Comparison of 10-day sequential therapy with 7-day standard triple therapy for Helicobacter pylori eradication in inactive peptic ulcer disease and the efficiency of sequential therapy in inactive peptic ulcer disease and non-ulcer dyspepsia.

BACKGROUND: Eradication rates of standard triple therapy for Helicobacter pylori infections have decreased in recent years due to a worldwide increase in bacterial resistance. Sequential therapy has the advantage of a two-phase treatment regimen and achieves a superior result for H. pylori eradication in peptic ulcer disease. However, no study has yet compared the efficacy of sequential therapy for H. pylori eradication exclusively in inactive duodenal ulcer (iDU) or non-ulcer dyspepsia (NUD). METHOD: We retrospectively recruited 408 patients with endoscopic proven iDU (170 patients) or NUD (238 patients) infected with H. pylori. Patients with iDU were assigned into two groups: iDU triple therapy group, 44 patients treated with 40 mg pantoprazole, 1000 mg amoxicillin and 500 mg clarithromycin, twice daily for 7 days; iDU sequential therapy group, 126 patients treated with 40 mg pantoprazole and 1000 mg amoxicillin, twice daily for the first 5 days, followed by 40 mg pantoprazole, 500 mg clarithromycin and 500 mg tinidazole, twice daily for the next 5 days. All patients with NUD were treated with sequential therapy and assigned as the NUD sequential group. Post-treatment H. pylori status was confirmed by a (13)C-urea breath test. RESULT: The eradication rates of intention-to-treat (ITT) and per-protocol (PP) analysis were 77.3 % (95 % CI 64.9-89.7 %) and 85.0 % (95 % CI 73.9-96.1 %) in the iDU triple therapy group and 87.3 % (95 % CI 81.5-93.1 %) and 92.4 % (95 % CI 87.6-97.2 %) in the iDU sequential therapy group. The overall eradication efficacy was superior in the sequential group than in the triple group, both with ITT analysis (83.5 % vs. 77.3 %, P = 0.29) and PP analysis (88.1 % vs. 85.0 %, P = 0.57). Eradication rates for ITT and PP analysis were 81.5 % (95 % CI 76.6-86.4 %) and 85.8 % (95 % CI 83.5-88.2 %) in the NUD sequential therapy group. Eradication rate was statistically better in the iDU sequential therapy group than the NUD sequential therapy group according to per protocol analysis (P = 0.04). Eradication rate was not significantly different between the iDU sequential- and iDU triple therapy groups according to protocol analysis (P = 0.14). CONCLUSION: The sequential regimen has a better eradiation rate in the iDU group than in the NUD group. There is no statistically difference between 10-day sequential therapy and 7-day standard triple in iDU group.

Combined analysis of murine and human microarrays and ChIP analysis reveals genes associated with the ability of MYC to maintain tumorigenesis.

The MYC oncogene has been implicated in the regulation of up to thousands of genes involved in many cellular programs including proliferation, growth, differentiation, self-renewal, and apoptosis. MYC is thought to induce cancer through an exaggerated effect on these physiologic programs. Which of these genes are responsible for the ability of MYC to initiate and/or maintain tumorigenesis is not clear. Previously, we have shown that upon brief MYC inactivation, some tumors undergo sustained regression. Here we demonstrate that upon MYC inactivation there are global permanent changes in gene expression detected by microarray analysis. By applying StepMiner analysis, we identified genes whose expression most strongly correlated with the ability of MYC to induce a neoplastic state. Notably, genes were identified that exhibited permanent changes in mRNA expression upon MYC inactivation. Importantly, permanent changes in gene expression could be shown by chromatin immunoprecipitation (ChIP) to be associated with permanent changes in the ability of MYC to bind to the promoter regions. Our list of candidate genes associated with tumor maintenance was further refined by comparing our analysis with other published results to generate a gene signature associated with MYC-induced tumorigenesis in mice. To validate the role of gene signatures associated with MYC in human tumorigenesis, we examined the expression of human homologs in 273 published human lymphoma microarray datasets in Affymetrix U133A format. One large functional group of these genes included the ribosomal structural proteins. In addition, we identified a group of genes involved in a diverse array of cellular functions including: BZW2, H2AFY, SFRS3, NAP1L1, NOLA2, UBE2D2, CCNG1, LIFR, FABP3, and EDG1. Hence, through our analysis of gene expression in murine tumor models and human lymphomas, we have identified a novel gene signature correlated with the ability of MYC to maintain tumorigenesis.

Endoluminal gastroplication for the treatment of gastroesophageal reflux disease: a 2-year prospective pilot study from Taiwan.

BACKGROUND AND AIM: Endoluminal gastroplication (ELGP) offers a minimally invasive option for the treatment of gastroesophageal reflux disease (GERD) in Western countries. However, long-term outcomes of ELGP in Asian populations have not been investigated. The aim of this prospective study was to evaluate the long-term benefits of ELGP in Asian patients with GERD. METHODS: Taiwanese patients diagnosed with GERD were enrolled and had the procedure performed with EndoCinch. The assessment included symptom scoring, validated GERD questionnaires, esophagogastroduodenoscopy, esophageal manometry and 24-h pH monitoring before and after the procedure over a 2-year period. RESULTS: Twenty-one consecutive patients were recruited and underwent ELGP. Patients reported improved heartburn symptom score (mean 64.0 vs 21.1, P < 0.001), regurgitation frequency score (mean 2.4 vs 1.3, P < 0.001), and GERD health-related quality of life (mean 23.1 vs 10.1, P < 0.001) at 24 months. The mean total time of pH < 4 reduced from 121.7 min to 67.1 min (P = 0.008) and mean DeMeester score reduced from 32.9 to 17.6 (P = 0.011) at 3 months. Antisecretory drug discontinuation rate was 81%, 57%, 52% and 48% at 1, 6, 12 and 24 months, respectively. Of the patients who had a favorable initial response to ELGP at 1 month, 41% resumed antisecretory medications at 24 months follow-up. All adverse events were mild and transient. CONCLUSIONS: Endoluminal gastroplication is a safe and modestly effective endotherapy for patients with GERD. It significantly improved symptoms in an Asian population. Approximately one in two patients continues to be off medication at 24 months follow-up. However, the long-term efficacy and durability are still to be determined.

Cellular senescence is an important mechanism of tumor regression upon c-Myc inactivation.

Oncogene-induced senescence is an important mechanism by which normal cells are restrained from malignant transformation. Here we report that the suppression of the c-Myc (MYC) oncogene induces cellular senescence in diverse tumor types including lymphoma, osteosarcoma, and hepatocellular carcinoma. MYC inactivation was associated with prototypical markers of senescence, including acidic beta-gal staining, induction of p16INK4a, and p15INK4b expression. Moreover, MYC inactivation induced global changes in chromatin structure associated with the marked reduction of histone H4 acetylation and increased histone H3 K9 methylation. Osteosarcomas engineered to be deficient in p16INK4a or Rb exhibited impaired senescence and failed to exhibit sustained tumor regression upon MYC inactivation. Similarly, only after lymphomas were repaired for p53 expression did MYC inactivation induce robust senescence and sustained tumor regression. The pharmacologic inhibition of signaling pathways implicated in oncogene-induced senescence including ATM/ATR and MAPK did not prevent senescence associated with MYC inactivation. Our results suggest that cellular senescence programs remain latently functional, even in established tumors, and can become reactivated, serving as a critical mechanism of oncogene addiction associated with MYC inactivation.

Clinical application of Carlsson's questionnaire to predict erosive GERD among healthy Chinese.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease, yet there is no definitive gold standard to describe and diagnose it. AIM: We used endoscopic examination and Carlsson's questionnaire to evaluate the prevalence of erosive esophagitis during health examinations of individuals in Taiwan. METHODS: From October 2001 to March 2002, 778 people underwent self-paid health examinations including esophagogastroduodenoscopic examinations. All subjects completed Carlsson's questionnaire before endoscopy. We determined the positive predict rate, negative predict rate, sensitivity, and specificity of the Carlsson's score for predicting esophagitis and relationships of the score (score > or =4 vs score <4) and esophagitis based on sex, age, body mass index (BMI), smoking, peptic ulcer and drinking habits. RESULTS: One hundred and thirty-one people with scores > or =4 were highly suspected to have GERD. Of them, 21 were diagnosed as having reflux erosive esophagitis (16.0%) on endoscopic examination. Of 647 people whose scores were <4, 49 were diagnosed with having reflux erosive esophagitis (7.6%). Thus, 70 people were diagnosed as having erosive esophagitis for a prevalence of 9% (70 of 778). The difference between scores > or =4 and <4 to detect esophagitis differed significantly (P < 0.001). Total esophagitis differed significantly according to BMI, drinking habit and sex. CONCLUSION: The prevalence of reflux esophagitis is 9.00% at a single medical center in Taiwan. Esophagitis is positively related to higher BMI, alcohol consumption and being of male sex. Predicting the prevalence of esophagitis in a general population by using Carlsson's questionnaire was unsatisfactory.

Accuracy of three diagnostic tests used alone and in combination for detecting Helicobacter pylori infection in patients with bleeding gastric ulcers.

OBJECTIVE: Accuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs. METHODS: A total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and (13)C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests. RESULTS: The prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P = 0.02) as opposed to RUT (P = 0.11), UBT had significantly higher sensitivity than RUT (P < 0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis. CONCLUSIONS: UBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombosis.

AIM: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with poor prognosis. The aim of this prospective study was to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with this disease. METHODS: Eighteen HCC patients with PVTT were treated with HAIC via a subcutaneously implanted injection port. A course of chemotherapy consisted of daily cisplatin (10 mg for one hour) followed by 5-fluorouracil (250 mg for five hours) for five continuous days within a given week. The patients were scheduled to receive four consecutive courses of HAIC. Responders were defined in whom either a complete or partial response was achieved, while non-responders were defined based on stable or progressive disease status. The prognostic factors associated with survival after treatment were analyzed. RESULTS: Six patients exhibited partial response to this form of HAIC (response rate=33%). The 3, 6, 9, 12 and 18-month cumulative survival rates for the 18 patients were 83%, 72%, 50%, 28%, and 7%, respectively. Median survival times for the six responders and 12 non-responders were 15.0 (range, 11-18) and 7.5 (range, 1-13) months, respectively. It was demonstrated by both univariate and multivariate analyses that the therapeutic response and hepatic reserve function were significant prognostic factors. CONCLUSION: HAIC using low-dose cisplatin and 5-fluorouracil may be a useful alternative for the treatment of patients with advanced HCC complicated with PVTT. There may also be survival-related benefits associated with HAIC.

Combination of interferon alfa-2a and amantadine does not improve the efficacy of interferon therapy in patients with chronic hepatitis C.

BACKGROUND/AIMS: A recent pilot study suggested that 18% of patients with hepatitis C viral infection achieved a sustained response to a 6-month course of 200 mg of oral amantadine alone with disappearance of serum hepatitis C virus ribonucleic acid. We prospectively studied 30 naive patients with chronic hepatitis C viral infection for the possible role of amantadine in improving the efficiency of interferon for the treatment of chronic hepatitis C. METHODOLOGY: Patients were assigned into two groups on a double-blind and randomized controlled basis. Placebo group received 4.5 MU of interferon alfa-2a thrice weekly and oral placebo daily for 24 weeks. Amantadine group received a combination of the interferon and 200 mg of oral amantadine daily for 24 weeks. Patients were observed and tested for blood chemistry every week for the initial 4 weeks and every 2 weeks thereafter during the treatment until 24 weeks. After the end of treatment, patients were followed up at 4-week intervals for an additional 12 months. RESULTS: At the end of treatment, 5 (33.3%) patients responded to the combination therapy, and 7 (46.7%) patients responded to interferon therapy alone. Twelve months after cessation of the treatment, 3 (21.4%) patients had a sustained complete response to the combination therapy, and 3 (20.0%) patients had a sustained complete response to interferon alone (P = 0.64). CONCLUSION: Amantadine does not increase the efficacy of interferon in the treatment of chronic hepatitis C.

Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study.

BACKGROUND: It is well accepted that in patients with uncomplicated peptic ulcers, Helicobacter pylori eradication therapy does not need to be followed by further antisecretory treatment. However, it is uncertain whether patients with bleeding peptic ulcers should receive maintenance antiulcer therapy after successful H pylori eradication and ulcer healing. The aim of this 5-year, prospective, randomized, controlled study was to investigate the role of long-term maintenance therapy after successful H pylori eradication and healing of bleeding ulcers. METHODS: A total of 82 consecutive patients with H pylori-associated bleeding peptic ulcers were enrolled in the study. After successful H pylori eradication with the 1-week proton pump inhibitor-based triple therapy and an additional 3-week treatment with 20 mg of omeprazole daily for ulcer healing, the patients were assigned to one of four 16-week maintenance treatment groups as follows: group A received 15 mL of an antacid suspension 4 times daily; group B received 300 mg of colloidal bismuth subcitrate 4 times daily; group C received 20 mg of famotidine twice daily; and group D, the control group, received placebo twice daily. Follow-up included an urea breath test labeled with carbon 13, biopsy-based tests, and repeated endoscopic examination. RESULTS: An analysis of variance revealed no difference in mean age and mean follow-up time among the groups. During a mean follow-up of 56 months, there was no peptic ulcer recurrence among the 3 treatment groups, and all of the patients remained free of H pylori infection during the study period. CONCLUSIONS: In patients with bleeding peptic ulcers, antiulcer maintenance treatment was not necessary to prevent ulcer recurrence after successful H pylori eradication and ulcer healing. In addition, the 1-week proton pump inhibitor-based triple therapy had the efficacy to ensure long-term eradication of H pylori in a region of high prevalence.

Density of Helicobacter pylori may affect the efficacy of eradication therapy and ulcer healing in patients with active duodenal ulcers.

AIM: To evaluate the association of pre-treatment Helicobacter pylori (H. pylori) density with bacterial eradication and ulcer healing rates in patients with active duodenal ulcer. METHODS: One hundred and four consecutive duodenal ulcer outpatients with H. pylori infection ascertained by gastric histopathology and (13)C-urea breath test (UBT) were enrolled in this study. H. pylori density was graded histologically according to the Sydney system (normal, mild, moderate, and marked). In each patient, lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) were used for 1 week, then 30 mg lansoprazole once daily was continued for an additional 3 weeks. Follow-up endoscopy was performed at 4 weeks after completion of the therapy, and UBT was done at 4 and 8 weeks after completion of the therapy. RESULTS: The H. pylori eradication rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 69.7 %/85.2 %; and the ulcer healing rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 63.6 %/77.8 % (intention-to-treat/per protocol analysis) in the mild, moderate, and marked H. pylori density groups, respectively. The association of pretreatment H. pylori density with the eradication rate and ulcer healing rate was both statistically significant (P=0.013/0.006 and 0.002/<0.001, respectively; using results of intention-to-treat/per protocol analysis). CONCLUSION: Intragastric bacterial load may affect both the outcome of eradication treatment and ulcer healing in patients with active duodenal ulcer disease.

Esophageal manometry in patients with clinical symptoms mimicking esophageal origin: a hospital-based ten-year experience.

BACKGROUND: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is seldom reported in Chinese. With the introduction of an easy and less uncomfortable method to perform esophageal manometry by low-compliance perfusion system, we studied symptomatic patients for more than 10 years. These data were analyzed and were compared to Western reports. METHODS: From August 1989 to June 1999, 264 patients with symptoms mimicking esophageal origin, such as chest pain, dysphagia or odynophagia, but without secondary motility disorders were enrolled. Esophageal manometry was performed on each patient. RESULTS: Among 264 manometric tracings, 142 (54%) were normal and 122 (46%) were abnormal. In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative test by edrophonium, and 2 were hypertensive LES. As in Western countries, the most common abnormality was NEMD. However, our series did not find many patients with DES, nutcracker esophagus and hypertensive LES. Similar results were noted in patients with NEMD, that most had increased nontransmitted contractions and low contraction amplitude. CONCLUSIONS: We found that primary esophageal motility disorder is not uncommon in Taiwan. Esophageal manometry should always be considered in patients with symptoms mimicking esophageal origin.

Lamivudine does not increase the efficacy of interferon in the treatment of mutant type chronic viral hepatitis B.

AIM: To study the role of lamivudine in improving the efficiency of interferon for the treatment of mutant type chronic hepatitis B. METHODS: Fifteen patients with mutant type chronic hepatitis B were prospectively studied. All patients had liver histology and serology to prove the diagnosis of chronic hepatitis B. Each patient received 4.5 million units of interferon alpha-2a thrice weekly and 100 mg of oral lamivudine daily for 24 weeks. Patients were observed and tested for blood chemistry every week for the initial 4 weeks and every 2 weeks thereafter during the treatment until 24 weeks. After the end of treatment, patients were followed up at 4-week intervals for an additional 6 months. Serum HBV DNA levels were tested using the liquid phase molecular hybridization assay. Those with non-detectable HBV DNA were also tested using the real-time polymerase chain reaction. One patient, who did not finish treatment due to depression, was excluded. RESULTS: At the end of treatment, 7 (50 %) patients had serum ALT levels within normal limits; 12 (86 %) patients had serum HBV DNA levels <5 pg/mL using the liquid phase molecular hybridization assay, but only 8 (67%) were <20 copies/dL using the real-time polymerase chain reaction. Six months after treatment, only two (14 %) patients had a sustained complete response to the combination therapy with serum ALT level <35 iu/L and undetectable serum HBV DNA levels. CONCLUSION: These pilot data showed that lamivudine did not increase the efficacy of interferon in the treatment of mutant type chronic hepatitis B. The liquid phase molecular hybridization assay was not sensitive enough to detect the low HBV DNA levels during combined interferon and lamivudine therapy.

Ligand receptor interactions in the Wnt signaling pathway in Drosophila.

Secreted Wnt proteins have numerous signaling functions during development, mediated by Frizzled molecules that act as Wnt receptors on the cell surface. In the genome of Drosophila, seven Wnt genes (including wingless; wg), and five frizzled genes have been identified. Relatively little is known about signaling and binding specificities of different Wnt and Frizzled proteins. We have developed an assay to determine the strength of binding between membrane-tethered Wnts and ligand binding domains of the Frizzled receptors. We found a wide spectrum of binding affinities, reflecting known genetic interactions. Most Wnt proteins can bind to multiple Frizzleds and vice versa, suggesting redundancy in vivo. In an extension of these experiments, we tested whether two different subdomains of the Wg protein would by themselves bind to Frizzled and generate a biological response. Whereas these two separate domains are secreted from cells, suggesting that they form independently folded parts of the protein, they were only able to evoke a response when co-transfected, indicating that both are required for function. In addition to the Frizzleds, members of the LRP family (represented by the arrow gene in Drosophila) are also necessary for Wnt signal transduction and have been postulated to act as co-receptors. We have therefore examined whether a soluble form of the Arrow molecule can bind to Wingless and Frizzled, but no interactions were detected.

Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure in patients with chronic hepatitis B.

BACKGROUND: We carried out a study to predict the prognosis of acute hepatic failure in patients with chronic hepatitis B. METHODS: We studied 25 consecutive patients with severe acute hepatitis. Severe acute hepatitis was defined as the development of acute hepatitis with a total serum bilirubin level of more than 15 mg/dl, prolonged prothrombin time (PT) of more than 5 s, and hepatic encephalopathy (HE). All patients were assessed for King's criteria. Positivity for King's criteria was defined as PT more than 100 s, or any three of the following: (age < 10 years or >40 years; cryptogenic or drug-induced hepatitis; jaundice for more than 7 days before the onset of HE; PT > 50 s; and serum bilirubin > 17.5 mg/dl). All but 1 patient had serial serum alpha-fetoprotein (AFP) levels measured every 1-2 weeks. RESULTS: Eleven of 17 patients who died during the study met the King's criteria, whereas none of the surviving patients met the criteria. The sensitivity was 64.7% and the specificity, 100% for King's criteria in predicting a poor prognosis. In 16 of the 17 deceased patients, the AFP levels were reduced while their jaundice increased (sensitivity, 94.1%; specificity, 87.5%). All 17 deceased patients met the King's criteria and/or had reduced AFP levels while their jaundice increased (sensitivity, 100%; specificity, 87.5%). CONCLUSIONS: Our observations suggest that the combined use of follow-up AFP levels and King's criteria is helpful in predicting the poor prognosis of severe acute hepatitis superimposed on chronic hepatitis B.

Correlation between the degree of duodenal bulbar deformity and the density of Helicobacter pylori infection in patients with active duodenal ulcers.

BACKGROUND: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer. METHODS: Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked). RESULTS: A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection. CONCLUSION: Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.

Reuse of CLO test in the diagnosis of helicobacter pylori infection.

Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period of time. However, the duration that these pellets can be stored at room temperature before second use remains unclear. A total of 360 patients, 190 males and 170 females, who required a CLO test during endoscopy, were enrolled in this study. Two biopsies were taken from the gastric antrum of each patient, one for testing with a new pellet and the other for testing with a reused pellet. The reused pellets were used randomly and were divided into five groups according to the time interval between their initial and second usages (1, 2, 3, 6, and > 6 mo). When a positive result was found, the time to color change was recorded. Good correlation was noted for nearly all the paired CLO tests in all groups with either both positive or both negative. Only four pairs produced discrepant results. There was no significant difference when the results of both new and reused CLO tests were compared using McNemar's test (p > 0.05). In positive pairs, there was no significant difference in the color change time of both tests in all five groups by two-tailed t-test (p > 0.05); Pearson's correlation and linear regression showed a strong correlation between the color time change in the five groups (p < 0.0001). Only 54 of the 427 negative pellets stored for more than 6 months could be reused because most were dried out or no longer yellow in color. In conclusion, negative CLO test pellets may be reused within 6 months after initial usage provided they are stored at room temperature.

Coinfection of TT virus and response to interferon therapy in patients with chronic hepatitis B or C.

AIM: To investigate the serum positive percentage of TT virus (TTV) in patients with chronic hepatitis B or C and the response of the coinfected TTV to interferon (IFN) during IFN therapy for chronic hepatitis B and C. METHODS: We retrospectively studied the serum samples of 70 patients with chronic hepatitis who had received IFN-alpha therapy from January 1997 to June 2000, which included 40 cases of hepatitis B and 30 hepatitis C. All the patients had been followed up for at least 6 months after the end of IFN therapy. The serum TTV DNA was detected using the polymerase chain reaction (PCR) before and every month during the course of IFN treatment. RESULTS: TTV infection was detected in 15% (6/40) of the chronic hepatitis B group and 30% (9/30) of the chronic hepatitis C group. Loss of serum TTV DNA during IFN therapy occurred in 3 of 6 patients (50%) and 6 of 9 (67%) of hepatitis B and C groups, respectively. Seronegativity of TTV was found all during the first month of IFN therapy in the 9 patients. There was no correlation between the seroconversion of TTV and the biochemical changes of the patients. CONCLUSION: TTV is not infrequently coinfected in patients with chronic hepatitis B and C in Taiwan, and more than half of the TTV infections are IFN-sensitive. However, the loss of serum TTV DNA does not affect the clinical course of the patients with chronic hepatitis B or C.

Endoscopic hemoclip treatment for bleeding peptic ulcer.

AIM:To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS:Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment.We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and re-clipping was performed if necessary and feasible.RESULTS:Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively.In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively.Hemostasis reached 100% in patients without shock regar-dless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2-5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION: Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device, the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.