000/mm3) (OR: 3.78; CI: 2.07–6.90) and low albumin level (<3.5 g/dl) (OR: 3.44; CI: 1.73–6.82) were significant, independent predictors for large EGV. Large EGV also could be independently predicted by Child-Pugh classification, splenomegaly (OR: 4.93; CI: 1.87–13.01), or portal vein thrombosis (OR: 2.37; CI: 1.28–4.39) while excluding the non-cirrhotic patients. In conclusion, splenomegaly, low platelet count (<135,000/mm3), and low albumin level (<3.5 g/dl) are clinical predictors to stratify HCC patients at risk of developing large EGV. Besides factors related to liver cirrhosis, portal vein thrombosis is also an important predictor for HCC patients with large EGV.