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1.
Medicine (Baltimore) ; 102(51): e36502, 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38134120

RESUMO

The prevalence of periodontitis and dyslipidemia continues to increase, and several studies have reported an association between the 2. Therefore, we assessed the relationship between periodontitis and hypertriglyceridemia using propensity score matching to efficiently address confounding factors, as well as complex sample analysis with data from Korea National Health and Nutrition Examination Survey VII (2016-2018). To match the 1:1 ratio between the groups with and without periodontitis, the propensity scores of covariates, such as age, sex, education, income, smoking, drinking, obesity, and diabetes mellitus, were calculated using logistic regression. Both results of logistic regression analysis using complex sample design for whole and matched sample after propensity score matching demonstrated a significant association between hypertriglyceridemia and periodontitis, of which the adjusted odds ratio was 1.28 (95% confidence interval = 1.10-1.50) and 1.29 (95% confidence interval = 1.09-1.52), respectively. Our findings suggest that dental healthcare workers can help raise awareness among patients with periodontitis regarding the association between periodontitis and hypertriglyceridemia, which may help them manage the condition and receive treatment.


Assuntos
Hipertrigliceridemia , Doenças Periodontais , Periodontite , Humanos , Pontuação de Propensão , Inquéritos Nutricionais , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Periodontite/complicações , Periodontite/epidemiologia , Hipertrigliceridemia/complicações , Hipertrigliceridemia/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco
2.
Gut Liver ; 17(4): 620-628, 2023 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-36999383

RESUMO

Background/Aims: The ursodeoxycholic acid (UDCA) response score (URS) was developed to identify poor responders to UDCA before treatment, in order to offer timely and proactive intervention. However, validation of the URS in Asian population is warranted. Methods: A total of 173 Asian patients diagnosed with primary biliary cholangitis (PBC) between 2007 and 2016 at seven academic institutions in Korea who started UDCA treatment were analyzed to validate the performance of URS. UDCA response was defined as an alkaline phosphatase level less than 1.67 times the upper limit of normal after 1-year of UDCA treatment. In addition, prognostic performance of URS for liver-related events, defined as newly developed hepatic decompensation or hepatocellular carcinoma was evaluated. Results: After 1 year of UDCA treatment, 133 patients (76.9%) achieved UDCA response. UDCA response rate was 98.7% for those with URS ≥1.41 (n=76) and 58.8% for those with URS <1.41 (n=97). The area under the receiver operating characteristic curve of URS in predicting UDCA response was 0.84 (95% confidence interval, 0.78 to 0.88). During a median follow-up of 6.5 years, liver-related events developed in 18 patients (10.4%). Among 117 patients with PBC stage I-III by histological evaluation, the 5-year liver-related event-free survival rate differed according to the URS; 100% for URS ≥1.41 and 86.5% for URS <1.41 (p=0.005). Conclusions: URS demonstrated good performance in predicting a UDCA treatment response in Asian PBC patients. In addition, the risk of liver-related events differed according to the URS for the PBC stage. Thus, URS can be used to predict the response and clinical outcome in patients with PBC.


Assuntos
Cirrose Hepática Biliar , Ácido Ursodesoxicólico , Humanos , Ácido Ursodesoxicólico/uso terapêutico , Cirrose Hepática Biliar/tratamento farmacológico , Cirrose Hepática Biliar/patologia , Colagogos e Coleréticos/uso terapêutico , Estudos de Coortes , República da Coreia , Resultado do Tratamento
4.
Int J Mol Sci ; 22(4)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33562603

RESUMO

Tenofovir disoproxil fumarate (TDF) has been regarded as the most potent drug for treating patients with chronic hepatitis B (CHB). However recently, viral mutations associated with tenofovir have been reported. Here, we found a CHB patient with suboptimal response after more than 4 years of TDF treatment. Clonal analysis of hepatitis B virus (HBV) isolated from sequential sera of this patient identified the seven previously reported TDF-resistant mutations (CYELMVI). Interestingly, a threonine to alanine mutation at the 301 amino acid position of the reverse-transcriptase (RT) domain, (rtT301A), was commonly accompanied with CYELMVI at a high rate (72.7%). Since the rtT301A mutation has not been reported yet, we investigated the role of this naturally occurring mutation on the viral replication and susceptibility to tenofovir in various liver cells (hepatoma cells as well as primary human hepatocytes). A cell-based phenotypic assay revealed that the rtT301A mutation dramatically impaired the replication ability with meaningful reduction in sensitivity to tenofovir in hepatoma cell lines. However, attenuated viral replication by the rtT301A mutation was significantly restored in primary human hepatocytes (PHHs). Our findings suggest that the replication capability and drug sensitivity of HBV is different between hepatoma cell lines and PHHs. Therefore, our study emphasizes that validation studies should be performed not only in the liver cancer cell lines but also in the PHHs to understand the exact viral fitness under antiviral pressure in patients.


Assuntos
Vírus da Hepatite B/efeitos dos fármacos , Hepatócitos/efeitos dos fármacos , Hepatócitos/virologia , Tenofovir/farmacologia , Antivirais/farmacologia , Carcinoma Hepatocelular/genética , Linhagem Celular Tumoral , Células Cultivadas , Farmacorresistência Viral/genética , Feminino , Genes Virais , Células Hep G2 , Vírus da Hepatite B/genética , Vírus da Hepatite B/fisiologia , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/genética , Hepatite B Crônica/virologia , Hepatócitos/metabolismo , Humanos , Neoplasias Hepáticas/genética , Pessoa de Meia-Idade , Mutação Puntual , DNA Polimerase Dirigida por RNA/genética , Inibidores da Transcriptase Reversa/farmacologia , Proteínas Virais/genética , Replicação Viral/efeitos dos fármacos , Replicação Viral/genética
5.
J Liver Cancer ; 21(1): 58-68, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37384267

RESUMO

Background/Aims: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related death in Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2015. Methods: Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative sample of patients newly diagnosed with HCC in Korea, were analyzed. A total of 1,558 patients with HCC registered in the KPLCR in 2015 were investigated. Results: The median age was 61.0 years (interquartile range, 54.0-70.0 years), and men accounted for 79.7% of the subjects. Hepatitis B virus infection was the most common underlying liver disease (58.1%). According to the Barcelona Clinic Liver Cancer (BCLC) staging system, stage 0, A, B, C, and D HCCs accounted for 14.2%, 31.5%, 7.6%, 39.0%, and 7.8% of patients, respectively. Transarterial therapy (32.1%) was the most commonly performed initial treatment, followed by surgical resection (23.2%), best supportive care (20.2%), and local ablation therapy (10.7%). Overall, 34.5% of patients were treated in accordance with the BCLC guidelines: 59.2% in stage 0/A, 48.4% in stage B, 18.1% in stage C, and 71.6% in stage D. The 1-, 3-, and 5-year OS rates were 67.1%, 50.9%, and 27.0%, respectively. Conclusions: In 2015, approximately 45% of Korean HCC cases were diagnosed at a very early or early stage, and 35% of patients underwent potentially curative initial treatment. BCLC guidance was followed in 34.5% of patients; in patients with stage B or C disease, there was relatively low adherence.

6.
J Vasc Interv Radiol ; 31(10): 1636-1644.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32943296

RESUMO

PURPOSE: To retrospectively investigate incidence, clinical outcome, and risk factors of iatrogenic pleural effusion in patients with hepatic tumors undergoing radiofrequency (RF) ablation using artificial ascites (AA). MATERIALS AND METHODS: Patients (N = 163) who underwent RF ablation using AA were classified into pleural effusion and non-pleural effusion groups according to the presence of pleural effusion on immediate follow-up CT and chest radiograph after RF ablation. The pleural effusion group included asymptomatic and symptomatic subgroups. The incidence and subsequent clinical outcomes of patients developing pleural effusion after RF ablation were evaluated. RESULTS: Overall, 96 patients (58.9%) developed pleural effusion, which resolved in 4.4 d ± 3.1. Hospital length of stay in the pleural effusion group was longer than the non-pleural effusion group (6.5 d ± 2.6 vs 5.7 d ± 2.8, P < .01). The pleural effusion group had longer AA infusion time (P = .01), larger infused AA volume (P < .01), and longer ablation time (P < .01) than the non-pleural effusion group. Eighteen patients (18.8%) developed symptomatic pleural effusion and had a larger infused AA volume than asymptomatic patients with pleural effusion (P < .01). Pleural effusion duration and hospital length stay were also longer in the symptomatic pleural effusion subgroup than in the asymptomatic subgroup (P < .01). Infused AA volume was the only independent prognostic factor of pleural effusion duration in multivariate analysis (P = .038). CONCLUSIONS: Pleural effusion frequently occurs after RF ablation using AA. Although generally considered negligible, pleural effusion could be a clinical problem and prolong hospitalization. Therefore, operators should be careful not to infuse too much AA when performing RF ablation.


Assuntos
Ascite , Doença Iatrogênica/epidemiologia , Neoplasias Hepáticas/cirurgia , Derrame Pleural/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Infusões Parenterais , Tempo de Internação , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
PLoS One ; 15(4): e0231485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267895

RESUMO

This study aimed to investigate the risk of metabolic syndrome (MS) in participants whose alanine aminotransferase (ALT) levels were within the normal range in the general population. A cross-sectional study was conducted using nationally representative samples from the Korea National Health and Nutrition Examination Survey 2007-2015. A total of 43,402 adults (men, 17,535; women, 25,867) with ALT ≤40 U/L without a history of hepatitis B and C, liver cirrhosis, or liver cancer were analyzed. The risk of MS was evaluated according to the ALT level. The prevalence of MS significantly increased as the ALT levels increased. The proportions of MS in men were 12.6%, 25.2%, and 39.7% in the ALT levels of <15, 15~30, and 30~40 U/L, respectively (p < 0.001), and those of women were 7.2%, 23.3%, and 44.7% in the ALT levels of <10, 10~20, and 20~40 U/L, respectively (p < 0.001). There was an ALT-dependent relationship in the risk of MS in participants with normal ALT level after adjustment for age, alcohol intake, and body mass index. The adjusted odds ratio (aOR) of MS in men was 2.48 (95% confidence interval [CI], 2.16-2.85) in an ALT level of 30~40 U/L compared with that in ALT <15 U/L (p < 0.001), and the aOR of MS in women was 2.67 (95% CI, 2.26-3.15) in an ALT level of 20~40 U/L compared with that in ALT <10 U/L (p < 0.001). Although within the normal range of ALT, the risk of MS increases as the ALT levels increase. The ALT level in the general population without a history of chronic liver disease may be a useful marker to evaluate for MS.


Assuntos
Alanina Transaminase/metabolismo , Síndrome Metabólica/metabolismo , Biomarcadores/metabolismo , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/métodos , Razão de Chances , Prevalência , Valores de Referência , Risco
9.
J Viral Hepat ; 27(1): 68-73, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505085

RESUMO

The study aimed to investigate the relationship between the use of COX inhibitors and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) using a nationwide population-based data. A nested case-control study was conducted using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002 to 2013 in Korea. We compared the use of COX inhibitors between HCC cases and matched controls by categorizing 5 groups according to the cumulative defined daily dose (cDDD, <28, 28-90, 91-180, 181-360, and >360) adjusting the use of antiviral agents. A total of 4980 patients with CHB were analysed as 996 HCC cases and 3984 matched controls. The number of COX inhibitor users (≥28 cDDD) was 358 patients (36%) and 1814 patients (45%) in the HCC group and control group, respectively. The use of COX inhibitors was significantly associated with a decreased risk of HCC development compared with nonusers (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.73, P < .001). There was a dose-dependent inverse relationship between the use of COX inhibitors and the risk of HCC. The adjusted ORs were 0.75 (95% CI: 0.63-0.90), 0.41 (95% CI: 0.31-0.56), 0.38 (95% CI: 0.25-0.57) and 0.49 (95% CI: 0.31-0.79) for the 28-90, 91-180, 181-360 and >360 cDDDs, respectively (P < .01). In conclusion, the use of COX inhibitors was associated with a reduced risk of HCC in CHB. COX inhibitor may have a chemopreventive role in HCC development in patients with chronic liver disease.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/virologia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , República da Coreia , Fatores de Risco , Adulto Jovem
10.
Biochem Biophys Res Commun ; 518(1): 80-86, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31421829

RESUMO

Noxa is a weak apoptosis activator consisting of a BH3 domain and a mitochondrial-targeting domain (MTD). BH3 binds Mcl-1 and Bcl2A1 and inactivates their anti-apoptotic activities, while MTD delivers BH3 to mitochondria. Previously we revealed that MTD may also function as an inducer of necrosis via conjugation with octa-arginine, which induces cytosolic Ca2+ influx from mitochondria. However, the mechanism(s) underlying this process has not been elucidated yet. Here, we show that calcium influx induced by an MTD peptide fused with octa-arginine residue (R8:MTD) originates not only from mitochondria but also from the extracellular space. However, calcium spikes were not sufficient for necrosis. R8:MTD induced mitochondrial permeability transition pore opening, fragmentation, and swelling. These mitochondrial events induced by MTD appeared to be necessary for necrosis induction, since DIDS, a VDAC inhibitor, inhibited the mitochondrial swelling and cell death induced by MTD. We show that R8:MTD disrupted endoplasmic reticulum (ER) structures but not peroxisomes or Golgi, indicating that R8:MTD causes necrosis by inducing ER events as well.


Assuntos
Retículo Endoplasmático/metabolismo , Mitocôndrias/metabolismo , Peptídeos/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/química , Ácido 4,4'-Di-Isotiocianoestilbeno-2,2'-Dissulfônico/farmacologia , Cálcio/metabolismo , Morte Celular/efeitos dos fármacos , Citosol/metabolismo , Retículo Endoplasmático/efeitos dos fármacos , Espaço Extracelular/metabolismo , Células HeLa , Humanos , Mitocôndrias/efeitos dos fármacos , Proteínas de Transporte da Membrana Mitocondrial/metabolismo , Poro de Transição de Permeabilidade Mitocondrial , Dilatação Mitocondrial/efeitos dos fármacos , Peptídeos/química , Domínios Proteicos , Canais de Ânion Dependentes de Voltagem/antagonistas & inibidores , Canais de Ânion Dependentes de Voltagem/metabolismo
11.
Medicine (Baltimore) ; 98(23): e15901, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169702

RESUMO

RATIONALE: Intrahepatic adrenocortical adenoma (IAA) arising from adrenohepatic fusion (AHF) is rare and its imaging findings are not well established. Moreover, it is easily misdiagnosed as malignant hepatic tumor in patients at risk of malignancy. Its key finding is the connection between the tumor and adrenal gland. When IAA from AHF is suspected, biopsy should be considered to avoid unnecessary surgery. Herein, we report 2 cases of IAA from AHF. PATIENT CONCERNS: A 59-year-old woman was admitted due to a 1.5-cm hypoechoic nodule in the right hepatic lobe detected on ultrasound for hepatocellular carcinoma (HCC) surveillance due to chronic hepatitis B. Contrast-enhanced computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) were performed to evaluate the hepatic mass. Another 75-year-old woman was admitted due to rectal adenocarcinoma detected on colonoscopy. Contrast-enhanced CT depicted a 2.5-cm mass in the right hepatic lobe. DIAGNOSIS: In case 1, CT and MRI showed a 1.5-cm subcapsular mass in the right hepatic lobe with typical findings of HCC in a patient with chronic hepatitis B. The mass was confirmed as IAA from AHF after the laparoscopic surgery. In case 2, CT showed advanced rectal malignancy and a 2.5-cm poorly enhancing mass in the right hepatic lobe. The tentative diagnosis was hepatic metastasis. However, based on the connection between the tumor and adrenal gland during preoperative review, the presumed diagnosis was changed to IAA from AHF, which was confirmed on biopsy. INTERVENTIONS: The hepatic mass connected with the right adrenal gland was laparoscopically resected in case 1. Laparoscopic lower anterior resection for rectal malignancy and percutaneous biopsy for the hepatic mass were performed in case 2. OUTCOMES: The first patient had an uneventful recovery, without recurrence on the 3-year follow-up CT. The second patient had an uneventful postoperative course and has been alive for 12 months postoperatively without pathologically proven IAA changes on follow-up CT. LESSONS: When hepatic mass is found adjacent to the right adrenal gland on imaging, the connection between the tumor and adrenal gland should be investigated. When IAA arising from AHF is suspected, biopsy should be considered to avoid unnecessary surgery.


Assuntos
Neoplasias do Córtex Suprarrenal/diagnóstico , Adenoma Adrenocortical/diagnóstico , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/patologia , Adenoma Adrenocortical/diagnóstico por imagem , Adenoma Adrenocortical/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Tomografia Computadorizada por Raios X
12.
Saudi J Gastroenterol ; 24(2): 115-121, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29637919

RESUMO

Background/Aim: To compare the treatment efficacy and safety between endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) for the treatment of rectal epithelial tumors, including large adenoma, cancer, and subepithelial tumors (SET). Patients and Methods: We conducted a retrospective analysis of the medical records of 71 patients with rectal tumors who were treated with ESD (48 patients) or TEM (23 patients) from January 2013 to December 2015. The patient group comprised 56 patients with epithelial tumors and 15 patients with SET. Treatment efficacy such as en bloc resection, procedure time, local recurrence, hospital stay, additional procedure rate, and safety between the treatment groups were evaluated and analyzed. Results: There were no significant differences in tumor size, location, macroscopic appearance, and histological depth between ESD and TEM groups. For ESD compared to TEM in rectal epithelial tumors, en bloc resection rates were 95% vs. 93.7% and R0 resection rates were 92.5% vs. 87.5% (P = 0.617); in rectal SET, en bloc resection rates were 100% vs. 100% and R0 resection rates were 87% vs. 85% (P = 0.91). The procedure time was 71.5 ± 51.3 min vs. 105.6 ± 28.2 min (P = 0.016) for epithelial tumors and 32.13 ± 13.4 min vs. 80.71 ± 18.35 min (P = 0.00) for SET, respectively. Hospital stay was 4.3 ± 1.2 days vs. 5.8 ± 1.8 days (P = 0.001) for epithelial tumors and 4.1 ± 4.1 days vs. 5.5 ± 2 days (P = 0.42) for rectal SET, respectively. There were no significant differences between recurrence rates, additional procedure rates, and complications in the two groups. Conclusions: ESD and TEM are both effective and safe for the treatment of rectal epithelial tumors and SET because of favorable R0 resection rates and recurrence rates. However, the ESD group showed shorter procedure times and hospital stays than the TEM group. Therefore, ESD should be considered more preferentially than TEM in the treatment of large rectal epithelial tumors and SET.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal/métodos , Adulto , Idoso , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Microcirurgia Endoscópica Transanal/efeitos adversos , Resultado do Tratamento
13.
Clin Mol Hepatol ; 23(2): 170-178, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28506056

RESUMO

BACKGROUND/AIMS: This study aimed to develop and validate a risk prediction model for the development of hepatocellular carcinoma (HCC) in treatment-naïve patients receiving oral antiviral treatment for chronic hepatitis B (CHB). METHODS: We investigated 2,061 Korean treatment-naïve patients with CHB treated with entecavir as an initial therapy. A risk score model for HCC development was developed based on multivariable Cox regression model in a single center (n=990) and was validated using the time-dependent area under the receiver operating characteristic curve (AUROC) in three other centers (n=1,071). The difference of HCC development among risk groups (low, intermediate, and high) categorized by risk score was also investigated. RESULTS: The cumulative incidence rates of HCC at 5 years were 11.2% and 8.9% in the testing and validation cohorts, respectively. HCC-Risk Estimating Score in CHB patients Under Entecavir (HCC-RESCUE) is formulated as (age+15×gender [female=0 / male=1]+23×cirrhosis [absence=0 / presence=1]). The AUROCs at 1 year, 3 years, and 5 years were 0.82, 0.81, and 0.81, respectively, in the validation cohort. A significant difference of HCC development in each risk group was determined by the 5-year HCC risk score in the validation cohort (low risk group, 2.1%; intermediate risk group, 9.3%; high risk group, 41.2%, p<0.001). CONCLUSIONS: The study presents a new risk score model with a good ability to predict HCC development and determine high risk patients for HCC development consisting of readily available clinical factors in treatment-naïve CHB patients receiving entecavir.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/diagnóstico , Guanina/análogos & derivados , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/diagnóstico , Administração Oral , Adulto , Área Sob a Curva , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , DNA Viral/sangue , DNA Viral/genética , DNA Viral/metabolismo , Feminino , Guanina/uso terapêutico , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/complicações , Hepatite B Crônica/virologia , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Fatores de Risco
14.
J Korean Assoc Oral Maxillofac Surg ; 42(4): 205-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27595087

RESUMO

Actinomycosis is an infection caused by the actinomyces genus and is associated with trauma or previous infection. A 58-year-old male patient was referred from a private dental clinic for root extraction of the lower right molar. The x-ray showed fractured root-like material distal to the distal root of the lower right second molar. A biopsy during extraction of the root-like material was performed, which revealed a sequestrum with actinomycosis by a pathological examination. In this case, the radiopacity of the suspicious lesion was higher than that of the surrounding alveolar bone, which confused it with the root tip. The diagnosis of actinomycosis required long-term antimicrobial therapy, which is very different from simple extraction or removal of sequestrum.

15.
Oncotarget ; 7(30): 47794-47807, 2016 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-27329596

RESUMO

OBJECTIVES: This study aimed to investigate the effect of oral antiviral treatment on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radiofrequency (RF) ablation. METHODS: Between January 2003 and December 2010, 228 patients without a history of antiviral treatment were treated with RF ablation for a single HBV-related HCC. We divided the patients into two groups, patients who received (n=125) or did not receive antiviral treatment (n=103), based on whether oral antiviral treatment was administered after RF ablation. The median duration of antiviral treatment was 60.1 months. HCC recurrence and overall survival were compared in the two groups in the full cohort and the propensity score-matched cohort. RESULTS: In the matched cohort, the probability of HCC recurrence at 5 years was 43.8% for the non-antiviral treatment group and 14.7% for the antiviral treatment group (p<0.001). The probability of overall survival at 5 years was 77.2% for the non-antiviral treatment group and 93.5% for the antiviral treatment group (p=0.002). Multivariable analysis showed that risk factors for HCC recurrence included large tumor size (hazard ratio (HR)=1.30, p=0.022), HBV DNA serum level (HR=1.11, p=0.005), and serum AFP level ≥20 ng/mL (HR=1.66, p=0.005). Overall survival was associated with larger tumor size (HR=1.86, p=0.001) and Child-Pugh Class B (HR=2.13, p=0.019). Oral antiviral treatment after RF ablation was significantly associated with a lower risk of tumor recurrence and death (HR=0.33, p<0.001, and HR=0.44, p=0.004). CONCLUSION: Use of oral antiviral treatment after curative RF ablation was associated with favorable outcomes in terms of tumor recurrence and overall survival in patients with HBV-related HCC.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/virologia , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/virologia , Administração Oral , Carcinoma Hepatocelular/patologia , Ablação por Cateter/métodos , Feminino , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/patologia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/virologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
16.
Clin Mol Hepatol ; 22(4): 477-486, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28081587

RESUMO

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is one of the most frequently applied curative treatments in patients with a single small hepatocellular carcinoma (HCC). However, the clinical significance of and risk factors for early massive recurrence after RFA-a dreadful event limiting further curative treatment-have not been fully evaluated. METHODS: In total, 438 patients with a single HCC of size ≤3 cm who underwent percutaneous RFA as an initial treatment between 2006 and 2009 were included. Baseline patient characteristics, overall survival, predictive factors, and recurrence after RFA were evaluated. In addition, the incidence, impact on survival, and predictive factors of early massive recurrence, and initial recurrence beyond the Milan criteria within 2 years were also investigated. RESULTS: During the median follow-up of 68.4 months, recurrent HCC was confirmed in 302 (68.9%) patients, with early massive recurrence in 27 patients (6.2%). The 1-, 3-, and 5-year overall survival rates were 95.4%, 84.7%, and 81.8%, respectively, in patients with no recurrence, 99.6%, 86.4%, and 70.1% in patients with recurrence within the Milan criteria or late recurrence, and 92.6%, 46.5%, and 0.05% in patients with early massive recurrence. Multivariable analysis identified older age, Child-Pugh score B or C, and early massive recurrence as predictive of poor overall survival. A tumor size of ≥2 cm and tumor location adjacent to the colon were independent risk factors predictive of early massive recurrence. CONCLUSION: Early massive recurrence is independently predictive of poor overall survival after RFA in patients with a single small HCC. Tumors sized ≥2 cm and located adjacent to the colon appear to be independent risk factors for early massive recurrence.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Ablação por Cateter , Feminino , Hepatite B/complicações , Hepatite C/complicações , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
17.
Clin Mol Hepatol ; 21(3): 232-41, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26523268

RESUMO

BACKGROUND/AIMS: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. METHODS: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. RESULTS: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). CONCLUSIONS: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Hepatite B Crônica/diagnóstico , Insuficiência Hepática Crônica Agudizada/tratamento farmacológico , Insuficiência Hepática Crônica Agudizada/etiologia , Adulto , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Antivirais/uso terapêutico , Ciclofosfamida/uso terapêutico , DNA Viral/análise , Doxorrubicina/uso terapêutico , Feminino , Vírus da Hepatite B/genética , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Hospitalização , Humanos , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prednisona/uso terapêutico , Prognóstico , Estudos Retrospectivos , Rituximab , Índice de Gravidade de Doença , Vincristina/uso terapêutico , Adulto Jovem
18.
Exp Mol Med ; 47: e184, 2015 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-26380927

RESUMO

Recent studies have shown that circulating microRNAs are a potential biomarker in various types of malignancies. The aim of this study was to investigate the feasibility of using serum exosomal microRNAs as novel serological biomarkers for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We measured the serum exosomal microRNAs and serum circulating microRNAs in patients with CHB (n=20), liver cirrhosis (LC) (n=20) and HCC (n=20). Serum exosomal microRNA was extracted from 500 µl of serum using an Exosome RNA Isolation kit. The expression levels of microRNAs were quantified by real-time PCR. The expression levels of selected microRNAs were normalized to Caenorhabditis elegans microRNA (Cel-miR-39). The serum levels of exosomal miR-18a, miR-221, miR-222 and miR-224 were significantly higher in patients with HCC than those with CHB or LC (P<0.05). Further, the serum levels of exosomal miR-101, miR-106b, miR-122 and miR-195 were lower in patients with HCC than in patients with CHB (P=0.014, P<0.001, P<0.001 and P<0.001, respectively). There was no significant difference in the levels of miR-21 and miR-93 among the three groups. Additionally, the serum levels of circulating microRNAs showed a smaller difference between HCC and either CHB or LC. This study suggests that serum exosomal microRNAs may be used as novel serological biomarkers for HCC.


Assuntos
Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , MicroRNAs/genética , Adulto , Idoso , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/diagnóstico , Exossomos/genética , Feminino , Perfilação da Expressão Gênica , Humanos , Fígado/patologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 94(24): e959, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26091461

RESUMO

Sympathetic hyperactivation is one of the causes of postoperative ileus, which occurs frequently after abdominal surgery and adversely influences the patient's prognosis. We aimed to investigate whether dexmedetomidine (DEX) could attenuate postoperative ileus in patients undergoing laparoscopic gastrectomy. Ninety-two patients were randomized to the control (n = 46) or DEX group (n = 46). DEX was administered at a loading dose of 0.5 µg/kg for 10 minutes, followed by an infusion rate of 0.4 µg/kg/h from insufflation of the pneumoperitoneum to the end of surgery. The primary goal was to compare postoperative bowel movements by evaluating the time to first flatus. The balance of the autonomic nervous system, duration of postoperative hospital stay, and pain scores were assessed. The time to first flatus was shorter in the DEX group compared with the control group (67.2 ± 16.8 hours vs 79.9 ± 15.9 hours, P < 0.001). The low-frequency/high-frequency power ratio during pneumoperitoneum increased in the control group, compared with baseline values and the DEX group. The length of postoperative hospital stay was shorter in the DEX group compared with the control group (5.4 ± 0.7 days vs 5.8 ± 1.1 days, P = 0.04). Patients in the DEX group had lower pain scores and required fewer analgesics at 1 hour postoperatively. DEX facilitated bowel movements and reduced the length of hospital stay in patients undergoing laparoscopic gastrectomy. This may be attributed to the sympatholytic and opioid-sparing effects of DEX.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Dexmedetomidina/uso terapêutico , Gastrectomia/efeitos adversos , Íleus/tratamento farmacológico , Íleus/etiologia , Laparoscopia/efeitos adversos , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Adulto , Idoso , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos
20.
PLoS One ; 10(4): e0124434, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25923439

RESUMO

Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.


Assuntos
Carcinoma Hepatocelular/mortalidade , Hepatite B/mortalidade , Neoplasias Hepáticas/mortalidade , Linfonodos/patologia , Veia Porta/patologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Feminino , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Hepatite B/patologia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Niacinamida/análogos & derivados , Niacinamida/uso terapêutico , Compostos de Fenilureia/uso terapêutico , Prognóstico , Estudos Prospectivos , Fatores de Risco , Sorafenibe , Análise de Sobrevida , Terminologia como Assunto
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