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Clinical course of sub-centimeter-sized nodules detected during surveillance for hepatocellular carcinoma

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World Journal of Gastroenterology 2012年第21期18卷 2654-2660页

作者： Yang Won Min Geum-Youn Gwak Min Woo Lee Moon Seok Choi Joon Hyoek Lee Kwang Cheol Koh Seung Woon Paik byung chul yoo Department of Medicine Samsung Medical Center Sungkyunkwan University School of MedicineSeoul 135-710 South Korea Department of Radiology Samsung Medical Center Sungkyunkwan University School of MedicineSeoul 135-710 South Korea

AIM: To evaluate the outcome of sub-centimeter-sized nodules (SCSNs) detected during surveillance for hepatocellular carcinoma (HCC) in patients at risk. METHODS: We retrospectively analyzed a total of 142 patients with liver cirrhosis or chronic hepatitis B or C without a prior history of HCC in whom a SCSN was detected during HCC surveillance. We calculated the rate of HCC development from SCSNs in the study population and analyzed the differences in the baseline clinical characteristics and imaging features between the patients with SCSNs that eventually developed into HCC and patients with SCSNs that did not develop into HCC.RESULTS: During 667 person-years of follow-up, HCC developed in 33 patients. The calculated HCC development rate was 4.9% per year. The cumulative one-, two-, three- and five-year HCC development rates were 5.6%, 10.6%, 14.1% and 20.4%, respectively. Upon baseline comparison, the HCC group was older (54.4 ± 8.3 years vs 48.9 ± 9.4 years; P = 0.003) and had lower albumin levels (3.56 ± 0.58 g/dL vs 3.84 ± 0.55 g/dL; P = 0.012) and higher baseline alpha-fetoprotein (AFP) levels (8.5 ng/mL vs 5.4 ng/mL; P = 0.035) compared to the non-HCC group. Nodule pattern and initial radiologic diagnosis also differed between the two groups. Multivariate analysis revealed that age [P = 0.012, odds ratio (OR) =1.075, 95% confidence interval (CI) =1.016-1.137], sex (P = 0.009, OR = 3.969, 95% CI: 1.403-11.226), and baseline AFP level (P = 0.024, OR = 1.039, 95% CI: 1.005-1.073) were independent risk factors for developing HCC. CONCLUSION: The overall risk of HCC development in patients with SCSNs is similar to that in liver cirrhosis patients. Patients with these risk factors need to be closely monitored during follow-up.

关键词：检测监测肝细胞癌结节临床发展速度蛋白水平危险因素

Tenofovir rescue therapy for chronic hepatitis B patients after multiple treatment failures

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World Journal of Gastroenterology 2012年第47期18卷 6996-7002页

作者： Yu Jin Kim Dong Hyun Sinn Geum-Youn Gwak Moon Seok Choi Kwang Cheol Koh Seung Woon Paik byung chul yoo Joon Hyeok Lee Department of Medicine Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 135-710South Korea

AIM:To evaluate the efficacy and safety of tenofovir disoproxil fumarate(TDF) for chronic hepatitis B(CHB) patients after multiple failures.METHODS:A total of 29 CHB patients who had a suboptimal response or developed resistance to two or more previous nucleoside/nucleotide analogue(NA) treatments were included.Study subjects were treated with TDF alone(n = 13) or in combination with lamivudine(LAM,n = 12) or entecavir(ETV,n = 4) for ≥ 6 mo.Complete virologic response(CVR) was defined as an achievement of serum hepatitis B virus(HBV) DNA level ≤ 60 IU/mL by real-time polymerase chain reaction method during treatment.Safety assessment was based on serum creatinine and phosphorus level.Eleven patients had histories of LAM and adefovir dipivoxil(ADV) treatment and 18 patients were exposed to LAM,ADV,and ETV.Twenty-seven patients(93.1%) were hepatitis B e antigen(HBeAg) positive and the mean value of the baseline serum HBV DNA level was 5.5 log IU/mL ± 1.7 log IU/mL.The median treatment duration was 16 mo(range 7 to 29 mo).RESULTS:All the patients had been treated with LAM and developed genotypic and phenotypic resistance to it.Resistance to ADV was present in 7 patients and 10 subjects had a resistance to ETV.One patient had a resistance to both ADV and ETV.The cumulative probabilities of CVR at 12 and 24 mo of TDF containing treatment regimen calculated by the Kaplan Meier method were 86.2% and 96.6%,respectively.Although one patient failed to achieve CVR,serum HBV DNA level decreased by 3.9 log IU/mL from the baseline and the last serum HBV DNA level during treatment was 85 IU/mL,achieving near CVR.No patients in this study showed viral breakthrough or primary non-response during the follow-up period.The cumulative probability of HBeAg clearance in the 27 HBeAg positive patients was 7.4%,12%,and 27% at 6,12,and 18 mo of treatment,respectively.Treatment efficacy of TDF containing regimen was not statistically different according to the presence of specific HBV mutations.History of prior exposure to specific antivir

关键词：慢性乙型肝炎抢救治疗患者 DNA水平核苷酸类似物乙型肝炎病毒聚合酶链反应 HBeAg

Virological response to adefovir monotherapy and the risk of adefovir resistance

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World Journal of Gastroenterology 2011年第30期17卷 3526-3530页

作者： Dong Hyun Sinn Geum-Youn Gwak Moon Seok Choi Kwang Cheol Koh Seung Woon Paik byung chul yoo Joon Hyeok Lee Hyang Ie Lee Department of Medicine Samsung Medical CenterSungkyunkwan University School of Medicine135-710 SeoulSouth Korea Department of Internal Medicine Eulji University Hospital302-799 DaejeonSouth Korea

AIM:To evaluate virological response to adefovir(ADV) monotherapy and emergence of ADV-resistant mutations in lamivudine(LAM)-resistant chronic hepatitis B patients.METHODS:Seventy-seven patients with documented LAM resistance who were treated with 10 mg/d ADV for>96 wk were analyzed for ADV resistance.RESULTS:At week 48 and 96,eight(10%)and 14(18%)of 77 LAM-resistant patients developed the ADV-resistant strain(rtA181V/T and/or rtN236T mutations),respectively.Hepatitis B virus(HBV)DNA levels during therapy were significantly higher in patients who developed ADV resistance than in those who did not.Incidence of ADV resistance at week 96 was 11%,8%and 6%among patients with complete virological response(HBV DNA level2000 IU/mL)at week 12,week 24 and week 48,respectively.HBV DNA levels >2000 IU/mL at week 24 showed best performance characteristics in predicting ADV resistance.CONCLUSION:Development of ADV resistance mutations was associated with HBV DNA levels,which could identify patients with LAM resistance who are likely to respond to ADV monotherapy.

关键词：病毒学耐药率应答治疗单药 DNA水平风险慢性乙型肝炎

Disease progression in chronic hepatitis C patients with normal alanine aminotransferase levels

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World Journal of Gastroenterology 2013年第14期19卷 2256-2261页

作者： Dong Hyun Sinn Geum-Youn Gwak Jae-uk Shin Moon Seok Choi Joon Hyeok Lee Kwang Cheol Koh Seung Woon Paik byung chul yoo Department of Internal Medicine Sanggye Paik HospitalInje University School of Medicine Department of Medicine Samsung Medical CenterSungkyunkwan University School of Medicine

AIM:To investigate whether the disease progression of chronic hepatitis C patients with normal alanine aminotransferase(ALT) levels differs by ALT levels.METHODS:A total of 232 chronic hepatitis C patients with normal ALT( 26 IU/L(highnormal),respectively(P = 0.043),and it was 1.4% and 4.8% for female patients with baseline ALT levels ≤ 22 IU/L(low-normal) and > 23 IU/L(high-normal),respectively(P = 0.023).ALT levels fluctuated during the follow-up period.During the follow-up,more patients with "high-normal" ALT levels at baseline experienced ALT elevation(> 41 IU/L) than did patients with "lownormal" ALT levels at baseline(47.7% vs 27.9%,P = 0.002).The 5 year cumulative incidence of disease progression was significantly lower in patients with persistently "low-normal" ALT levels than "high-normal" ALT levels or those who exhibited an ALT elevation > 41 U/L during the follow-up period(0%,8.3% and 34.3%,P < 0.001).CONCLUSION:A "high normal" ALT level in chronic hepatitis C patients was associated with disease progression,suggesting that the currently accepted normal threshold of serum ALT should be lowered.

关键词： Alanine aminotransferase Upper limits of normal Disease progression Hepatitis C virus Hepatocellular carcinoma

Seroprevalence of anti-HAV among patients with chronic viral liver disease

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World Journal of Gastroenterology 2011年第2期17卷 236-241页

作者： Hyun Chin Cho Seung Woon Paik Yu Jin Kim Moon Seok Choi Joon Hyeok Lee Kwang Cheol Koh byung chul yoo Hee Jung Son Seon Woo Kim Division of Gastroenterology Samsung Medical CenterSungkyunkwan University School of Medicine Division of Gastroenterology Center for Health PromotionSamsung Medical CenterSungkyunkwan University School of Medicine Biostatics Team Samsung Medical CenterSungkyunkwan University School of Medicine

AIM:To investigate the current seroprevalence of hepatitis A virus(HAV) antibodies in patients with chronic viral liver disease in Korea.We also tried to identify the factors affecting the prevalence of HAV antibodies. METHODS:We performed an analysis of the clinical records of 986 patients(mean age:49±9 years,714 males/272 females) with chronic hepatitis B virus(HBV) or hepatitis C virus(HCV) infection who had undergone HAV antibody testing between January 2008 and December 2009.RESULTS:The overall prevalence of IgG anti-HAV was 86.61%(854/986) in patients with chronic liver disease and was 88.13%(869/986) in age-and gendermatched patients from the Center for Health Promotion.The anti-HAV prevalence was 80.04%(405/506) in patients with chronic hepatitis B,86.96%(20/23) in patients with chronic hepatitis C,93.78%(422/450) in patients with HBV related liver cirrhosis,and 100%(7/7) in patients with HCV related liver cirrhosis.The anti-HAV prevalence according to the decade of age was as follows:20s(6.67%) ,30s(50.86%) ,40s(92.29%) ,50s(97.77%) ,and 60s(100%) .The antiHAV prevalence was significantly higher in patients older than 40 years compared with that in patients younger than 40 years of age.Multivariable analysis showed that age≥40 years,female gender and metropolitan cities as the place of residence were independent risk factors for IgG anti-HAV seropositivity. CONCLUSION:Most Korean patients with chronic liver disease and who are above 40 years of age have already been exposed to hepatitis A virus.

关键词：慢性乙型肝炎甲肝病毒感染率患者丙型肝炎病毒血清阳性率平均年龄病毒抗体

Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization

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World Journal of Gastroenterology 2006年第43期12卷 6992-6997页

作者： Do Young Kim Moon Seok Choi Joon Hyoek Lee Kwang Cheol Koh Seung Woon Paik byung chul yoo Sung Wook Shin Sung Wook Choo Young Soo Do Jong chul Rhee Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea Depart- ment of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea

AIM: To evaluate whether the Milan criteria are useful in patients with hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE) before liver transplantation (LT). METHODS: Thirty-six HCC patients who fulfilled the Milan criteria after having received TACE and subsequently underwent LT were included (TACE + LT group) in the study. As controls, 21 patients who also met the Milan criteria and underwent LT without prior treatment were selected (LT group). Post-LT clinical outcomes, such as HCC recurrence, survival rate, and histologic features of explanted livers, were compared between the two groups. RESULTS: Baseline characteristics were not different between the two groups. Pre-LT maximal tumor diameter in TACE + LT group was similar to that of LT group (2.0 ± 0.6 cm vs 2.3 ± 0.9 cm; P = 0.10). Post-LT histologic findings also revealed similar maximal tumor diameter in the two groups (2.4 ± 1.4 cm vs 2.3 ± 0.9 cm; P = 0.70). Explanted livers showed similar incidence of unfavorable pathologic features. The morality within 60 d after transplantation was not different between the two groups (8.3% vs 9.5%; P = 0.99). Post-LT 5-year survival rate (57% vs 74%; P = 0.70) and cumulative recurrence rate (8.3% vs 4.8%; P = 0.90) were not significantly different between the two groups. CONCLUSION: The Milan criteria are still a useful selec- tion criteria showing favorable outcomes in HCC patientsreceiving TACE before LT.

关键词：肝细胞癌肝移植治疗病理机制

Expression of heat shock proteins (HSP27, HSP60, HSP70, HSP90, GRP78, GRP94) in hepatitis B virus-related hepatocellular carcinomas and dysplastic nodules

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World Journal of Gastroenterology 2005年第14期11卷 2072-2079页

作者： Seung Oe Lim Sung Gyoo Park Jun-Hi yoo Young Min Park Hie-Joon Kim Kee-Taek Jang Jae Won Cho byung chul yoo Gu-Hung Jung Cheol Keun Park School of Biological Sciences Seoul National University SeoulKorea Hepatology Center and Laboratory of Hepatocarcinogenesis Bundang Jesaeng General Hospital KyungkidoKorea School of Chemistry Seoul National University SeoulKorea Department of Pathology Samsung Medical Center Sungkyunkwan University School of MedicineSeoulKorea General Surgery Samsung Medical Center Sungkyunkwan University School of MedicineSeoulKorea Internal Medicine Samsung Medical Center Sungkyunkwan University School of MedicineSeoulKorea

AIM: Expression of heat shock proteins (HSPs) is frequently up-regulated in hepatocellular carcinoma (HCC), which evolves from dysplastic nodule (DN) and early HCC to advanced HCC. However, little is known about the differential expression of HSPs in multistep hepatocarcinogenesis. It was the purpose of this study to monitor the expression of HSPs in multistep hepatocarcinogenesis and to evaluate their prognostic significance in hepatitis B virus (HBV)related HCC.METHODS: Thirty-eight HCC and 19 DN samples were obtained from 52 hepatitis B surface antigen-positive Korean patients. Immunohistochemical and dot immunoblot analyses of HSP27, HSP60, HSP70, HSP90, glucoseregulated protein (GRP)78, and GRP94 were performed and their expression at different stages of HCC development was statistically analyzed.RESULTS: Expression of HSP27, HSP70, HSP90, GRP78, and GRP94 increased along with the stepwise progression of hepatocarcinogenesis. Strong correlation was found only in GRP78 (Spearman's r= 0.802). There was a positive correlation between the expressions of GRP78, GRP94, HSP90, or HSP70 and prognostic factors of HCC. Specifically, the expression of GRP78, GRP94, or HSP90 was associated significantly with vascular invasion and intrahepatic metastasis.CONCLUSION: The expressions of HSPs are commonly up-regulated in HBV-related HCCs and GRP78 might play an important role in the stepwise progression of HBVrelated hepatocarcinogenesis. GRP78, GRP94, and HSP90 may be important prognostic markers of HBV-related HCC, strongly suggesting vascular invasion and intrahepatic metastasis.

关键词：热负荷蛋白基因表达乙型肝炎病毒肝细胞癌发育异常结节

Characteristics of fever and response to antipyretic therapy in military personnel with adenovirus-positive community acquired pneumonia

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Military Medical Research 2020年第3期7卷 324-334页

作者： Hongseok yoo Jimi Oh chul Park Division of Pulmonary and Critical Care Medicine Department of Internal MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351South Korea Department of Anesthesiology and Pain Medicine Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea Division of Pulmonary Medicine Department of Internal MedicineWonkwang University HospitalIksan 54538South Korea

Background:In 2014,an outbreak of adenoviral pneumonia occurred in the Korean military training center.However,there are limited data on the characteristics of the fever and its response to antipyretic therapy in immunocompetent adults with adenovirus-positive community-acquired pneumonia(CAP).Methods:The medical records of the patients who were admitted to the Armed Forces Chuncheon Hospital for the treatment of CAP between January 2014 and December 2016 were retrospectively analyzed.The patients were divided into three groups,namely,the adenovirus-positive(Adv)group,the adenovirus-negative(Non-Adv)group and the unknown pathogen group,according to the results of a polymerase chain reaction(PCR)test and sputum culture used to measure adenovirus and other bacteria or viruses in respiratory specimens.We evaluated and compared the demographics,clinicolaboratory findings and radiological findings upon admission between the two groups.Results:Out of the 251 military personnel with CAP during the study periods,67 were classified into the Adv group,while 134 were classified into the Non-Adv group and 50 were classified into the unknown pathogen group.The patients in the Adv group had a longer duration of fever after admission((3.2±1.6)d vs.(1.9±1.2)d vs.(2.2±1.5)d,P=0.018)and symptom onset((5.8±2.2)d vs.(3.9±2.5)d vs.(3.7±2.0)d,P=0.006)than patients in the Non-Adv and unknown pathogen groups,respectively.The patients in the Adv group had a higher mean temperature at admission(37.8±0.3 vs.37.3±0.3 vs.37.3±0.3,P=0.005),and more patients were observed over 40 and 39 to 40(14.9%vs.2.2%vs.4.0%,35.8%vs.3.7%vs.6.0%,P<0.001)than those in the Non-Adv and unknown pathogen groups,respectively.The Adv group more commonly had no response or exhibited adverse events after antipyretic treatment compared to the Non-Adv group(17.9%vs.1.5%,35.0%vs.4.3%,P<0.001,P=0.05,respectively).In addition,the time from admission to overall clinical stabilization was significantly longer in the patients in the Adv group than in those in the Non-Adv gr

关键词： Adenovirus Fever Response to antipyretic treatment

Long-type double-balloon enteroscopy-assisted ERCP using hand-made accessories in Roux-en-Y hepaticojejunostomy(with video)

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Hepatobiliary & Pancreatic Diseases International 2021年第4期20卷 407-408页

作者： Min Jae Yang Ah Reum Kim Jae chul Hwang byung Moo yoo Jin Hong Kim Department of Gastroenterology Ajou University School of MedicineSuwonSouth Korea

To the Editor:Short-type balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography(BE-ERCP)is becoming the procedure of choice for biliopancreatic disease treatment in patients with postoperative anatomy^([1,2]).However,it has not yet been available in many countries.Although a long-type balloon enteroscope with a200-cm working length has been widely used for small bowel endoscopy,its use for ERCP was limited by the lack of commercially available extra-long accessories^([3]).

关键词： balloon anatomy ERCP