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1.  Durability after discontinuation of nucleos(t)ide therapy in chronic HBeAg negative hepatitis patients 
Clinical and molecular hepatology  2013;19(3):300-304.
Background/Aims
Relapse has been reported after stopping nucleos(t)ide (NUC) therapy in the majority of chronic HBeAg negative hepatitis patients. However, the ideal treatment duration of HBeAg negative chronic hepatitis B (CHB) is not well known. We investigated the frequency of relapse in HBeAg negative CHB patients receiving NUC therapy.
Methods
The NUC therapy was discontinued at least 3 times undetectable level of HBV DNA leave 6 months space in 45 patients. Clinical relapse was defined as HBV DNA >2,000 IU/mL and alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >2 times of upper limit of normal range. Virological relapse was defined as HBV DNA >2,000 IU/mL.
Results
Clinical relapse developed in 16 (35.6%) and 24 (53.3%) patients after stopping therapy at 6 months and 12 months off therapy, respectively. Virological relapse developed 22 (48.9%) and 33 (73.3%) patients at 6 months and 12 months off therapy. The factors such as age, gender, cirrhosis, baseline AST, ALT, HBV DNA levels, treatment duration, and consolidation duration were analyzed to investigate the predictive factors associated with 1 year sustained response. Of these factors, cirrhosis (86.1% in CHB, 22.2% in LC) was significantly associated with 1 year virological relapse rate. Baseline HBV DNA and total treatment duration tended to be associated with virological relapse.
Conclusions
Virological relapse developed in the majority (73.3%) of HBeAg negative CHB patients and clinical relapse developed in the half (53.3%) of patients at 1 year off therapy. Cirrhosis may be associated with the low rate of virological relapse.
doi:10.3350/cmh.2013.19.3.300
PMCID: PMC3796680  PMID: 24133668
Chronic hepatitis B; Durability; Nucleos(t)ide analogue
2.  Preoperative Colonoscopy for Detection of Synchronous Neoplasms after Insertion of Self-Expandable Metal Stents in Occlusive Colorectal Cancer: Comparison of Covered and Uncovered Stents 
Gut and Liver  2013;7(3):311-316.
Background/Aims
In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents.
Methods
Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents.
Results
Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent.
Conclusions
A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.
doi:10.5009/gnl.2013.7.3.311
PMCID: PMC3661963  PMID: 23710312
Colorectal neoplasms; Stents; Colonoscopy; Neoplasms, multiple primary
3.  Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones 
BMC Gastroenterology  2013;13:15.
Background
Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting.
Methods
One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n = 62) or EST plus LBD (n = 69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared.
Results
There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P = 0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P = 0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P = 0.593), impaction of basket and stone (0% vs. 1.4%, P = 0.341), and perforation (0% vs. 1.4%, P = 0.341).
Conclusions
LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.
doi:10.1186/1471-230X-13-15
PMCID: PMC3556067  PMID: 23324454
Common bile duct stones; Endoscopic sphincterotomy; Large-balloon dilation
4.  Association between apolipoprotein E genotype, chronic liver disease, and hepatitis B virus 
Clinical and molecular hepatology  2012;18(3):295-301.
Background/Aims
Apolipoprotein E (ApoE) plays an important role in regulating lipid and lipoprotein metabolism, and ApoE genotypes are known to affect plasma lipoprotein concentrations. We investigated whether ApoE genotype determines the disease outcome in hepatitis B virus (HBV)-infected individuals, and verified the association between ApoE genotype and the occurrence of hepatocellular carcinoma (HCC) in patients with chronic liver diseases of various etiologies.
Methods
This hospital-based, case-controlled study enrolled 156 subjects (47 healthy controls, 50 HBV-related liver cirrhosis patients, and 59 HCC patients). ApoE genotypes were determined using PCR-based ApoE genotyping kits. The biological significance of ApoE genotype was verified by measuring serum ApoE levels using an ELISA kits.
Results
The ε3 allele was the most common allele, with allele frequencies among the entire cohort of 5.8%, 84.3%, and 9.9% for the ε2, ε3, and ε4 alleles, respectively. Significantly more of those patients carrying the ε3/3 genotype had developed liver cirrhosis compared to the control subjects. Being an ApoE4 carrier was associated with a lower probability of developing liver cirrhosis. The allele frequencies and genotype distribution of ApoE did not differ significantly between the liver cirrhosis and HCC patients. The serum level of ApoE was significantly higher in patients with liver cirrhosis than in the healthy controls, but did not differ significantly with the ApoE genotype.
Conclusions
The ApoE ε3/3 genotype frequency was higher in patients with HBV-associated liver cirrhosis than in the controls.
doi:10.3350/cmh.2012.18.3.295
PMCID: PMC3467433  PMID: 23091810
Apolipoprotein E; Hepatitis B virus; Genotype; Liver cirrhosis
5.  Relevance of interleukin-10RB to chronic hepatitis B virus infection and biological activities of interferon-λ and interleukin-22 
Hepatology International  2012;7(1):111-118.
Purpose
The association of a single nucleotide polymorphism of interleukin (IL)-10RB codon 47 with the chronic hepatitis B virus (HBV) infection has been reported in two ethnic populations with different results, but not in a Korean population. IL-10RB is a subunit of receptor complexes for interferon-lambda (IFN-λ) and IL-22, which have antiviral and hepatocyte-protective activity, respectively. This study examined the association of IL-10RB K47E with the outcomes of HBV infection in Korean subjects and the cellular response to these cytokines.
Methods
Genotypes of IL-10RB and the outcomes of HBV infection were analyzed in 1,000 Korean patients. The effect of IFN-λ or IL-22 on HBV replication and cell viability was assessed in hepatoma cells expressing IL-10RB K47 or E47. The transcript level of IL-10RB was examined in Epstein Barr virus-transformed B cells and hepatoma cells.
Results
IL-10RB K47E was associated with chronic HBV infection but not with hepatoma in the Korean population. IL-10RB K47E was associated with the transcript level of IL-10RB in transformed B cells but not with the responses in hepatoma cells to IFN-λ or IL-22. HBV replication or 5-fluorouracil-induced cell death was suppressed by treatment of IFN-λ or IL-22 in an IL-10RB K47E-independent manner.
Conclusions
IL-10RB K47E is related to chronic HBV infection in a Korean population, but not to cellular responsiveness to IFN-λ and IL-22.
Electronic supplementary material
The online version of this article (doi:10.1007/s12072-012-9361-8) contains supplementary material, which is available to authorized users.
doi:10.1007/s12072-012-9361-8
PMCID: PMC3601266  PMID: 23519428
Chronic hepatitis B; HBV replication; IFN-λ; IL-10R2; IL-22; Single nucleotide polymorphism
6.  A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction 
Clinical Endoscopy  2012;45(1):78-83.
Background/Aims
The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent.
Methods
We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the technical success rate, functional success rate, early complications, late complications, stent patency and survival rate.
Results
There was one case in the covered SEMS group that had failed technically, but was corrected successfully using lasso. Functional success rates were 90.5% in the covered SEMS group and 91.3% in the plastic stent group. There was no difference in early complications between the two groups. Median patency of the stent was significantly prolonged in patients who had a covered SEMS (233.6 days) compared with those who had a plastic stent (94.6 days) (p=0.006). During the follow-up period, stent occlusion occurred in 11 patients of the covered SEMS group. Mean survival showed no significant difference between the two groups (covered SEMS group, 236.9 days; plastic stent group, 222.3 days; p=0.182).
Conclusions
The patency of the covered SEMS was longer than that of the plastic stent and the lasso of the covered SEMS was available for repositioning of the stent.
doi:10.5946/ce.2012.45.1.78
PMCID: PMC3363115  PMID: 22741136
Malignant biliary obstruction; Self-expandable metal stent; Plastic stent
7.  Current Nucleos(t)ide Analogue Therapy for Chronic Hepatitis B 
Gut and Liver  2011;5(3):278-287.
Although the prevalence of chronic hepatitis B has decreased considerably in recent years due to widespread use of the hepatitis B virus (HBV) vaccine, its prevalence still remains high in adults, and this can place a significant burden on health care in areas with endemic HBV. Since the introduction of nucleos(t)ide analogues (NUCs), there has been marked improvement in the care of patients with chronic hepatitis B, resulting in increased survival. However, the emergence of drug resistance in patients treated with NUCs is a major concern. The number of multi-drug resistant patients is increasing, and many patients may not respond to the currently available drugs. In this review, we describe the current status of NUC therapy for antiviral-naïve and -resistant patients.
doi:10.5009/gnl.2011.5.3.278
PMCID: PMC3166666  PMID: 21927654
Chronic hepatitis B; Nucleos(t)ide analogue; Drug resistance; Hepatitis B virus
8.  Lactational coumestrol exposure increases ovarian apoptosis in adult rats 
Archives of Toxicology  2009;83(6):601-608.
This study is the first to examine the increased apoptosis in the adult rat ovary after lactational exposure to coumestrol (COU), a potent phytoestrogen. Lactating dams were gavaged at doses of 0.01, 0.1, 1, and 10 mg/kg COU during the lactation period and the reproductive effects of female pups were investigated in young adults. Rats were sacrificed at postnatal days (PND) 81–84. Ovarian weights were reduced significantly at 0.1 and 1.0 mg/kg COU. The reduction in the ovarian weight occurred in parallel with an increase in the apoptosis at PND 135–140. A marked dose-dependent increase in the expressions of active caspase-3 and -7 was observed in ovarian granulosa cells. Immunostaining for active caspase-3 and the TUNEL staining of apoptotic cells were also increased in ovaries exposed to COU in a dose-dependent manner. These results suggest new sights into the effect of lactational exposure to COU on the female reproductive health.
doi:10.1007/s00204-008-0400-0
PMCID: PMC2695544  PMID: 19165469
Ovarian apoptosis; Coumestrol; Lactational exposure; Caspase-3

Results 1-8 (8)