This study aimed to compare the effect of long-term continuous entecavir (ETV) compared with tenofovir disoproxil fumarate (TDF) on the reduction of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) related liver cirrhosis. This study recruited patients who had CHB-related liver cirrhosis and received ETV or TDF treatment for more than 6 months. Regular assessments of ultrasonography and alpha-fetoprotein test were arranged every 3 months for HCC detection. Five-year cumulative incidence of HCC and risk factors for HCC development were analyzed. A total of 286 consecutive cirrhotic patients were included, 198 in the ETV group and 88 in the TDF group. During a median follow-up of 57.5 months, 25 (12.6%) patients in the ETV group and 12 (13.6%) patients in the TDF group developed HCC. The 5-year cumulative incidence of HCC was comparable between the ETV and TDF groups (6.57% vs. 9.09%, log-rank p = .242). Multivariate Cox proportional hazard analysis revealed that male, old age, diabetes, and low platelet count were independent risk factors for HCC development. This study observed that long-term ETV or TDF provided comparable preventive effects on HCC development in patients with CHB-related liver cirrhosis.

The relationship between hormone replacement therapy (HRT) and hepatocellular carcinoma (HCC) was discussed for several decades. However, the long-term effects of HRT on female patients with hepatitis C during nature postmenopausal periods are unclear. This study aimed at investigating the effect of HRT on HCC risk and overall survival. We conducted a retrospective population-based cohort study using data from Taiwan's National Health Insurance Research Database from January 1, 2000 to December 31, 2013. The treated cohort, consisting of 1022 patients with hepatitis C who received hormone analog therapy for at least 90 days (treated cohort), was matched with the control cohort, consisting of 1022 untreated patients with hepatitis C (controls) who had never received a hormone prescription, through propensity score adjustment; furthermore, cumulative incidence was calculated, and multivariable analyses were performed. The treated and control cohorts were followed up for mean periods of 7.47 and 6.64 years, respectively. The treated cohort had a significantly lower crude hazard ratio (HR) of HCC of 0.43 (95% confidence interval [CI]: 0.30-0.61, P < .001), with an adjusted HR of 0.49 (95% CI 0.31-0.76, P = .001). After adjustment for other confounders and comorbidities, the hormone analog treatment was associated with a reduced risk of HCC. Subgroup analyses provided estimates of the strength of the associations between HRT and reduced HCC risk in different age categories. Our retrospective population study in Taiwan revealed that using hormone analog reduces the risk of HCC and mortality in patients with hepatitis C virus infection who are receiving HRT, such as menopausal women.

Conclusion:Our data indicates patterns of differential expression due to the influence of malaria parasites both locally and across tissues in challenged mice.Our preliminary data further suggests that the.immune response towards a Plasmodium infection shows spatiotemporal patterns on the transcriptional level, providing a promising outlook for more detailed studies on the influence of the parasite on the surrounding liver environment.

There has been no clear consensus on the optimal consolidation periods following HBeAg seroconversion (SC) in HBeAg-positive chronic hepatitis B (CHB) patients. Our study aimed to prospectively compare relapse rates between 12 months' and 18 months' consolidation periods to see whether or not there is beneficial durability of tenofovir disoproxil fumarate (TDF) therapy with longer consolidation periods.We enrolled a total of 137 HBeAg-positive Asian CHB patients treated with TDF monotherapy. Forty-six patients achieved HBeAg SC. Then, they were randomly assigned to consolidation period of either 12 months (group A) or 18 months (group B). After stopping TDF therapy, all patients were followed up for 12 months.Thirteen patients (56.5%) relapsed in group A and 12 patients (52.2%) relapsed in group B after 12 months' follow-up (P = .958). Pretreatment HBsAg level is the only significant predictor for off-therapy recurrence by univariate analysis (P = .024). Baseline HBeAg >1000 S/CO in group B patients were significantly less likely to relapse than those of group A (P = .046). Baseline alanine aminotransferase (ALT) >133 U/L could significantly predict occurrence of HBeAg SC (P = .008; 95% CI: 0.545-0.763; AUC: 0.654).Overall, a prolonged consolidation period has no positive effect on TDF therapy on sustained viral suppression in HBeAg-positive Asian CHB patients. However, a prolonged consolidation period was beneficial to patients with high baseline semi-quantitative HBeAg levels in terms of off-treatment durability. Baseline ALT > 133 U/L could significantly predict the occurrence of HBeAg SC.

BACKGROUND:Liver cirrhosis is an uncommon but not rare side effect of amiodarone-induced hepatotoxicity. Patients with hepatitis B virus and hepatitis C virus infections are at a high risk for developing liver cirrhosis. However, the relationship between this treatment and risk of liver cirrhosis in high-risk chronic hepatitis B and chronic hepatitis C patients is unknown.PATIENTS AND METHODS:The present study identified amiodarone users (N=8,081) from the Taiwan National Health Insurance Research Database from 1997 through 2013. A total of 32,324 subjects with age, comorbidities, gender, and index date-matched non-amiodarone users were selected as controls (non-amiodarone cohort). The incidences of cumulative liver cirrhosis were compared between cohorts. Stratified Cox's regression hazard models were used to assess possible comorbidity-attributable risks for liver cirrhosis.RESULTS:The amiodarone cohort had a nonsignificant risk of liver cirrhosis compared with the non-amiodarone cohort, with a HR of 1.17 (95% CI: 0.93-1.47; P=0.1723). Patients with specific comorbid diseases, including type 2 diabetes mellitus, chronic hepatitis B, chronic hepatitis C, and heart failure, were probably at a high risk of developing liver cirrhosis. The use of statins was associated with a significant 42% reduction in the risk of liver cirrhosis.CONCLUSION:Patients in the amiodarone cohort had no excess risk of liver cirrhosis compared with patients in the non-amiodarone cohort. Long-term surveillance for liver toxicity in high-risk patients with amiodarone treatment is suggested.

Purpose: This event is an aggregative phenomenon, and because the infection control practitioners immediately take some intervention measures to quickly and effectively prevent the first-line medical staff from being threatened by scabies infection and prevent further expansion of the infection, we provide medical community with the experience of our hospital for reference. Methods: On April 1, 2013, it was reported that more than one staffs in the ward had suffered from itching and erythematous papules one after another since March 25, we immediately counted the number of staffs with symptoms, traced the source of infection, taken contact infection protective measures, such as cleaning and disinfection of environmental and clothing. Results: It was diagnosed by the dermatologist that a total of 16 staffs suffered with scabies (including two suspected cases), among which 10 were registered nurse, 2 were nurse specialists, one was a teacher and 3 were students; all 16 staffs had erythematous papules (100%), mainly located in arms (75%). We investigated the source of infection and found two patients: For one patient, scabies was excluded by department of dermatology through twice consultations in February (at admission) and March; for the other patient, scabies was excluded through consultation on March 26 (at admission), and then scabies was diagnosed through the second consultation on April 1. Conclusions: The two patients had been into the same ward but different beds, it was speculated that improperly diagnosis resulted in the delayed preventive measures and then interact infection. No new cases occurred after April 6, so it was closed a month later. It was recommended that the timing of preventive use of drugs should be investigated for high-risk cases, clinical application of personal protective equipment should be strengthened every day, and information on medical staff’s health should be informed.

SummaryBackgroundThe study was conducted to reveal the most appropriate empiric antibiotics for the treatment of community‐acquired biliary tract infections (CA‐BTI) at a regional hospital in Taiwan.MethodsThe study was performed between October 1, 2010 and October 31, 2012. All positive bile culture results of presumptive community‐acquired origins were collected. The associated etiologic microorganisms and their antimicrobial susceptibilities were analyzed. The appropriateness of empiric therapy (defined as the effectiveness of the antibiotics against the etiologic agents) and the subsequent treatment response were examined through the review of medical records.ResultsA total of 115 patients (cholecystitis, 83 cases, 72.2%; cholangitis, 32 cases, 27.8%) and 189 isolates (136 Gram‐negative bacilli, 37 Gram‐positive cocci, and 16 anaerobes) were analyzed. The most frequent pathogens were Escherichia coli (n = 69, 36.5%), Klebsiella spp. (n = 37, 19.6%), enterococci (n = 29, 15.3%), and Bacteroides spp. (n = 11, 5.8%). Penicillin resistance (5.4%) was low in Gram‐positive cocci, whereas higher resistance (>20%) to cefazolin, cefuroxime, and ampicillin–sulbactam was found in Gram‐negative bacilli. Anaerobes also demonstrated high resistance to clindamycin (37.5%) but less to metronidazole (12.5%). Appropriate empiric therapy was found in 92 (80%) cases, and among them, 83 (90.2%) were treated successfully. The treatment success rate (69.6%) was significantly lower among the remaining 23 cases with inappropriate empiric therapy (16 of 23 vs. 83 of 92, p < 0.05). A high treatment success rate (97.2%) was observed among cases empirically treated with ceftriaxone plus metronidazole.ConclusionThe combination of ceftriaxone plus metronidazole appears to be the most appropriate empiric antibiotics for the treatment of CA‐BTI at this hospital. Because different hospitals may encounter microorganisms of different antimicrobial susceptibilities, similar approaches may be followed by other hospitals where appropriate empiric therapy has not yet been established for the treatment of CA‐BTI.

Hemophagocytic syndrome (HS) that occurs in the course of adult-onset Stills disease (AOSD) has been reported only rarely in the literature. HS and AOSD share overlapping clinical and laboratory features, therefore, it is difficult to recognize HS as a complication of AOSD. Here, we report the case of a 46-year old woman with classical features of AOSD. Severe pancytopenia and jaundice associated with extreme hyperferritinemia occurred during high-dose steroid treatment. Bone marrow biopsy showed typical pathological features of hemophagocytosis, which confirmed the coexistence of HS with AOSD. The patient was treated with methylprednisolone pulse therapy of 500 mg/day for 3 days, as recommended in cases of HS complicating AOSD, and her condition improved gradually. During the disease course, extensive studies could not identify any viral infection or other known underlying etiology for the reactive hemophagocytosis. Currently, the patient is in remission on low-dose prednisolone and azathioprine.

We report a rare case of diffuse esophageal intramural pseudodiverticulosis in a 35-year-old man complaining of severe dysphagia and vomiting for several months. The advanced morphological change in the esophagus caused irregular track formation, mimicking an ulcerative lesion on esophagogram. Endoscopic examination revealed an esophageal stricture with intact mucosa. Endoscopic ultrasonography and chest computed tomography showed multiple hyperechoic lesions of unknown nature and multiple air collection sites in the esophageal wall, respectively, making diagnosis difficult. The patient finally received a subtotal esophagectomy because of severe symptoms. The lesion was pathologically proven to be intramural pseudodiverticulosis with marked submucosal fibrosis. Our experience suggests that awareness of this rare pathology and the related image changes will be helpful for early diagnosis and treatment in the future.

BACKGROUND/AIMS Laparoscopic cholecystectomy is considered as a standard procedure for symptomatic gallstones. However, the incidence of iatrogenic bile duct injury is higher that the conventional cholecystectomy. In the present study was analyzed the results in 6 patients with iatrogenic bile duct injury during laparoscopic cholecystectomy with restenotic hepaticojejunostomy treated with self-modified Gianturco-Rosch stents. METHODOLOGY Data were collected retrospectively on May 2000 to October 2008 on six patients with major bile duct injury secondary to cholecystectomy. All patients underwent surgical reconstruction with a Roux-en-Y hepaticojejunostomy and presented clinically as obstructive jaundice. Percutaneous transhepatic and/or endoscopic retrograde cholangiography, cholangioplasty by balloon dilation and biliary catheter placement were done in each patient prior to stents placement. Modified Gianturco-Rosch stents with 3cm length and 10mm diameter were used. Follow-up was obtained with direct patients contact or hospital records. RESULTS Metallic stents were successfully implanted in all 6 patients and the mean patency rate was 46.5 months (range = 14-101 months). One patient required percutaneous recanalization procedure for recurrent cholangitis and obstruction. CONCLUSIONS Gianturco-Rosch stents placement should be considered in patient with post-hepaticojejunostomy restenosis that repeat surgery is not feasible.

Background/Aims: Patients with chronic hepatitis C (CHC) can achieve a sustained virologic response if they received pegylated interferon plus ribavirin therapy; however, some of them do not respond or relapse after treatment. The aim of this study was to compare the ability of two statistical models to predict treatment outcomes. Methods: Clinical data, biochemical values, and liver histological features of 107 patients with CHC were collected and assessed using a logistic regression (LR) model and an artificial neural network (ANN) model. Both the LR and ANN models were compared by receiver-operating characteristics curves. Results: Aspartate aminotransferase (p = 0.017), prothrombin time (p = 0.002), body mass index (BMI; p = 0.003), and fibrosis score of liver histology (p = 0.002) were found to be significant predictive factors by univariate analysis. The independent significant predicting factor was BMI by multivariate LR analysis (p = 0.0095). The area under receiver-operating characteristics of the ANN model was larger than that of the LR model (85 vs. 58.4%). Conclusions: It was found that BMI is an independent factor for identifying patients with favorable treatment response. A useful ANN model in predicting outcomes of standard treatment for CHC infection was developed and showed greater accuracy than the LR model.

BACKGROUND/AIMS:Visceral and renal arteries pseudoaneurysms are uncommon but potentially lethal complications of hepatic and pancreatobiliary interventions. To evaluate the clinical outcome of transcatheter arterial coils embolotherapy, we reviewed our institution's experience with the management for bleeding pseudoaneurysms.METHODOLOGY:From January 1988 through December 2004, 20 patients were encountered who developed massive bleeding from pseudoaneurysms following hepatobiliary and pancreatic interventions. All patients underwent diagnostic angiography and transarterial embolization was carried out thereafter.RESULTS:Embolization was technically successful without major post-procedural complications in all patients. Bleeding was stopped after embolization in 17 patients (85%), and rebleeding did occur in one patient during the follow-up periods. Repeat coil embolotherapy was performed in one patient with recurrent bleeding, but they needed surgical intervention because of failed re-embolization. Another two patients needed surgical ligation and one of the patients died of sepsis two weeks later.CONCLUSIONS:An emergency angiography should be considered in all patients in whom pseudoaneurysm is suspected following hepatobiliary and pancreatic interventions. Transcatheter arterial coil embolization is a safe and effective treatment for pseudoaneurysm. Surgical intervention should be reserved for patients for whom embolization fails or for whom it is not possible.

Bezoars are foreign that are formed by concretions of undigested food particles, masses of foreign bodies and undigested seeds and fibers of fruits that impact in the gastrointestinal tract, with the stomach being the most common site. They usually result in intestinal obstruction, ulcer formation, hemorrhage and perforation. Management of bezoars is usually surgical with fragmentation and milking it cephalad or caudad depending on its location and level of obstruction. A colonic bezoar causing bowel obstruction is a very rare occurrence. Experiencing it twice in a lifetime at the same location is even a rarer occurrence. We present a case of a recurrent colonic phytobezoar, secondary to habitual chewing and ingestion of betel nut fiber, which was successfully managed surgically. To the best of knowledge, a recurrent obstructing colonic bezoar related to betel nut chewing has never been reported before in literature.