Search PubMed⌕ Search

Biomedical subjects

Sheng-Nan Lu

Publications and source records attributed to Sheng-Nan Lu.

70 records · Page 4Linked to original sources
PubMed2002

Is delayed normalization of alanine aminotransferase a poor prognostic predictor in chronic hepatitis C patients treated with a combined interferon and ribavirin therapy?

BACKGROUND AND AIMS: Decreased alanine aminotransferase (ALT) level is the accepted basic indicator of an interferon (IFN) therapeutic effect in chronic hepatitis C. This study assessed whether delayed normalization of ALT predicts a poor response to a combined therapy of IFN and ribavirin in patients with chronic hepatitis C virus (HCV) infection. METHODS: Patients were treated with IFN-alpha 2b three times weekly and oral ribavirin for 24 weeks. The ALT values were assessed monthly and patterns of changes in ALT activity were analyzed. Serum HCV-RNA was checked at weeks 0, 12, 24, and 48. RESULTS: A total of 103 patients completed therapy and 69 (67%) of them achieved a sustained viral response (SVR). There was no significant difference in the SVR between patients with or without early normalization (week 12) of ALT level (69 vs 56%). Of the sustained responders, nine patients (13%) with delayed ALT normalization had a SVR. Nine of the 12 patients (75%) with abnormal ALT and negative HCV-RNA at week 12 had a SVR compared with none of four patients who had positive HCV-RNA at week 12 (P = 0.0192). CONCLUSIONS: Lack of normalization of the ALT level at week 12 does not preclude successful virological outcome in hepatitis C patients receiving a combined therapy of IFN and ribavirin. Hepatitis C virus RNA at week 12 may be a useful predictor of treatment outcome in patients without early biochemical response.

Alanine Transaminase↗
PubMed2002

Clinical characteristics and distribution of genotypes of TT virus infection in a hepatitis C virus-hyperendemic township of a hepatitis B virus-endemic country (Taiwan).

BACKGROUND: The prevalence of TT virus (TTV) viremia, without definite clinical significance, has been reported to be higher among chronic hepatitis C patients. The status and clinical characteristics of TT virus (TTV) infection and distribution of TTV genotypes in a hepatitis C virus (HCV) hyperendemic township (Masago community) in a hepatitis B virus (HBV) endemic country (Taiwan) were investigated. METHODS: Sera from 100 Masago residents were tested for alanine aminotransferase (ALT) and markers of HBV, HCV and GB virus C/hepatitis G virus (GBV-C/HGV) and TTV-DNA. Sera of 250 blood donors as a control group were tested for TTV-DNA. Sera of Masago residents and blood donors with positive TTV-DNA were directly sequenced, and phylogenetic analyses were performed subsequently. RESULTS: The prevalences of TTV viremia in different age groups among individuals from Masago were significantly higher than that among blood donors. In regard to the subtypes of TTV, 23, seven, two, eight, one, six and one isolate were related to the genotypes 1a, 1b, 2a, 2b, 3, 4 and 5, respectively, from Masago and 21, 14, one, nine and three isolates were related to the genotypes 1a, 1b, 2a, 2b, and 4, respectively, from donors. No clinical or virological factor was associated with TTV viremia or TTV genotypes. CONCLUSIONS: TT Virus prevalence was higher among HCV hyperendemic township residents than blood donors with similar genotype distributions (genotype 1 was the most prevalent) in Taiwan. Neither TTV viremia nor a particular genotype was associated with HBV, HCV or GBV-C/HGV infection and abnormal ALT levels.

Adult↗
PubMed2002

Comparison of prevalence for paraumbilical vein patency in patients with viral and alcoholic liver cirrhosis.

OBJECTIVES: The patent paraumbilical vein (PUV) is a venous collateral that is often found in patients with cirrhosis and portal hypertension. It can be effectively demonstrated by conventional ultrasonography (US). We conducted this prospective study to elucidate the prevalence and etiology of PUV patency for cirrhotic patients. METHODS: From August, 1997, to July, 1998, one of the authors (S.-N.L.) observed PUV patency for all cirrhotic patients during routine upper abdominal US examination. All cirrhotic patients diagnosed with portal hypertension were further analyzed. Portal hypertension was diagnosed by sonographic evidence of splenomegaly or ascites, or endoscopic varices. Cases presenting with hepatocellular carcinoma and sonographic evidence of prehepatic portal hypertension were excluded. Once a PUV patency with a diameter of > or = 3 mm was suspected based on conventional US, it was confirmed by color Doppler US. Of the 493 cirrhotic patients examined, 252 with portal hypertension and without hepatoma were enrolled in this study. RESULTS: Significant PUV patency was detected in 11.1% of the enrolled patients (28 of 252). With univariate analysis, a significantly higher prevalence was demonstrated for alcoholic patients (p < 0.0001), whereas prevalence was relatively low for those with chronic hepatitis B or C infection (p = 0.0159). A trend toward increased prevalence was noted with Child-Pugh classification (p = 0.001). Furthermore, a higher prevalence was noted in younger cirrhotic patients (p = 0.0037). Alcoholism was still a significant factor despite adjustment of Child-Pugh classification using multiple logistic regression, (OR = 3.88, 95% CI = 1.34-8.55). CONCLUSION: A significantly higher prevalence of PUV patency was demonstrated for patients with alcohol-induced liver cirrhosis in comparison to those with postviral cirrhosis.

Adult↗
PubMed2002

Predicting the prevalence of antibody to hepatitis C virus (HCV) in a community by the prevalence of elevated levels of alanine aminotransferase: a method to identify areas endemic for HCV.

To identify areas endemic for hepatitis C virus (HCV), we attempted to predict the prevalence of antibody to HCV (anti-HCV) in a community by the prevalence of elevated levels of alanine aminotransferase (ALT). The results of health examinations of 2,273 women > or = 40 years old in five townships in central Taiwan were analyzed. The overall prevalence of elevated ALT levels was 11.6%. A township (20.3%) and 10 villages were identified as having a high prevalence (17.9-40.0%) of elevated ALT levels. Five communities with variant rates of elevated ALT levels, which ranged from 8.0% to 27.3%, were selected for correlation with the prevalence of anti-HCV among adults (> or = 40 years old). The prevalence of anti-HCV, which ranged from 10.1% to 72.1%, were obtained by community screenings and/or hospital-based studies. The correlation equation used was the prevalence of anti-HCV (%) = 3.33 x (prevalence of elevated ALT levels (%) - 5.7%) (r2 = 0.94, P < 0.01). Using this method, areas endemic for HCV can be identified by determining the community prevalence of elevated ALT levels.

Adult↗
PubMed2002

Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma.

OBJECTIVE: To determine with the use of color Doppler sonography whether bile duct tumor thrombi had detectable vasculature in hepatocellular carcinoma. METHODS: Among 491 patients with tissue-proven hepatocellular carcinoma, 9 (1.8%) had bile duct tumor thrombi. All 9 patients had spectral Doppler sonography guided by color Doppler sonography (3.75-MHz convex probe). RESULTS: All 9 patients had dilated bile ducts with isoechoic thrombi. Eight patients had tumors infiltrating into and obstructing adjacent major bile ducts. The other patient had common hepatic duct tumor emboli that were not adjacent to primary tumors. Color signals were detectable within bile duct tumor thrombi in 7 patients. All of them had pulsatile waveforms on spectral analyses. CONCLUSIONS: Bile duct tumor thrombosis with obstructive jaundice was a rare complication of hepatocellular carcinoma. A detectable color signal with pulsatile waveforms was shown in most cases by color Doppler sonography with spectral analyses.

Bile Duct Neoplasms↗
PubMed2002

Eosinophilic gastroenteritis involving the distal small intestine and proximal colon.

Eosinophilic gastroenteritis (EG) is an unusual disorder. It is characterized by eosinophil infiltration of the gut wall histologically and is manifested by gastrointestinal (GI) symptoms clinically. This disease entity preferentially affects the stomach and proximal small intestine. Mucosal layer disease is the most common form of this uncommon disease. We present a case of EG with transmural distal small intestinal and proximal colonic involvement whose clinical symptoms included watery diarrhea, abdominal pain, and body weight loss. Colonoscopy showed non-specific colitis in the proximal colon. Small bowel series showed diffuse jejunal dilatation with wall thickening and rigidity. Abdominal computed tomography also showed a thickened bowel wall with partial ileus and ascites. Diagnosis was established through endoscopic biopsy and ascites paracentesis, while at the same time excluding the possibility of parasite infection. Treatment with prednisolone produced a dramatic response. A high index of suspicion in cases of peripheral eosinophilia with concomitant GI symptoms is needed for the early diagnosis of this uncommon disease.

Adult↗
PubMedDate not supplied

Flash-echo gray-scale imaging in the subtraction mode for assessing perfusion of small hepatocellular carcinoma.

PURPOSE: The aim of this study was to evaluate the effectiveness of using flash-echo imaging (FEI) in the subtraction mode to assess the vascularity of small hepatocellular carcinomas (HCCs) that had been unsatisfactorily assessed with power Doppler sonography. METHODS: Between May 2000 and April 2001, we prospectively assessed nodular small HCCs using FEI in the subtraction mode after power Doppler sonography resulted in unsatisfactory images. After microbubble contrast was injected, we used the FEI technique to assess tumor perfusion in the arterial, portal, and delayed phases. RESULTS: Our study population comprised 14 patients (10 men and 4 women) whose ages ranged from 31 to 79 years (mean, 61 +/- 13.7 years) and whose tumors ranged in size from 0.8 to 3 cm (mean, 1.8 +/- 0.5 cm). Power Doppler sonography was unable to assess tumor vascularity in 6 cases because of interference by heart pulsation, and it failed to detect a color signal in the other 8 cases. All tumors were enhanced with FEI. In the arterial phase, 7 of the 14 tumors (50%) showed hyperperfusion relative to liver parenchyma enhancement, 5 of 14 (36%) showed isoperfusion, and 2 of 14 (14%) showed hypoperfusion. In the portal phase, 3 of the 14 tumors (21%) showed isoperfusion, and the other 11 (79%) showed hypoperfusion. In the delayed phase, all 14 tumors showed hypoperfusion. CONCLUSIONS: Despite heart pulsation and slow vascular flow, FEI in the subtraction mode was sensitive and effective in assessing the perfusion of small HCCs.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytodiagnosis of liver tumors.

OBJECTIVE: To present our experience with liver fine needle aspiration (FNA) diagnosis and the adjunctive use of cell blocks with reticulin stain. STUDY DESIGN: The authors reviewed the results of cytopathologic diagnosis obtained by FNA biopsy over a 1-year period, from January 2000 to December 2000, in patients who presented primarily with ultrasonographically suspected liver nodules. FNA smears from 936 patients and cell blocks from 796 patients were reviewed. RESULTS: Among the 936 aspirates studied, the most common malignancy was hepatocellular carcinoma (HCC), which was diagnosed in 427 cases (45.6%), followed by metastatic adenocarcinoma, with 52 cases (5.6%). The concurrent cell block was available in 796 cases. Among them, 574 (72.1%) contained sufficient tissue for diagnosis. Combining analysis of cytologic and histologic specimens, the sensitivity of ultrasound-guided FNA for diagnosis of liver tumors was 85.1% and the specificity 98.7%. The results were better than isolated cytologic analysis, which gave a sensitivity of 78.4% and specificity of 97.4%. The lower diagnostic accuracy of cytology resulted mainly from its lower ability to distinguish well-differentiated HCC from benign lesions. In the cell block sections with reticulin stain, all HCCs showed a decreased or absent reticulin pattern, whereas all the benign hepatocellular lesions usually had a normal trabecular reticulin framework. CONCLUSION: FNA cytology assisted by cell block examination can be an accurate and minimally invasive method for the definitive pathologic diagnosis of primary benign and malignant liver masses and for confirmation of tumors metastatic to the liver. In addition, reticulin staining should be part of the routine assessment of cell blocks. It enhances diagnostic accuracy, particularly for well-differentiated HCC.

Adenocarcinoma↗
PubMedDate not supplied

Combined cytologic and histologic diagnosis of liver tumors via one-shot aspiration.

BACKGROUND/AIMS: Ultrasound-guided fine needle aspiration is considered to be a safe alternative in diagnosing liver tumors. Combined cytologic and histologic preparation via one-shot fine needle aspiration was evaluated, especially in outpatients. METHODOLOGY: During a 1-year period, 95 patients (including 57 outpatients and 38 inpatients) who had received 97 sessions of fine needle aspiration and had final diagnosis were enrolled. Using a 22-gauge needle, the aspirate from liver tumor was processed for cytology and cell block histology simultaneously in patients without ascites and/or bleeding tendency. RESULTS: From 94 malignant and 3 benign tumors, the accuracy of cytology was 88.7%; while, the difference between outpatients and inpatients was not significant (91.2% vs. 85%). No complication after fine needle aspiration was elicited in both groups. The rates of inadequate specimen preparation for cytology and histology were 0% and 13.4%, the false-negative rates of malignancy were 11.7% for cytology and 16% for histology. The inadequate and false-negative rates of histology were not associated with gender, underlying liver cirrhosis, or tumor size, type, and location. CONCLUSIONS: Ultrasound-guided 22-gauge one-shot fine needle aspiration is safe, convenient and reliable in diagnosing liver tumor, and can be performed in outpatients meticulously.

Adenocarcinoma↗
PubMedDate not supplied

High-dose interferon-alpha 2b plus ribavirin combination therapy for GB virus-C/hepatitis G virus infection--a study in patients with chronic hepatitis C.

BACKGROUND/AIMS: The efficacy of interferon-alpha and ribavirin combination therapy for GB virus C/hepatitis G virus infection is not well understood. We previously conducted a double-blind, placebo-controlled trial using high-dose interferon-alpha 2b with or without ribavirin for patients with interferon-alpha-relapsed chronic hepatitis C. METHODOLOGY: Fifty-two patients were randomly assigned and completed the 24-week treatment of interferon-alpha 2b (6 million units three times per week) plus ribavirin (1000 to 1200 mg/daily), or plus a matched placebo. Patients were then followed for an additional 24 weeks. RESULTS: Of the 52 patients, 5 patients (9.6%) had hepatitis G virus viremia before or during enrollment. Two patients received interferon-alpha 2b alone and three patients received interferon-alpha 2b and ribavirin combination therapy. At the end of treatment, all of the 5 patients had undetectable hepatitis G virus RNA in sera. Early loss of hepatitis G virus RNA at week 4 of treatment was observed in the 2 patients on combination therapy. Hepatitis G virus RNA reappeared at the end of follow-up in these 5 patients. CONCLUSIONS: In conclusion, interferon-alpha 2b and ribavirin combination therapy could induce earlier loss of hepatitis G virus RNA than interferon-alpha 2b alone. Either interferon-alpha 2b alone or interferon-alpha 2b and ribavirin combination therapy achieved transient but not sustained virological response to hepatitis G virus viremia.

Adult↗
PubMedDate not supplied

One-week low-dose triple therapy without anti-acid treatment has sufficient efficacy on Helicobacter pylori eradication and ulcer healing.

BACKGROUND/AIMS: The aim of this study was to determine the efficacy of a 1-week low-dose proton pump inhibitor-based triple therapy without further acid suppression for cure of Helicobacter pylori infection and the ulcer healing in peptic ulcer disease. METHODOLOGY: Patients with endoscopically proven peptic ulcers who were H. pylori positive participated in this study. All patients were treated for 1 week with omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and tinidazole 500 mg b.d., then patients were treated randomly for another 4 weeks with either omeprazole 20 mg once daily (OCM-O group; n = 40) or without acid suppressing agents (OCM group; n = 39). Patients were investigated endoscopically for H. pylori and ulcer status before treatment, four weeks (week 5) and 8 weeks later (week 9) after anti-H. pylori treatment. H. pylori infection was assessed by rapid urease test and histology. RESULTS: The eradication rates of H. pylori were 72.5% (95% CI: 59-86%) and 76.3% (95% CI: 63-90%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM-O group and were 87.2% (95% CI: 77-98%) and 97.1% (95% CI: 92-100%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM group (p < 0.05 in per protocol analysis). In respect to ulcer healing status at week 5, 89.5% (34/38) of patients in the OCM-O group and 80% (28/35) of patients in the OCM group had healed ulcers; at week 9, 86.8% (33/38) of patients in the OCM-O group and 88.6% (31/35) of patients in the OCM group had healed ulcers (p = NS). When the ulcer status was analyzed in relation to the H. pylori status, at week 5 ulcer had healed in 84.4% (54/64) of patients with clearance of H. pylori infection and in 88.9% (8/9) of those with persistent infection. At week 9, ulcer healing increased up to 93.8% (60/64) of patients with clearance of H. pylori infection and decreased to 44.4% (4/9) of patients with persistent infection. The adverse events (20%) were mild in these two treatment groups and no patients required discontinuation of the study medications. CONCLUSIONS: Continuation of antisecretory drug therapy beyond a one-week low-dose triple therapy consisting of omeprazole, clarithromycin and tinidazole is actually excessive regarding eradication efficacy and peptic ulcer healing.

Adult↗
PubMedDate not supplied

Correlations between hepatitis B virus genotype and cirrhotic or non-cirrhotic hepatoma.

BACKGROUND/AIMS: Hepatoma arising in cirrhotic and non-cirrhotic livers might have different virological and clinical factors in hepatitis B virus carriers. This study was performed to elucidate the correlation between hepatitis B virus genotypes and clinical characteristics of patients with cirrhotic and non-cirrhotic hepatoma. METHODOLOGY: One hundred and fifty-five hepatitis B virus carriers who received hepatic resection for hepatoma were investigated to determine hepatitis B virus genotypes and clinical features. RESULTS: Of 155 patients, 84 were genotype B infection, and 67 genotype C. Compared to genotype C carriers, genotype B analogs had a significantly lower rate of liver cirrhosis (p=0.005), lower hepatitis B e antigen positive rates (p=0.0008), and lower fibrosis scores (p=0.003). In comparison to cirrhotic hepatoma patients, non-cirrhotic counterparts were younger (p=0.041), had a higher platelet count (p<0.001), lower hepatitis B e antigen positive rates (p=0.023), predominantly genotype B (p=0.005), lower inflammation scores (p<0.001). Using multivariate analysis, non-cirrhotic hepatoma was associated with genotype B infection (OR=2.85, 95% CI=1.44-5.64) and younger age (OR=0.967, 95% CI=0.94-0.99) in hepatitis B virus carriers. CONCLUSIONS: Our study suggested that hepatitis B virus genotype B infection might be an important factor for non-cirrhotic hepatoma.

Adult↗
PubMedDate not supplied

Telomerase activity and telomerase catalytic subunit in hepatocellular carcinoma.

BACKGROUND/AIMS: Telomerase activation has been found in most malignant tumors. Human telomerase reverse transcriptase is a catalytic subunit of human telomerase and a rate-limiting factor of the enzymatic activity of telomerase. The present study was designed to examine the usefulness of detecting human telomerase catalytic subunit mRNA and telomerase activity as a molecular diagnostic marker for human liver cancers. METHODOLOGY: Thirty-one specimens of hepatocellular carcinoma and corresponding adjacent tissues were analyzed for human telomerase reverse transcriptase expression by reverse transcription polymerase chain reaction and for telomerase activity by polymerase chain reaction-based telomeric repeat amplification protocol. RESULTS: Human telomerase reverse transcriptase mRNA expression was observed in 97% of hepatocellular carcinoma tissues, in contrast none of the non-tumorous liver tissues did. Telomerase activity was detected in 94% of hepatocellular carcinoma and in only 16% of adjacent liver tissues. Human telomerase reverse transcriptase mRNA expression and telomerase activity were observed in all 3 grade I (well-differentiated) hepatocellular carcinoma. Significant correlations between human telomerase reverse transcriptase mRNA expression and hepatocellular carcinoma and also between telomerase activity and HCC were found (both p<0.001). CONCLUSIONS: The results indicate that human telomerase catalytic subunit mRNA expression and telomerase activity might be associated with hepatocellular carcinogenesis and could be as markers for diagnosis of hepatocellular carcinoma.

Adult↗
PubMedDate not supplied

Prediction of viremia for cases of hepatitis C virus (HCV) infection using a third-generation anti-HCV enzyme immunoassay test.

BACKGROUND/AIMS: Positive results for anti-hepatitis C virus (HCV) testing reveal subjects are infected by HCV, with presence of HCV RNA indicating persistent infection. In this study, we attempted to evaluate the validity of the HCV viremia using a commercially available, third-generation anti-HCV test. METHODOLOGY: Sample rate/cut-off rate (S/CO) ratios for 1,907 anti-HCV-positive tests (S/CO >1, AxSYM HCV 3.0; Abbott, IL, USA), which had been performed during the last three years, were retrospectively analyzed. Cases with S/CO values between 1 and 100 were divided into 20 groups according to S/CO range (in increments of 10) and ALT (normal or elevated). Ten random cases were obtained for each of the 20 groups. If cases in any group numbered < or =10, all were recruited. Totally, 193 cases were enrolled for HCV RNA detection (COBAS Amplicor; Roche Diagnostics, NJ, USA). RESULTS: The S/CO distribution was biphasic, with two S/CO peaks in the ranges 1-10 (10.7%) and 81-90 (24.2%). Regardless of the ALT level, all samples with S/COs < or =10 were negative for HCV RNA. Of the samples with S/CO values >10, the optimal cut-off was 40 with sensitivity and specificity for both of 81%. In conclusion, subjects with S/CO values < or =10 (10.7%) were more likely to be cases of past infection or of non-specific reaction. Most (90%, 108/120) of the subjects with S/COs >40 represent current or persistent infection. To predict viremia in subjects with S/COs between 10 and 40, 6.7% of all anti-HCV-positive subjects was invalid by a cross-sectional observation. CONCLUSIONS: Follow-up or further study is recommended. The third-generation EIA test plays a semiquantitative role for the prediction of viremia in HCV infection.

Hepacivirus↗
PubMedDate not supplied

One-week versus two-week H2-receptor antagonist in combination with amoxicillin and tinidazole for eradication of Helicobacter pylori infection.

BACKGROUND/AIMS: Eradication regimens combining two antibiotics with a proton pump inhibitor have been studied intensively in Helicobacter pylori (H. pylori) infection; however, only a few reports have focused on the role of H2-receptor antagonists (H2-RAs) in eradication therapy. The mechanism involved in the synergy between antibiotics and H2RAs are still elusive. So we compared the efficacy of two regimens: a 1-week or 2-week course of high-dose H2-RA-based triple therapy in patients with H. pylori infection, and assessed the impact of primary resistance for metronidazole on the treatment outcome. METHODOLOGY: One hundred and twenty patients with peptic ulcers and nonulcer dyspepsia were randomly assigned to a one-week course of famotidine 40mg b.i.d., amoxicillin lg b.i.d. and tinidazole 500 mg b.i.d. (FAT1 group; n = 60) or a 2-week course of famotidine 40 mg b.i.d., amoxicillin lg b.i.d. and tinidazole 500 mg b.i.d. (FAT2 group; n = 60). Upper endoscopy was performed prior to treatment and at least 4 weeks after completion of treatment and discontinuation of the antisecretory therapy. H. pylori status was assessed by biopsy urease test, histology and culture. RESULTS: In the intention-to-treat analysis, eradication of H. pylori was achieved in 38 of 60 patients (63.3%; 95% CI: 51-76%) in the FAT1 group, compared to 48 of 60 patients (80%; 95% CI: 70-92%) in the FAT2 group (NS). In the per protocol analysis, eradication therapy was achieved in 38 of 54 patients (70.4%; 95% CI: 58-82%) in the FAT1 group and 48 of 53 patients (90.6%; 95% CI: 83-98%) in the FAT2 group (p < 0.05). The overall eradication rates for strains susceptible and resistant to metronidazole were 79.7% (95% CI: 71-89%) vs. 60% (95% CI: 44-74%) in the intention-to-treat analysis (p = 0.016) and 84% (95% CI: 76-92%) vs. 71.9% (95% CI: 56-88%) in the per protocol analysis (p = 0.12). Seven patients in the FAT1 group and six patients in the FAT2 group available for follow-up reported adverse events (11.7% and 10% respectively) without necessity of discontinuation of the study medications. Serious adverse events were not observed. CONCLUSIONS: A 2-week course of high-dose H2-RA-based triple therapy is well tolerated and sufficiently effective in eradicating H. pylori infection. Presence of metronidazole resistance has a negative impact on the treatment efficacy.

Adult↗